How to reduce the pain of plantar fasciitis

Plantar fasciitis is a common cause of pain in the foot and heel, but can be quite severe and stop you from doing activities that you enjoy. There are a number of different causes, so you need to find out why it has happened in order to fully treat it and then prevent it reoccurring.

So, what is plantar fasciitis?

Plantar fasciitis is inflammation and injury to the long ligament (plantar fascia) in the sole of the foot. The role of this ligament is to support the small bones in the foot while the surrounding muscles control the movement. Injury can cause small tears in the ligament which then leads to local inflammation and pain.

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The most common potential causes:

• Standing for long periods of time.
• Unsupportive footwear putting strain on the foot and ankle.
• Excessive running (particularly with inadequate footwear) and more likely if the intensity of exercise is increased suddenly.
• Impact to the foot and heel, e.g. from a fall.

Symptoms.

Symptoms of plantar fasciitis include pain in the heel and sole of the foot, local swelling and pain on walking or any pressure applied to the heel/sole. The pain is usually worse first thing in the morning or after periods of rest and there may be stiffness in the ankle joint.

Other causes of heel pain.

It is important to rule out other possible causes of heel pain, such as stress fractures in the foot and ankle, bony growths on the heel bone (heel spurs), muscle tears and osteoarthritis in the nearby joints. These problems are treatable, but will require a different course of treatment to plantar fasciitis. Consulting an osteopath or podiatrist will ensure you get the correct diagnosis and advice, usually meaning a faster recovery to getting back on your feet comfortably!

As it is an inflammatory problem, plantar fasciitis can be more likely to occur in people with inflammatory conditions such as psoriatic arthritis, axial spondyloarthritis (including ankylosing spondylitis, AS) and reactive arthritis. It's important to speak to your rheumatologist or GP if you have one of these conditions and develop persistent symptoms of plantar fasciitis. It may be that the management of your condition needs to be altered or they can offer on advice on anti-inflammatory medications.

Treatment for plantar fasciitis.

If the heel pain is caused by plantar fasciitis, there are lots of options for treatment and self help. Usually a combination of the following work well:

1. Rest in moderation. Decrease the amount of time you spend on your feet without a break. To reduce the inflammation irritating the area, you want to do small amounts of activity regularly, with frequent breaks. Reduce the amount of running and walking you do for a few weeks while the injury heals. If your job requires you to stand for long periods of time, use a cushioned mat on the floor to reduce the pressure on your feet.

2. Ice the area regularly. Half fill a plastic bottle with water and freeze solid. Place this on the floor and roll the sole of your foot up and down over it like a rolling pin (wear a sock to protect your skin). You can do this for 5 minutes every hour as necessary.

3. Calf stretches, particularly after standing or walking for some time. Stand with your toes on the edge of a step (holding onto the railing for balance) and gently relax one heel down towards the floor for 10-20 seconds. When you've finished the stretch, relax the ankle you've just stretched and push up with the other side. Repeat on the other side.
You can do this stretch up to three times daily as long as it doesn't aggravate the pain after you've finished the stretch. You can also stretch the calf seated, this is particularly good to do in the morning before you put weight on your foot, watch this video for more info.

4. Wear supportive footwear, particularly if on your feet for long periods of time. Read a previous blog post on the correct footwear here.

5. While recovering from plantar fasciitis, it can be useful to insert some thin wadding in the heel part of the sole of the shoe, with a small cut out at the back where the pain at the heel occurs. This can allow you to be active while reducing the pressure locally on the heel. It's best to visit an osteopath or podiatrist for this to make sure it's applied correctly and important to do the same on both sides.

6. Reduce time spent in high heels and perform calf stretches during the day and at the end of the day to limit the effect of them.

7. Orthotics (shoe inserts) may be useful if there is a problem with the muscles and bones in the foot to avoid excessive strain on the plantar fascia. Podiatrists are able to advise on the correct orthotics and can usually custom make them or alter 'off the shelf' insoles if needed.

8. Strengthen the intrinsic muscles of the foot and the muscles surrounding the ankles. Exercises to improve proprioception (awareness of joint/body positioning) can reduce the risk of ankle sprains and muscle strains. Take a look at these exercises: Plantar fascia strengthening, standing on one leg and side steps.

9. Swimming is a great all round exercise for the legs and ankles, strengthening the muscles while not putting pressure on the painful heel. Begin gently and gradually build up over time as your strength improves.

10. In severe cases that don't respond to any other treatment, steroid injections or surgery may be used, but this is usually quite unlikely.

Hopefully these tips will help you improve your plantar fasciitis and reduce the likelihood of it returning in the future. It can take quite a while for plantar fasciitis to go completely, but these tips can help ease the symptoms greatly and speed up the recovery.

If you have any questions, please don't hesitate to get in contact:
Call me on 07543 557746
Email zoeclarkosteopath@gmail.com
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Zoë Clark is a registered osteopath trained at the British College of Osteopathic Medicine in London. Practicing in Howe near Norwich (01508 558373) and Burston, near Diss (07543 557746) in Norfolk.