Plantar fasciitis is a common condition in which the plantar fascia (thick fibrous band of the arch of the foot) becomes irritated usually at the point where it attaches to the heel bone. Occasionally the irritation results in the formation of calcium inside the fibrous band and this is known as a heel spur. THere are many different modalities of treatment for this problem and no single one is universally successful. Therefore, trial and error, through the different modalities may be necessary to determine what will work best for you. The following is a list of treatments you are to follow unless they have been crossed out (by yourself for trying them and not having success).
1. Ice Massage
1. Ice Massage
- Freeze water in a water bottle (size that would fit into a bicycle water bottle holder). The bottle is placed on the floor and the arch of the foot is rolled back and forth across the frozen water bottle icing and massaging the plantar fascia. This is to be done for 5-10 minutes three times a day.
- For this you will need a white pages phone book. With shoes on you are to stand on the edge of the book with legs straight for 1 to 2 minutes. You then stand on it with your knees bent as far forward as possible for 1 to 2 minutes. This is to be done every morning and every night as well as after any sporting activities.
- Sit on the floor with your leg straight. Then a rolled up towel is wrapped around the arch and pulled back towards you stretching the plantar fascia. This should be held for 30 secs and repeated 5 times every morning and every night.
- The purpose of the night splint is to keep the ankle bent at a 90-degree angle. This is to prevent the plantar fascia from healing during rest in a shortened position with the foot pointed down. This should help reduce pain in the first few steps in the morning. This will be continued every night for at least 6 weeks.
- There are a number of different options for supporting the arch. These include an off the shelf arch support such as super feet (heel cuff, heel spur pad) soft orthotics or custom-made semi rigid orthotics. A plantar fascia brace (PFD). A “low dye” taping of the arch can be learned and done before sports in order to support the arch and correct the foot mechanics. Specialized heel pads can be used to take pressure off the plantar fascia attachment to the bone. Always wear a supportive shoe or sandal (Birkenstock) at home. Never go barefoot for a prolonged period of time.
- A non-prescription anti-inflammatory called Ibuprofen 600-800 mg three times a day for 1 to 4 weeks. Alternatively, a prescription anti-inflammatory may be given to you. Anti-inflammatory gel can be massaged into the heel pad over the tender area 3 times a day. With saran wrap applied over the gel at night time. Cortisone injections into the plantar fascia is occasionally necessary to help settle down the inflammation.
- This will consist of passive treatment such as ultrasound, laser, interferential, TENS. Active treatment will include more detailed stretches, strengthening exercise drills. If you are using the anti-inflammatory gel, then bring this to the physiotherapist who will use the ultrasound to help the gel penetrate deeper into the tissues.
