There are many diagnoses within the differential of heel pain; however, plantar fasciitis is the most common cause of heel pain for which professional care is sought. Approximately 10% of the United
States population experiences bouts of heel pain, which results in 1 million visits per year to medical professionals for treatment of plantar fasciitis. The annual cost of treatments for plantar
fasciitis is estimated to be between $192 and $376 million dollars. The etiology of this condition is multifactorial, and the condition can occur traumatically; however, most cases are from overuse
Each time we take a step forward, all of our body weight first rests on the heel of one foot. As our weight moves forward, the entire foot begins to bear the body's weight, and the foot flattens and
this places a great deal of pressure and strain on the plantar fascia. There is very little elasticity to the plantar fascia, so as it stretches only slightly; it pulls on its attachment to the heel.
If the foot is properly aligned this pull causes no problems. However, if the foot is "pronated" (the foot rolls outward at the ankle, causing a break down of the inner side of the shoe), the arch
falls excessively, and this causes an abnormal stretching of the relatively inflexible plantar fascia, which in turn pulls abnormally hard on the heel. The same pathology occurs with "supination"
(the rolling inward of the foot, causing a break down of the outer side of the shoe). Supinated feet are relatively in flexible; usually have a high arch, and a short or tight plantar fascia. Thus as
weight is transferred from the heel to the remainder of the foot, the tight plantar fascia hardly stretches at all, and pulls with great force on its attachment to the heel.
The main symptom of plantar fasciitis is heel pain when you walk. You may also feel pain when you stand and possibly even when you are resting. This pain typically occurs first thing in the morning
after you get out of bed, when your foot is placed flat on the floor. The pain occurs because you are stretching the plantar fascia. The pain usually lessens with more walking, but you may have it
again after periods of rest. You may feel no pain when you are sleeping because the position of your feet during rest allows the fascia to shorten and relax.
Your doctor will check your feet and watch you stand and walk. He or she will also ask questions about your past health, including what illnesses or injuries you have had. Your symptoms, such as
where the pain is and what time of day your foot hurts most. How active you are and what types of physical activity you do. Your doctor may take an X-ray of your foot if he or she suspects a problem
with the bones of your foot, such as a stress fracture.
Non Surgical Treatment
There are many different ways to treat plantar fasciitis but there is no one treatment that works for everyone. Different treatment techniques affect patients in different manner. Every patient has
to be dynamic in their treatment activity. Trying a few different treatment techniques is usually necessary before finding the suitable ones. As progress is made and the pain decreases a new
treatment approach should be considered.
The most dramatic therapy, used only in cases where pain is very severe, is surgery. The plantar fascia can be partially detached from the heel bone, but the arch of the foot is weakened and full
function may be lost. Another surgery involves lengthening the calf muscle, a process called gastrocnemius recession. If you ignore the condition, you can develop chronic heel pain. This can change
the way you walk and cause injury to your legs, knees, hips and back. Steroid injections and some other treatments can weaken the plantar fascia ligament and cause potential rupture of the ligament.
Surgery carries the risks of bleeding, infection, and reactions to anesthesia. Plantar fascia detachment can also cause changes in your foot and nerve damage. Gastrocnemius resection can also cause
You may begin exercising the muscles of your foot right away by gently stretching them as follows. Prone hip extension, Lie on your stomach with your legs straight out behind you. Tighten up your
buttocks muscles and lift one leg off the floor about 8 inches. Keep your knee straight. Hold for 5 seconds. Then lower your leg and relax. Do 3 sets of 10. Towel stretch, Sit on a hard surface with
one leg stretched out in front of you. Loop a towel around your toes and the ball of your foot and pull the towel toward your body keeping your knee straight. Hold this position for 15 to 30 seconds
then relax. Repeat 3 times. When the towel stretch becomes too easy, you may begin doing the standing calf stretch. Standing calf stretch, Facing a wall, put your hands against the wall at about eye
level. Keep one leg back with the heel on the floor, and the other leg forward. Turn your back foot slightly inward (as if you were pigeon-toed) as you slowly lean into the wall until you feel a
stretch in the back of your calf. Hold for 15 to 30 seconds. Repeat 3 times. Do this exercise several times each day. Sitting plantar fascia stretch, Sit in a chair and cross one foot over your other
knee. Grab the base of your toes and pull them back toward your leg until you feel a comfortable stretch. Hold 15 seconds and repeat 3 times. When you can stand comfortably on your injured foot, you
can begin standing to stretch the bottom of your foot using the plantar fascia stretch. Achilles stretch, Stand with the ball of one foot on a stair. Reach for the bottom step with your heel until
you feel a stretch in the arch of your foot. Hold this position for 15 to 30 seconds and then relax. Repeat 3 times. After you have stretched the bottom muscles of your foot, you can begin
strengthening the top muscles of your foot. Frozen can roll, Roll your bare injured foot back and forth from your heel to your mid-arch over a frozen juice can. Repeat for 3 to 5 minutes. This
exercise is particularly helpful if done first thing in the morning. Towel pickup, With your heel on the ground, pick up a towel with your toes. Release. Repeat 10 to 20 times. When this gets easy,
add more resistance by placing a book or small weight on the towel. Balance and reach exercises, Stand upright next to a chair. This will provide you with balance if needed. Stand on the foot
farthest from the chair. Try to raise the arch of your foot while keeping your toes on the floor. Keep your foot in this position and reach forward in front of you with your hand farthest away from
the chair, allowing your knee to bend. Repeat this 10 times while maintaining the arch height. This exercise can be made more difficult by reaching farther in front of you. Do 2 sets. Stand in the
same position as above. While maintaining your arch height, reach the hand farthest away from the chair across your body toward the chair. The farther you reach, the more challenging the exercise. Do
2 sets of 10. Heel raise, Balance yourself while standing behind a chair or counter. Using the chair to help you, raise your body up onto your toes and hold for 5 seconds. Then slowly lower yourself
down without holding onto the chair. Hold onto the chair or counter if you need to. When this exercise becomes less painful, try lowering on one leg only. Repeat 10 times. Do 3 sets of 10. Side-lying
leg lift, Lying on your side, tighten the front thigh muscles on your top leg and lift that leg 8 to 10 inches away from the other leg. Keep the leg straight. Do 3 sets of 10.