S. M. A. R. T. Patient Education Pages
Plantar Fasciitis – S.M.A.R.T. Prevention
Plantar Fasciitis (fash – ee – itis) is inflammation of the fascia, a thick, fibrous band of tissue that extends from the bottom of the heel to the ball of the foot.
Inflammation and pain occur when the fascia is stretched beyond its limits, most commonly with repeated multiple microtears that exceed the body's ability to self-repair, but also sometimes due to a sudden rupture.
SYMPTOMS
The classic symptom of plantar fasciitis is pain upon rising in the morning because the plantar fascia must stretch from its shortened resting position to its longest, weight-bearing position.
Most commonly, pain is felt on the inside bottom of the heel, sometimes extending into the arch. The pain might be minor or sharp and severe.
The pain can occur suddenly or it might build up over time. Pain can increase and decrease in a seemingly random manner over months and even within a given day. In more severe cases, pain increases during the day.
CAUSES
The role of the plantar fascia is to support the foot’s arch and to absorb the shock of each step. It contracts and extends as necessary, stretching to its fullest length when your foot is on the ground and bearing your body’s full weight. It usually occurs in only one foot.
Common causes of plantar fasciitis are:
- excessive weight
- flat feet or, conversely, high arches
- legs of different length
- sports such as running and jogging
- sudden increases in intensity or time in running or jogging
- standing for long periods of time
- running, jogging or standing on hard or uneven surfaces
- poorly fitting or worn-out shoes
For athletes, overuse is a more common cause than anatomical conditions. For seniors, causes are more commonly related to a decrease muscle strength, acquired flat feet and a decrease in the body's healing ability.
S.M.A.R.T. PREVENTION
As always, prevention is the best medicine. Plantar fasciitis can be treated, but recovery is often slow and recurrence is frequent. Treatment options include rest, stretching, strengthening, change of shoes, arch supports, orthotics, night splints, anti-inflammatory agents and surgery.
As resolution of plantar fasciitis can be six to 18 months, a frustrating length of time, we present some S.M.A.R.T. prevention tips below.
STRETCH
Stretching is one of the most beneficial things we can do to prevent painful injuries and to improve athletic performance.
As always, we encourage you to prepare your muscles for stretching with gentle circulation-boosting movement. Walking slowly for at least 5 minutes is a good way to warm up your muscles for those who do not already have symptoms of plantar fasciitis.
Prepare your muscles with slow, controlled stretches that never go to the point of pain. Stretch before, during and after any activity to reduce stress on muscles and joints and promote flexibility and mobility.
Stretches that bring flexibility and length to calf and hamstring muscles (those on the back of your leg) are especially important. Exercises that stretch and strengthen ankle, foot and toe muscles also help support the plantar fascia.
Frequently used stretching techniques include:
Wall Stretch, also known as Runner's Stretch
- Stand with your hands against a wall.
- Take a giant step backward, keeping the both legs straight or with a slight bend at the knee.
- Press the sole of your foot sole into the floor.
- Hold for a minute then repeat with the other foot.
- Repeat on each foot 4 to 5 times.
A Kneeling Version of Runner's Stretch
- Kneel on one foot.
- Lean forward so that your body weight is over your knee, keeping your front heel on the ground
Curb, Stair or Slantboard Stretches
- Stand with the balls of your feet on a stair or curb
- Slowly let the heels of your feet move down below the level of the stair.
- Alternatively, use a slantboard that achieves the same position.
Plantar Rolling Stretches
- Place your foot arch over a 425 gm (15-oz) size can, rolling pin or tennis ball.
- Slowly move the foot back and forth allowing the tin can or tennis ball to roll around under the arch.
- This activity will help to stretch, strengthen and massage the affected area.
Toe Flex
- These can be done before getting out of bed.
- Place a towel or rubber exercise band under the sole
of your foot.
- Pull on the towel, flex your shin and pull your toes toward you
- Hold for as long as 3 minutes
Toe Curl
(These can also be done in bed.)
- Curl your toes under as tightly as possible and release.
- Repeat several times.
Toe Curl 2
- Practice picking up marbles and coins with your toes.
- This can be done sitting or standing.
MOVE
A regular, low-to-medium intensity activity contributes to better physical health and promotes an overall feeling of well being.
Plantar fasciitis does not mean you must stop exercising. Just switch to a non-weight-bearing exercise like swimming or cycling (exercise bike or road bike) while your rehabilitation proceeds. When returning to a weight-bearing exercise, do so gradually and at a low intensity.
ADD IT UP
You do not need to do all your daily activity at one time. The accumulation of minutes throughout the day is as good for your health as an hour at one time. Try to accumulate 60 minutes of activity a day.
Vary your activities to build the balanced muscle strength and flexibility that supports joints.
REDUCE STRAIN
As always, we advise that you use the proper equipment for your activity and your body and that you learn and use the proper technique.
Listen to your body. If you have foot pain, some simple changes can help.
Reduce the intensity of your weight-bearing activity or the amount of time you are on your feet.
Replace worn out shoes.
Wear shoes with good arch support. If your shoe doesn’t offer good support, a commercially available insert may be sufficient. If not, consider orthotics.
Do not go barefoot. Even in the house, wear shoes that offer cushioning and arch support, like athletic shoes, or contoured foot beds, heel cups and arc support, like some casual shoes.
If excess weight is a factor, consider seeking guidance on safe weight reduction.
Icing your heel might help to reduce inflammation and pain. Apply cold packs 3 to 4 times a day for 5 to 10 minutes each time, never more than once per hour.
TALK TO A PHYSIOTHERAPIST
Our extensive array of therapies can help you to recuperate faster and more completely from plantar fasciitis so that you can return to your regular activities sooner.
After a thorough physical and medical assessment, your personalized course of treatment may include:
- Cold therapy to reduce swelling
- Stretching exercises for the fascia, calf and hamstring muscles and targeted strengthening exercises for the foot and leg
- Taping the foot to improve foot biomechanics and relieve stress on the plantar fascia
- Advice on motion control shoes or orthotics
We will spend time discussing with you how your injury occurred and what you might do to prevent future injuries, as well as consulting with you to design a gradual and safe return to activity.
