Plantar Fasciitis

Orthopaedic Department

www.yeovilhospital.nhs.uk

Heel bone

(calcaneus)

Area

of pain

Plantar

f ascia

What is plantar fasciitis? The plantar fascia is a band of fibrous tissue in the sole of the foot, running from the heel bone to the bases of the toes. It helps support the arch of the foot and acts as a shock absorber when walking. Literally, plantar fasciitis is inflammation of the plantar fascia. With excessive stress on the plantar fascia, and or loss of its usual elasticity, small tears can occur in its fibres. This can result in pain and localised inflammation. Sometimes a spur of bone will form on the heel as a response to the repetitive pulling on the plantar fascia. This is a result of the condition rather than the cause of the pain.

What are the causes? The causes include:

Excessive weight

Unaccustomed increase in activity

Inappropriate footwear

Excessively high arched or flat feet

Calf muscle tightness

What are the symptoms? Pain in the heel on the sole of the foot, sometimes also

felt in the instep

Pain worst on the first step in the morning and after getting up following a period of inactivity

Pain aggravated by long periods of standing or time on your feet

What is the treatment? The mainstay of treatment is a rigorous plantar fascia and calf stretching programme (see page 5) to lengthen the tight tissues, decreasing the tension and allowing healing. This is best coupled with silicone heel cushions (Viscospot) to protect the painful area. The stretching may cause an initial increase in your symptoms but this will usually settle over the first week if you keep to the programme. The majority of patients’ symptoms begin to improve within 1 to 2 weeks of starting the treatment and the vast majority will have improved significantly within 8 weeks.

Before your first step in the morning

Seated plantar fascia stretch Hold for 10 seconds, repeat 10 times

Other treatments you may also find helpful in combination with the stretching programme and heel cushions are:

Non-steroidal anti-inflammatory tablets or locally applied gel

Ice packs (a plastic bottle of water frozen and then rolled under the foot)

Night stretching splints

The stretching programme To achieve the greatest benefit and prevent making your condition worse, you should perform the stretching programme gently and consistently. You will need to spend about half an hour a day performing the four stretches. This is broken down into three sessions of three stretches, with an additional stretch performed before getting out of bed in the morning.

Morning session 10 minutes per session

Wall plantar stretch + Wall calf stretch

+ Step calf stretch

Hold each stretch for 1 minute Repeat each stretch 3 times

Midday session

Night session

Seated plantar fascia stretch Sit with your bare foot crossed over the opposite knee. With the hand of the affected side pull the toes and foot back towards the shin until you feel the stretch in the arch of the foot. To check that the stretch is correct, feel the taut plantar fascia with the opposite hand. Hold this stretch for 10 seconds and repeat 10 times.

Wall plantar stretch With your shoes on, stand facing a wall. Dig the heel of the affected foot against the floor close to the wall, such that the undersides of your toes are against the wall with your toes bent backwards. Push the knee of the affected foot towards the wall. You should feel the stretch both in the arch of the foot and in the calf. Your knee should not be able to touch the wall. To increase the stretch, move your heel closer to the wall and your toes further up the wall, again pushing your knee towards the wall. Hold this stretch for one minute and repeat three times.

Rela

x leg

Stretch

Stretch

Wall calf stretch Stand facing the wall, with your hands resting on the wall in front of you at shoulder height. Reach the affected foot out behind you, with the toes pointing forwards towards the heel of the opposite foot, such that, with your knee completely straight, your heel can still just sit flat on the floor. Then bend the opposite knee, pushing forwards such that you feel a stretch in the affected calf. Hold this stretch for one minute and repeat three times.

Rotate foot

towards midline

Relax leg

Stretch

Straight knee

Hips in

Step calf stretch Stand with the balls of your feet resting on the edge of a step, holding on to something for balance. With your knees straight, allow your heels to sink below the step such that you feel a stretch in the calf. Hold this stretch for one minute and repeat three times. Initially you may find this is uncomfortable and you may only be able to do this by sharing the weight through each foot. With time, as you are better able to tolerate the stretch, you may find it better to perform the stretch on only the affected side, lifting the other foot into the air.

Stretch

Direction of

movement

Frequently asked questions I’ve tried physiotherapy and insoles before and it didn’t work, why should this? Not all stretching programmes and insoles are as effective. Until this treatment has been tried in full it is not possible to rule it out. Should I continue to exercise? Rest tends to allow the plantar fascia to tighten and has not been shown to resolve your symptoms faster. Running causes sudden impact and stress to the painful area with each step and is probably best avoided until your symptoms resolve. If you do choose to continue running, select soft running surfaces, wear your heel cushions and decrease the intensity of your training. Other non-impact exercise, such as swimming, cycling and cross-training are preferable as they cause less stress on the plantar fascia. How long should I continue with the stretching programme and heel cushions? Continue until your symptoms have fully resolved. If after stopping the treatment your symptoms begin to return, simply restart the programme until the symptoms resolve again. What if my treatment fails? If after 3 months of performing the stretches correctly and wearing the heel cushions consistently you have not improved, you will need further assessment and consideration of alternative therapy. This may include injections or heel shockwave therapy. Only very rarely is surgery required.

Evidence base behind treatment strategy DiGiovanni, BF; Nawoczenski, DA; Malay, DP et al.: Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up. J Bone Joint Surg Am. 88:1775-1781, 2006.

Pfeffer, G; Bachetti, P; Deland, J et al.: Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis. Foot Ankle Int. 20:214-221, 1999. With thanks to the Physiotherapy Department, Yeovil District Hospital NHS Foundation Trust, for their help in producing this leaflet.

Leaflet No: 09-15-101 Author: JRB Grundy 01/15 Review date: 01/17

If you need this leaflet in another format, e.g. large print or another language, please telephone 01935 384233.

If you require further information or advice, please contact: Orthopaedic Secretary: 01935 384818