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NHSW14Lea-032011

Provided by: Physiotherapy

Worcestershire PCT

Produced by the physiotherapy department, February 2011.Due for review February 2013.

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Patient Information

Advice and Exercises for the Treatment of Plantar Fasciitis

What is plantar fasciitis?

Plantar fasciitis means inflammation of the plantar fascia. The plantar fascia is a strong band of tissue (like a ligament) that stretches from the heel to the toes. It supports the arch of the foot and also acts as a shock absorber in the foot. Repetitive small injuries to the fascia with or without inflammation are thought to be the cause of plantar fasciitis. The injury site is usually near to where the plantar fascia attaches to the heel bone.

Plantar fasciitis causes pain under the heel. It usually goes in time. Treatment may speed up recovery. Treatment includes good footwear and exercises. A steroid injection or other treatments may be used in more severe cases.

Fibrous bandPlantar Fascia

Area of painfrom PlantarFascitisHeel bone

(Calcaneus)

What are the symptoms of plantar fasciitis?

Pain is the main symptom. This can be anywhere on the underside of the heel. Commonly, one spot is found as the main source of pain. This pain is often under the heel bone, and may be tender to touch.

The pain usually eases on resting the foot, but is often worst when first used in the morning or after long periods where no weight is placed on the foot. Gentle exercise may ease things a little as the day goes by, but a long walk often makes the pain worse.

Who gets plantar fasciitis?

Plantar fasciitis is quite common. It mainly affects people over 40 and seems to be more common in women. However, it can occur at any age. It is also common in athletes. Situations where it is more likely include the following:

• If you do lots of walking, running, standing, etc, when you are not used to it. Conversely, people with a sedentary lifestyle are also more prone to plantar fasciitis.

• If you have recently started exercising on a different surface.

• Wearing shoes with poor cushioning or poor arch support.

• Sudden gains in weight or being overweight will put extra strain on the heel.

• Overuse or sudden stretching of the sole.

• Tightness of the Achilles tendon (at the bottom of the calf muscles above the heel) causing reduced ability to flex the ankle.

Often there is no apparent cause, particularly in older people. A com-mon misconception is that the pain is due to a bony growth or ‘spur’ coming from the heel bone (calcaneus). Many people have a bony spur of the heel bone but not everyone with this gets plantar fasciitis.

Stand about 40cm away from a wall and put both hands on the wall at shoulder height, feet slightly apart, with one foot in front of the other. Bend the front knee but keep the back knee straight and lean in towards the wall to stretch. You should feel the calf muscle tighten. Keep this position for 10 – 15 seconds then relax. Do this about 3 times, then switch to the other leg. Now repeat the same exercise for both legs but this time bring the back foot forward slightly so that the back knee is also slightly bent, Lean against the wall as before, keep the position, relax and then repeat 3 times before switching to the other leg. Repeat this routine twice a day.

Stand on the bottom step of some stairs with your legs slightly apart and with your heels just off the end of the step. Hold the stair rails for support. Lower your heels, keeping your knees straight. Again you should feel the stretch in your calves. Keep the position for approximately 20 seconds then relax. Repeat six times. Try to do this exercise twice a day.

These are the stretches you can do to help

Fibrous bandPlantar Fascia

Area of painfrom PlantarFascitisHeel bone

(Calcaneus)

Sit on the bed with your legs out in front of you. Loop a towel around the ball of one of your feet. With your knee straight, pull your toes up towards you. Hold the position for 10 - 15 seconds and repeat three times. Repeat the same exercises for the other foot. Try to do this morning and night.

You may find it helpful to massage the bottom of your foot. Sit down on a chair and cross your leg (as the diagram shows). Hold your toes and gently stretch them back towards you using small circular movements, massage along the foot, from the heel to the toes.

Fibrous bandPlantar Fascia

Area of painfrom PlantarFascitisHeel bone

(Calcaneus)

For this exercise you need an object such as a rolling pin or a drinks can. Whilst sitting in a chair put the object under the arch of your foot. Roll the arch of your foot over the object in different directions. Perform this exercise for a few minutes for each foot at least twice a day.

Fibrous bandPlantar Fascia

Area of painfrom PlantarFascitisHeel bone

(Calcaneus)

Home ice treatment

1. Prepare the ice pack using a pack of frozen peas wrapped in a damp tea towel.

2. Place a plastic bag or dry towel under the area to be treated. Ensure limb is well supported and comfortable, preferably elevated.

3. Smooth a small amount of oil e.g. Baby oil or cooking oil all around the area to be treated. DO NOT PLACE ICE PACK ONTO UNPROTECTED SKIN.

4. Place ice pack firmly over the area and wrap a dry tea towel around the limb and ice pack.

5. Leave ice pack in place for 5 - 15 minutes then remove.

THIS TREATMENT CAN BE REPEATED UP TO 3 TIMES A DAY.

Frozen peas must be clearly marked and should not be eaten after use.