The Foot Specialty Practice Plantar Fasciitis

Plantar fasciitis is probably the most common cause of heel pain in adults. The plantar fascia is a thick band of fibrous connective tissue that attaches to the heel bone, runs across the bottom of the foot and then fans out to attach at the base of each toe, about the ball of the feet (Figure 1). It provides support for the arch of the foot, helps to lift the arch during normal walking, and also acts as a shock absorber during walking and running. Overuse of this band of fascia (ligament), most commonly during weight-bearing activities such as running or even extended periods of standing, can cause small, repetitive tears in the fibers that make up the fascia. The resultant inflammation and swelling produces the pain of plantar fasciitis. Damage is most common in areas where the stress on the connective tissue is greatest and where the fascia is thinnest, as it curves around the heel. Pain usually occurs at the attachment at the heel or in the arch itself. Plantar fasciitis is particularly common in older people because the heel fat pad that normally protects the plantar fascia in this region thins with age. Patients with plantar fasciitis typically feel sharp pain in the heel, mainly on rising in the morning and at the beginning of a walk or run, that may fade as the foot warms up. The pain may also occur with prolonged standing and is sometimes accompanied by stiffness.
Fibrous Band of Plantar

Heel bone (calcaneus)

Area of pain

Treatments for Plantar Fasciitis include:
• • • • • • • Icing Exercises Rest Steroid Injections Orthotics Splints Use of non-steroidal anti-inflammatory drugs (NSAIDs) to treat pain and inflammation

Stretching Exercises
Exercises are not only effective for the relief of active plantar fasciitis, but also help to minimize recurrence of this painful condition. This brochure will provide practical instruction in the use of some of these simple exercises. Exercises for recovery from or prevention of plantar fasciitis are generally divided into two types: 1) Stretching Exercises, 2) Strengthening Exercises. Stretching exercises are used to increase the flexibility of the muscles of the thigh and calf and of the plantar fascia itself. Tightness in the muscles of the leg can result in disproportionate stress being applied to the plantar fascia during

walking and running, increasing the risk of injury. Stretching exercises for the plantar fascia itself can increase the flexibility of the fascia and thus reduce the potential for damage. Five examples of stretching exercises with illustrations follow: A. WALL GASTROCNEMIUS STRETCH

while bending both knees, putting a little more weight on the back leg. Continue until you feel stretching in your lower calf. Hold the stretch for 30 seconds and repeat 2-3 times on each side.

D. HAMSTRING STRETCH The gastrocnemius is one of major muscle groups in the calf. To stretch this muscle, place your hands against the wall and stand with both feet flat on the floor, one foot forward of the other (Figure 2). Keep the rearmost leg straight and the foot pointed straight ahead. Lean forward without arching the back, placing your weight on the forward leg while bending it at the knee. You should feel stretching in the mid-calf of the straight leg. Hold the stretch for 10-15 seconds, release, and then repeat 6-8 times. Reverse the position of the legs and then stretch the other leg.
The hamstring is a major muscle of the thigh that runs from just below the knee to the buttocks and lifts the lower leg and bends the knee. If the hamstring is too tight, the bend in the knee during walking and running is exaggerated, which, in turn, results in increased pull on the heel bone and too much tension in the plantar fascia. To stretch the hamstring, lie with your back flat to the floor with your eyes focused upward. Grasp the back of the thigh with both hands and, with the leg bent, pull the thigh until it is perpendicular to the floor and then slowly straighten the knee (Figure 5). Repeat the exercise with the other leg.

B. A.

The gastrocnemius can also be stretched using a simple exercise that can be performed while standing on a stair (Figure 3). Stand with the ball of the foot on the edge of a stair and heels off the step. While holding the banister for balance, rise as high as possible on the toes and then lower yourself slowly as far as you can without rolling the foot inward or outward until you feel a stretch in the calf. Hold this position for 1-2 seconds and then repeat 10-20 times. C. SOLEUS STRETCH The soleus is the other major muscle in the calf. To stretch this muscle, assume a position similar to that for the Wall Gastrocnemius Stretch but with both of the legs bent and the buttocks dropped (Figure 4). Make sure your feet are facing straight ahead and not turned out. Gently lean into the wall and keep your heels on the floor

E. SEATED PLANTAR FASCIA STRETCH
During normal walking, the plantar fascia lengthens and then shortens as the foot lands. If the plantar fascia is insufficiently elastic, repetitive lengthening and shortening can result in damage to the fibers of the fascia with subsequent inflammation. Exercises that stretch the plantar fascia can improve its flexibility and help it withstand the stresses that are placed on it without damage. The plantar fascia can be easily stretched while sitting. Sit on a chair or on the edge of a bed with one leg crossed over the other (Figure 6). Place the fingers of the hand of the same side as the crossed leg across the base of the toes and pull the toes back toward the shin while keeping the leg steady until stretch is felt in the bottom of the foot. Repeat the exercise five times for each foot. This exercise is particularly effective when done before taking the

first steps of the day and after prolonged sitting or inactivity.

B. TOE WALKING With your body erect and your hands behind your back, walk on your toes with the toes pointed straight ahead (Figure 9). As the foot is placed down, allow the heel to come as close as possible to the floor without touching. Then rise on the toes as high as possible before pushing off the ground. Taking very short steps, walk across the room. Repeat the exercise with the toes pointed outward 30° and then with the toes pointed inward 30°.

F. ROLLING STRETCH
The rolling stretch (Figure 7) is another simple way to stretch the plantar fascia. To perform this exercise, sit on the edge of a bed and place your foot on a hard cylindrical object such as a plastic water bottle or a ball. Roll the foot over the object while maintaining pressure against it. Continue rolling for 30-60 seconds, stop, and then repeat for a total of five times. This stretch should be performed three times per day. For pain relief while performing the exercise, use a water bottle filled with cold water or chill the ball in the refrigerator prior to performing the exercise.

C. HEEL WALKING

STRENGTHENING EXERCISES
These exercises are designed to strengthen the muscles in the foot and ankle that support the arch of the foot. Strengthening these muscles will take stress off the plantar fascia. All of these exercises are best done barefoot. Three examples with illustrations follow:

With your body erect and your hands behind your back, lift your toes as high as you can and walk across the room on your heels with the toes pointed straight ahead (Figure 10). Take very short steps and do not allow the toes to touch the ground. Repeat the exercise with the toes pointed outward 30° and then with the toes pointed inward 30°.

A. TOWEL TOE CURLS Lay a hand towel on an uncarpeted floor and place the bare foot on the towel (Figure 8). Keeping the heel on the floor, curl the toes, pulling the towel toward you. Continue pulling the towel with the toes until it is bunched under the arch of the foot. Repeat this procedure 10 times with each foot. As your feet get stronger, resistance can be increased by placing a soup can or other weighted object on the end of the towel.

SUMMARY

Inflammation of the plantar fascia, most commonly as a result of overuse, is a painful and potentially debilitating condition. Icing, rest, and use of nonsteroidal antiinflammatory drugs (NSAIDs) can relieve the pain but do little to treat the underlying causes of plantar fasciitis. Regular performance of a series of leg and foot exercises is not only an effective treatment for the pain of plantar fasciitis but also an effective deterrent for recurrence of this painful condition. Please check with your doctor or podiatrist before starting any exercise routine.

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