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Plantar Fasciitis

What is it? 

Plantar Fasciitis is a chronic inflammation of the plantar fascia, a long ligament that attaches to your heel and the ball of your foot that helps to hold up your arch. The plantar fascia is also indirectly attached to your Achilles tendon. Sometimes, the surrounding soft tissue (muscles, tendons, ligaments, or nerves) can be inflamed as well. It is an extremely common problem that is very easily treatable. 

What causes it? 

Plantar Fasciitis can be triggered by many things: new shoes, working more hours, a new workout routine, standing for long periods on hard surfaces, recent weight gain or a specific injury. Often times, it is difficult to pinpoint the exact reason why it started. The initial injury may cause small micro-tears to the plantar fascia which can trigger pain and inflammation. If your normal gait has some asymmetry, this new injury can take longer to heal and may become chronic because of ongoing abnormal tension.

Why does the first step I take after resting hurt the most? 

After the initial injury, your body tries to heal the affected area. Most often, it partially heals while you sleep at night. At night, your foot and plantar fascia are in relaxed positions. When the body starts to fix the micro-tears, it maintains that relaxed position. When you first get out of bed and step down, your sudden body weight and stretches the relaxed plantar fascia, causing new tears to the fragile tissue that is trying to heal. Over weeks and months, your heel is now an area that has gone through many cycles of re-injury and healing. After a while, the generalized inflammation to the area may or may not start to cause the surrounding soft tissues to become sore as well. 

How do you treat it?

There are many things you can do for immediate short term pain relief to start the healing process. Ultimately though, you will want to prevent re-injury as much as possible and if you do have a recurrence, speed your healing as quickly as possible. 

Immediate short term treatments - to start the healing process 

  This stretch and the calf stretch are the two critical treatments to start immediately.
 • You MUST do this stretch BEFORE putting any weight on your foot (That means before you get out of bed, or after you’ve been sitting for over an hour.) 
 • Cross your affected foot over the opposite knee.
  Use the same side hand as the injured side to pull back your toes firmly. 
  Use your other hand to feel the tight plantar fascia to make sure you are stretching properly. You may not feel like you are stretching your foot.
 • Hold this stretch for 30 seconds, release it for 5 seconds. Repeat 4-10 times in one sitting.
  Repeat this this stretch at least 3 times daily, MOST IMPORTANTLY FIRST THING IN THE MORNING BEFORE STEPPING DOWN. 
  You must do these exercises EVERY DAY. 
  Be patient. Your body still needs to complete the process of healing in its own time frame. This exercise allow healing to continue in an uninterrupted fashion. 
  It may take 8-12 weeks of stretching* (if only doing this stretch) to feel significant relief of pain. → Alternative plantar fascia stretch - for those unable to reach their feet easily
  While sitting upright, either on the edge of the bed or a chair, press your toes to the ground to the side and a little  behind you.
  Your big toe joint should be bent as much as is comfortable and your heel should be up in the air
  Face a wall and lean on it with both hands flat. 
  Put your affected foot behind you with your leg straight until you feel your calf stretching. 
  Make sure the toes of your back leg are pointed forward when doing the stretch. → Alternatively, you can also stretch by putting your toes on a higher ledge or against the wall and lean forward with your heel on the ground 
 3 ICE 
  For about 15-20 minutes at a time 
  Rolling a frozen water bottle on the ground under your foot will ice it and also help stretch the plantar fascia.
 4 NSAIDS (non-steroidal anti-inflammatory drugs) 
  Examples are: ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn).
  Take 600 mg of ibuprofen every 8 hours (or 500 mg of naproxen every 12 hours) for 10 days on a consistent basis.  This will help maintain a steady level in your body. 
  Take NSAIDs with food to prevent stomach upset.
  Do not take NSAIDs if you currently or have ever had a stomach ulcer or problems with bleeding. 
  Acetaminophen (Tylenol) is not an NSAID. 
 5 REST 
  If possible, only do regular activities of daily living such as working, cooking, grocery shopping.
  Limit extra activities such as hiking, running or excessive walking while your heel hurts. 
  These are splints you wear on your leg at night while sleeping.
  They provide a gentle stretch to your calf and some to your plantar fascia. 
  They work because they give you 6-8 hours of constant stretching with no effort on your part. 
  Some medical plans cover these night splints, but many people just order them from Check with your insurance company to see if you are covered. 
  These are steroid injections that reduce the inflammation to the area under your heel. 
  These are not a cure for your plantar fasciitis. They only provide pain relief to help you break the cycle of pain and inflammation.
  Sometimes they don't help at all, but they have the potential to provide pain relief for months.
  This is a relatively new therapy that REPLACES surgical treatment. 
  It is extremely effective and has virtually no side effect.
  It is unfortunately not yet widely available in California but our office is planning to offer this service in the near future. 
  Please ask us for more information if you are interested!
 Long term treatments - to promote faster healing and prevent recurrence 

Custom orthotics are the BEST way to fix the underlying problem with your stance and gait that either caused or prevented the quick healing of your heel pain.
It is a hard plastic device, with a padded top-cover for comfort, that is created from an exact mold of your foot.
You will notice the most relief within the first two months of wearing them, but you will continue to get stronger and improve for months and years. 
RIGID (not soft) over the counter orthotics such as Powersteps or Superfeet can be helpful but are limited because they are not custom made. It’s like the difference between prescription glasses and drugstore reading glasses. 
Different people with different feet have different specific needs when it comes to finding the best shoe. However, there are some general guidelines that almost everybody can follow.
Don’t buy shoes that are too tight. For typical running or athletic styled shoes, you should have at LEAST half an inch of space between your longest toe and the end of the shoe. Your bare foot should also not be wider than the actual shoe! 
The sole of the heel should be very stable and not easy to twist or bend. 
The shoe should naturally want to bend at the base of the toes, where your foot naturally wants to bend. 
Don’t buy shoes that bend and move in a way that your foot cannot.
For more specific advice, talk to your podiatrist. 
The foot is a machine that is made to carry the body around. 
The more weight the foot must carry, the more work it must do. 
When the foot does more work, it can become tired and injured more easily. 
If you need advice or help losing weight, talk to your podiatrist or your general doctor.


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