Help for Plantar Fasciitis

Michael Shea, MD; Karl B. Fields, MD

Practice Essentials Series Editors:
Kim Harmon, MD; Aaron Rubin, MD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 30 - NO. 7 - JULY 2002

If your feet, especially the heels and arches, hurt when you step out of bed in the morning, you may have plantar fasciitis. It may take 6 months or longer for the pain to go away, but there are some things you can do in the meantime to cope with the pain and heal faster.

Q. What is plantar fasciitis?

A. Strong, fibrous bands connect the bones inside the bottom of your foot (figure 1). "Plantar" means the sole of the foot, and "fascia" means band (like a rubber band). When the plantar fascia is injured or irritated, it's called plantar fasciitis. The damage leads to pain in your heels and arches.

Q. What causes plantar fasciitis?

A. Sometimes it is caused by overuse, but other factors may contribute, such as improper footwear, flat feet, or high-arched feet. If your calf muscles are weak or your feet are not flexible, you may develop the condition. Runners often suffer from plantar fasciitis if they increase the distance or intensity of their workouts too fast.

Q. What can I do to lessen the pain?

A. Follow your doctor's instructions and apply ice for 10 minutes several times a day (especially after activity and at bedtime), using an ice bath or cubes in a bag. If ice cubes aren't available, a bag of frozen peas works well, or you can roll your feet on frozen juice cans or chilled soda cans. If you do this while standing, hold a chair for balance.

Your doctor may prescribe painkillers, such as aspirin or ibuprofen. Foam heel cups or shoe inserts (called orthotic devices) may also be helpful. You may need an injection into the heel, or you may need to wear a splint at night. Your doctor may recommend surgery, but this is usually a last resort.

In addition to other therapies, stretching and strengthening exercises for the Achilles tendon (the cord you can feel at the back of your ankle) and the calf muscles will help you heal faster. These exercises are done barefoot.

• Do heel raises on the stairs to help stretch and strengthen the Achilles tendon and the plantar fascia (figure 2).
• Walk on your toes only, then walk on your heels only, then walk backward to the starting point. Carry hand weights (10 to 20 pounds) to increase the value of these exercises.
• Walk or run barefoot whenever possible.

As the pain decreases and your strength improves, gradually return to your usual activities. Exercises that keep your full weight off your feet, such as bicycling or swimming, will help you maintain fitness during recovery.

Remember: This information is not intended as a substitute for medical treatment. Before starting an exercise program, consult a physician.

Dr Shea and Dr Fields are family practice physicians at Moses Cone Family Practice in Greensboro, North Carolina.