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How to treat plantar fasciitis

How to treat plantar fasciitis

Plantar fasciitis is a common condition that causes pain in the bottom of your foot, usually around the heel and arch of the foot. It's caused by irritation and damage to the plantar fascia, a band of tissue that connects the heel bone to the base of the toes.

Plantar fasciitis gets better with time for most people. Resting the foot, wearing insoles or supportive shoes, losing weight - if overweight or obese - night splints, and stretching exercises for the calf muscles and plantar fascia can all be helpful for treating the condition. These are enough for most people, but if they don't work, other options include injections, shock wave therapy, and surgery.

If you think you may have plantar fasciitis find out what to do here. This will tell you if you need to see a doctor and how it is treated.

In this series of articles centred around plantar fasciitis you can read about symptoms of plantar fasciitis, treatment of plantar fasciitis, and the causes of plantar fasciitis - all written by one of our expert GPs.

The rest of this feature will take an in-depth look at the treatment of plantar fasciitis as, at Patient, we know our readers sometimes want to have a deep dive into certain topics.

What's the treatment for plantar fasciitis?

Most treatments for plantar fasciitis involve treating its causes by reducing the amount of stress on the plantar fascia.

Changing activities

Standing for long periods of time, walking, and running can all put stress on the plantar fascia. So, reducing those activities - until the symptoms improve - can help the plantar fascia to heal. Exercise is good for physical and mental health, so people who can't walk or run could try other exercises that don't put stress on the feet, such as swimming, cycling, or yoga.

Changes might be needed at work, if your job involves lots of standing or walking.

Avoiding running on hard surfaces - try switching to grass - can also help reduce any damage to the plantar fascia.

Footwear and insoles

Wearing supportive shoes with good arch support and cushioned heels can reduce the strain on the plantar fascia and help with symptoms. Avoid walking or running barefoot.

Insoles and heel pads can be bought to wear inside shoes, giving extra support. These can help to support the arch of the foot. They work best if worn inside shoes at all times, and should be worn in both shoes even if the pain is only in one foot.

There are also insoles that contain magnets - however, these are more expensive and don't appear to work any better than other insoles.

Weight loss

Losing weight, if overweight or obese, reduces the load and pressure on your feet.

Night splints

Splints can be worn at night whilst in bed. These keep the ankle at a 90 degree angle - pointing upwards - which stretches the plantar fascia and the calf muscles. The theory is that the plantar fascia heals in this position and lengthens slightly, allowing it to cope better with stretching forces when walking, running, or standing. Splints come as rigid supports or in a sock form such as the Strassburg sock.

Exercises and stretches

Regular stretches and exercises to stretch your leg muscles and plantar fascia can help to lengthen them slightly, reducing the tension and stress in the plantar fascia when walking.

You can watch our physiotherapist taking you through exercises for plantar fasciitis in this video.

Foot Pain - Inflammation Control

Lilly Sabri

Some exercises that help include:

Wall Stretch

  1. Stand around 40 cm away from a wall and put both hands on the wall at shoulder height, feet slightly apart, with one foot in front of the other.
  2. Bend your front knee but keep your back knee straight and lean-in towards the wall to stretch. You should feel your calf muscle tighten.
  3. Keep this position for several seconds, then relax. Do this 10 times then switch to the other leg.
  4. Now repeat the same exercise for both legs but this time, bring your back foot forward slightly so that your back knee is also slightly bent. Lean against the wall as before, keep the position.
  5. Relax and then repeat 10 times before switching to the other leg.

Repeat this routine twice a day.

Stair Stretch

  1. Stand on the bottom step of some stairs with your legs slightly apart and with your heels just off the end of the step.
  2. Hold the stair rails for support.
  3. Lower your heels, keeping your knees straight. You should feel this stretch your calf.
  4. Keep the position for 20-60 seconds, then relax.
  5. Repeat six times.

Try to do this exercise twice a day.

Floor stretch

  • Sit on the floor with your legs out in front of you
  • Loop a towel around the ball of one of your feet.
  • With your knee straight, pull your toes towards your nose.
  • Hold the position for 30 seconds and repeat three times.
  • Repeat the same exercise for the other foot.

Try to do this once a day.

Chair stretch

  1. Sit on a chair with your knees bent at right angles and your feet and heels flat on the floor.
  2. Lift your foot upwards, keeping your heel on the floor.
  3. Hold the position for a few seconds and then relax.
  4. Repeat around 10 times.

Try to do this exercise five to six times a day.

Foot roll

For this exercise you need an object such as a rolling pin or a drinks can and it is best to take your shoes off.

  1. Whilst sitting in a chair, put the object under the arch of your foot.
  2. Roll the arch of your foot over the object in different directions.

Perform this exercise for a few minutes for each foot at least twice a day.

Physiotherapists can also suggest other exercises tailored to symptoms.

Pain relief

Tablets such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) - such as ibuprofen, can help with pain. NSAID gels or creams, applied directly to the foot, can also be useful to reduce pain and inflammation.

An ice pack, wrapped in a towel, can also be applied to the skin for 15 to 20 minutes to ease pain.

Most people find that these treatments are enough to treat their plantar fasciitis. However, for some people with particularly severe symptoms, or where these treatments haven't worked, there are further options.

Steroid injections

Steroid injections can be given into the plantar fascia. These are generally best done with an ultrasound machine, to ensure the injection goes into the right place. Steroid injections are thought to reduce inflammation, and therefore reduce pain.

Steroid injections tend to give short-term relief for around four weeks. The injection itself, though, can be very painful, and this pain can last for several days. Steroid injections also have risks, such as causing thinning of the protective fat pad of the heel (fat pad atrophy), which can lead to further heel pain. There is also a rare risk of weakening the plantar fascia and causing it to tear completely (plantar fascia rupture).

Extracorporeal shock wave therapy

Extracorporeal shock wave therapy (ESWT) treatment involves using a special device to give low-energy sound waves through the skin - mechanical shock wave. This treatment was first, and still is, used for treating kidney stones. It's not clear how it works in plantar fasciitis, but one leading theory is that it causes a helpful form of inflammation that improves healing.

ESWT can be uncomfortable or painful whilst the treatment is being given. Symptoms should improve after the treatment finishes - this is usually immediate, but can sometimes take several weeks. ESWT is thought to have few risks, although there may be a small risk of plantar fascia rupture.

Surgery

For the few people for whom all other treatment options haven't worked, surgery can be an option. The main procedures are:

  • Cutting part of the plantar fascia - to reduce the tension on it.
  • Gastrocnemius recession - lengthening the calf muscles to reduce tension from them being overly-tight.

Like any surgery, these have risks. Whilst rare, they include problems like nerve damage during the operation, infection, and developing blood clots in the veins of the leg.

What causes plantar fasciitis?

Plantar fasciitis is a common condition that causes pain in the bottom of your foot, usually aro...

How long does plantar fasciitis last?

Plantar fasciitis lasts for different times depending on the severity, the causes, and what treatment is used. Milder cases might last for weeks and months, but some people have symptoms for longer, such as a year or more. More than eight out of 10 people with plantar fasciitis recover completely within a year.

Can plantar fasciitis go away on its own?

Plantar fasciitis can get better on its own. Like most injuries, the body is generally good at healing itself with time. Rest or reduction in activities that bring on the pain can be enough. However, the treatments discussed here can speed healing.

Complications of plantar fasciitis

In some people, plantar fasciitis may last for a long time and can stop them from doing their normal activities. People with pain from plantar fasciitis might adjust the way they walk or run, which can sometimes put extra stress on parts of the hips, knees, and back and cause pain there.

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