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Plantar Fasciitis

What is Plantar Fasciitis and What Causes it to Develop?

The plantar fascia is a thick, tough membrane on the bottom of the foot that supports muscles and arches. It is attached to the heel bone and fans forward toward the toes. Plantar fasciitis (inflammation of the fascia) usually occurs with repetitive stress commonly caused by sports such as running or racquet sports. This leads to inflammation and pain in the heel. As the fascia is pulled away from the bone, the body reacts by filling in the space with new bone. This causes a "heel spur" to form. The heel spur is not the problem, but the result of the fasciitis. Plantar fascia injury may also occur at mid foot or near the toes. Since it is difficult to rest the foot, the condition is aggravated with every step. As well, a vicious cycle is set up in which the fascia partially repairs during the night and then is again partially ripped away when the sufferer gets out of bed in the morning. Predisposing factors include; flat or high arched feet, over-doing a new sport, shoes without adequate support for the activity, running on soft terrain, and tight Achilles tendon.

Treatment of Plantar Fasciitis

  1. Modified Activity—Use pain as your guide. If your foot is too painful with weight-bearing sports, they can be temporarily replaced with swimming or cycling. Conversely, your sport can be maintained at a lower level by decreasing the amount of time doing your sport and/or doing it on alternate days only. Go back into your regular routine slowly. If you have a lot of pain during an activity or the following morning, you're doing too much. Avoid prolonged standing or excessive walking on hard or rough surfaces.
  2. Ice/Heat—Icing your heel for 15 minutes several times a day will reduce inflammation. You should also ice your heel for 15 minutes after activity. When using ice, protect your skin with a towel. Soak your feet at night in a warm bath with Epsom salts.
  3. Daily Routines—Don't go barefoot, always wear shoes that support your arch. Before getting out of bed in the morning, do gentle stretching exercises: With legs out straight, pull the toes up toward your knees. Repeat with knees bent. Get out of bed directly into a pair of shoes or sandals with arch support. Soak your feet at night in a warm salt bath.
  4. Medication—Your doctor may prescribe anti-inflammatory medication to reduce the inflammation. Be careful that the medication does not mask pain as a guide when doing activity. Your doctor may recommend a cortisone injection, which is usually most effective if done soon after the injury.
  5. Physiotherapy—Your doctor may recommend that you see a physiotherapist. The initial objective of physiotherapy is to decrease the inflammation. The therapist will teach you exercises to strengthen the small muscles of your feet as well as to improve the flexibility of the fascia and Achilles tendon. Achieving the above will provide more support for and put less stress on the weakened, inflamed plantar fascia.
  6. Adjustments—Your doctor or physiotherapist may recommend heel pads, heel cups, arch supports, orthotics, or taping of your foot. These adjustments help to reduce shock as the heel lands and to support the arch. In turn, less stress is placed on the fascia.
  7. Surgery—surgery is rarely required.
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