Comfort Shoe Specialists
11693 Manchester Rd
St. Louis, MO 63131
314-822-3300
Plantar
Fasciitis/Heel Pain
and Medicare providers
Anatomy
Plantar
fasciitis is the most common foot problem and one of the hardest to
overcome. The plantar fascia is a
thick fibrous tissue that attaches to the heel bone (calcaneus's) and spans
across the bottom of the foot and arch and attaches to the back of the toes.
It acts like a bowstring to maintain the arch of the foot.
Click on the Plantar fascia above
The Injury
The fascia endures tension that is near 2 times body weight during walking at the moment when the heel of the trailing leg begins to lift off the ground. This moment of maximum tension is increased and "sharpened" (it increases suddenly) if there is lack of flexibility in the calf muscles. The problem starts when the fascia is overused, and micro tears within the fascia become inflamed, usually at the insertion at the heel, resulting in pain. The fascia may tear at the midsole and near the toes as well. Plantar fasciitis is an ongoing injury process, since it is difficult to rest the foot, and gradually becomes worse. When sleeping or at rest, the fascia is shortened and tight, as do the calf muscles. Thus upon rising, a painful re-injury occurs. Heel spurs are the body’s way of attempting to help the fascia to re-attach to the heel. The bone calcifies toward the torn tissue to help it heal. Heel spurs do not cause the initial pain, nor do they cause the problem, they are a result of the problem. Spurs do not hurt unless they are very large, fractured, or fat pad atrophy is present.
Contributing factors
· Flat (pronated) feet
· High arched rigid feet
· Poor shoe support
· Short shoes
· Walking/running uphill
· Soft terrain (sand)
· Increasing age
· Sudden weight increase
· Tight calf muscles
When the calves are tight, the Achilles tendon pulls the heel bone upward, thus pulling the fascia tight (Left). When the calf muscles are stretched the less pull on the heel bone, thus less pull on the fascia (right).
What to expect
For most patients, the time period for complete resolution of pain is equal to the time period from when pain started until the treatment begins. However, most people find significant relief four to six weeks after treatment starts.
Treatment
Medication: Most physicians will prescribe an anti-inflammatory to relieve pain. Over the counter drugs such as Ibuprofen, Alieve, and Motrin could be used.
Rest: Listen to your body. If the pain is so debilitating, you may have to stay off your feet for a period of time.
Stretching: It is absolutely necessary to do the stretches at least 2 times a day to find relief from plantar fasciitis. Stretching the calf muscles without re-injuring the fascia 2 times a day and especially before getting out of bed in the morning is well known to be a cure for many people.
Custom Cushioned Orthoses: For most people a custom orthotic device is necessary to maintain the long arch to keep the plantar fascia as short as possible and prevent further injury. An over the counter orthotic device may be tried for 6 to 8 weeks, but if no relief is found, a custom orthoses is required.
Shoes: 80% of the US population unknowingly wear their shoes at least one size too small. The fascia attaches to the backsides of the toe bones and short shoes cause the toes to contract, which pulls fascia tighter and causes micro tears while walking. Your shoes need at least ˝” from the end of the shoe to the longest toe while standing.
Keep a pair of supportive shoes that are easy to get on (like Birkenstock sandals) and keep them next to your bed. Put them on before standing up. This will hold your arch up and lessen the chance of injury upon rising. Do not go barefoot while having heel pain.
Ice: Icing the area for 30
to 60 minutes is very helpful to reduce the inflammation.
It is also important to ice the area 15 minutes after activity.
Night Splints: In chronic
cases, a dorsiflexion night splint is used.
This is a brace that holds the front of your foot pointed slightly toward
your knee and keeps your calf muscles stretched while sleeping.
This prevents re-injury upon rising.
Surgery: Surgery is rarely
required for plantar fasciitis. It
would only be considered if all other treatments fail.
Exercises
1.
2.
Calf Stretches 1. Lean against a wall and bend the knee of the unaffected foot. Keep that foot forward. While keeping your heels on the ground and the back knee straight, lean forward toward the wall. You will feel a mild pull in your calf area but NO pain. Hold for 10-15 seconds and relax. Repeat 10 times. 2. Place the balls of your feet on the edge of a stair, curb, phonebook, or ideally an incline board(3.). Keep both legs straight and allow the heels to lower toward the ground. This is a prolonged stretch. Hold this position for 1 minute and gradually increase to 5 minutes. Once again, you should feel a mild pull but no pain.
Toe Curls Place a towel on the ground and using your toes, grab the towel and pull it toward you. Resistance can be increased with a weight at the end of the towel. There are 19 muscles in the foot and 18 connect directly to your toes. This helps strengthen your entire foot.
Towel Stretch (not pictured) Keep a towel near your bed. Before getting out of bed, toss it across the ball of your foot, keeping your knee straight. Pull until you feel a mild pull in your calf muscles. Hold 5 to 10 seconds. Repeat 10 times.
Article about Plantar Fasciitis