"Walking on Nails" - Plantar Fasciitis Treatment Recommendations

Plantar Fasciitis is one of the most common, and most debilitating, foot injuries. Plantar fasciitis is most famous for complaints of pain along the bottom of the foot. Plantar fasciitis is defined as inflammation of the soft tissue along the plantar surface of the foot. This muscle tissue runs from the base of the heel, along the arch, and up to the big toe. Some of the most common complaints I hear from patients are "The first few steps in the morning are

horrible, I feel like there is a knife stabbing me." and "I can't wear any of my good shoes anymore because my feet hurt so bad with every step I take.". Most cases of plantar fasciitis will not resolve on their own. Physical therapists are highly trained in gait analysis (biomechanics of how you walk) and can assist you with determining the source of the problem. As with any injury it is important to recognize the signs early and begin immediate intervention.

Some things to watch out for:
- Pain in the foot, usually across the arch and along the bottom of the foot, after walking or running
- Pain in the foot, arch, and heel with the first few steps in the morning
- Pain in the foot, arch, and heel with the use of dress shoes
- Tightness along the Achilles tendon as well as along the bottom of your foot
- Sneakers are the only shoe that is comfortable

  
 If your pain has been going on for more than 3-4 weeks without resolve and appears to be lasting longer or worsening, get to a physical therapist. They can provide you with a thorough analysis of your walking pattern and help point you in the right direction with orthotics, stretching, hands on treatment to decrease scar tissue formation (such as Graston), and modalities such as ultrasound or iontophoresis if needed.

 

If you are attempting to self-treat, then consider these helpful tips:
 
1. Stretch, stretch, stretch. Stretch your gastrocnemius (calf muscle that starts above the knee), stretch your soleus (calf muscle that starts below your knee), and stretch the bottom of your foot.
 
       - A simple gastroc stretch can be performed by placing both hands on a wall in front of you. The foot to  be   stretched (say right foot) should be slightly behind you with your right knee extended. With your right foot remaining flat on the floor, slowly lunge forward until a stretch is felt in the right leg.
       - A soleus stretch is performed using the same position as above, except bending the right knee, not straightening it. A stretch will still be felt lower the right leg, towards the Achilles tendon
       - A plantar fascia stretch can be performed seated with you having your right foot in your lap. Pull back on your big toe until a stretch is felt across the bottom of your foot.
 
* It is recommended that all stretches are held for 30 seconds and repeated 5 times.

2. Anti-inflammatories: take anti-inflammatory medication as directed by your primary care physician

3. Gentle strengthening: light strengthening for the muscles on the bottom of the foot as well as the gastroc  and anterior tibialis (shin) muscles. These should be performed initially in a non or partial weight bearing position. This will help to limit the amount of stress placed on your muscle groups.

4. Friction massage: once inflammation sets in, scar tissue isn't far behind. Scar tissue will limit the amount of mobility the muscle tissue has along the bottom of your foot. An easy solution is to use a tennis ball and roll your foot on the tennis ball for 2-3 minutes at a time. This will help to break up scar tissue and improve blood flow to the muscles in your foot.

 









5. Night splints: When we sleep at night, the resting position of the foot is pointing downward. This allows the muscles on the bottom of the foot to rest in a shortened position. When you get out of bed in the morning and take that first step, they are immediately put on stretch - OUCH! A night splint can help. The splint is designed to keep your foot in a somewhat stretched position throughout the night, allowing for less painful steps in the morning.

Plantar fasciitis is a painful disorder that worsens over time if not properly treated. Physical therapists have extensive training in evaluation and treatment of foot and ankle disorders. If you are in pain, and nothing seems to help, ask your doctor to refer you to a physical therapist. They can help.

Andrea Johnson, PT, DPT