Plantar fasciitis – what is it and should we care?
Find out what you can do to treat that pain in your heels.
Feeling a sharp pain in your heels especially when you wake up in the morning and plant your feet on the ground? That may just be plantar fasciitis.
Plantar fasciitis is an inflammation of the plantar fascia, which is a thick, fibrous band of ligament directly beneath the skin on the bottom of the foot, connecting the heel to the front of the foot. It is the most common cause of heel pain and affects approximately one in 10 people at some point during their lifetime.
Plantar fasciitis is a result of micro-tears due to excess tension and stress placed on the plantar fascia. Repeated stretching and re-tearing of the plantar fascia causes persistent inflammation and pain that may last for months or even years. The intense pain from plantar fasciitis, especially in the morning, comes from the tightening of the plantar fascia that occurs during sleep.
The factors that may lead to an increased risk of plantar fasciitis include:
• Ages from 40 to 60.
• Obesity, which leads to excess stress on the plantar fascia.
• Repetitive impact activity such as long-distance running.
• Abnormal foot mechanics such as flat feet, a high foot arch, or an altered walking pattern can lead to increased stress on the plantar fascia.
• Occupations that require long hours of standing or walking.
• New or increased physical activity that the body is not conditioned for.
Plantar fasciitis can be treated mechanically by stretching and strengthening exercises for the plantar fascia.
1. Plantar fascia massage: This is a good exercise to do before getting out of bed. Cross the injured foot over the knee of your other leg and pull upwards until you feel a stretch in the arch of your foot. Massage the bottom of your foot, moving from the heel toward your toes and across the width of the plantar fascia. Start gently and gradually press harder as you become able to tolerate more pressure. Do this for around five minutes.
2. Arch roll: Roll your injured foot back and forth from your heel to your mid-arch over a frozen can or tennis ball. Repeat for three to five minutes, two times a day.
3. Towel stretch: Sit on a hard surface with your injured leg stretched out in front of you. Loop a towel around your toes and the ball of your foot and pull the towel toward you while keeping your leg straight. Hold this position for 15 to 30 seconds and then relax. Repeat three times.
4. Standing calf stretch: Stand facing a wall with your hands on the wall for support. Place your feet pointing straight ahead, with the injured foot behind the other. The back leg should have a straight knee and front leg a bent knee. Slowly shift forward toward the wall until you feel a stretch in the back of your calf. Hold the stretch for 45 seconds. Return to the starting position and repeat three times. Do this exercise several times each day.
5. Achilles stretch: Stand with the balls of your feet on a step. Gently lower the heel of the injured foot toward the step below lower until you feel a stretch in the arch of your foot. Hold the stretch for 45 seconds, then rest, and repeat three times. Do this exercise several times each day.
1. Toe curls: Place a small towel on the floor. Curl the towel toward you using the toes of your injured foot, then relax. Repeat 10 to 20 times, twice a day. Add more resistance by placing a book or small weight on the towel.
2. Heel raise: Stand behind a chair with both feet flat on the floor. Using the chair as a support, stand on your toes and hold for five seconds, then slowly lower yourself down. To make it more challenging, do this without the chair for support, then later on try doing this exercise while standing on the injured foot only. Do 15 raises and repeat two or three times a day.
3. Marble pick-ups: Put marbles on the floor next to a cup. Using your toes, pick up the marbles and place them in the cup. Do this exercise several times each day.
Tips on prevention
1. Stretch before, during and after physical activity. Tight calves and hamstring muscles put excess strain on the plantar fascia. Adequate warm-up and cooldown allows the muscles to be relaxed and the joints mobile, thus reducing strain on the plantar fascia.
2. Ensure proper footwear with good heel support. In more severe cases, heel inserts or orthotics may be used. Running on soft surfaces or indoors on a treadmill reduces impact to the heels.
3. Land with a mid-foot strike instead of a heel strike. Landing on the middle of your foot while running reduces impact to the heels.
4. Dial down the intensity and duration of high-impact sports.
5. Engage in other non-weight-bearing sports or low impact sports such as swimming, cycling or yoga.
(EDITOR’S NOTE: If these measures don’t work after several months, do see a doctor. He or she might recommend surgery or other procedures like injections and non-surgical extracorporeal shockwave therapy. Surgery is recommended as an option only when the pain is severe and other treatments have failed.)
Dr Edwin Ong is from DTAP Clinic. He focuses on comprehensive and holistic care for men’s health, women’s health and other acute and chronic medical issues including viscosupplementation treatment for knee arthritis.
(** PHOTO CREDIT: Unsplash/Damir Spanic)