Plantar fasciitis, sometimes called a heel spur, is a condition that causes pain on the bottom of the heel when putting weight on the foot. There can be many underlying causes of heel pain, and sometimes finding the precise reason for the pain can be difficult. Even so, several options are available for treatment.

The plantar fascia is a band of tissue, similar to a tendon, which runs from the front of the heel bone (calcaneus) to the ball of the foot. This dense strip of tissue helps to support the arch of the foot.

When the foot is on the ground the full weight of the body is concentrated on the plantar fascia. This force stretches the tissue as the arch of the foot tries to flatten from the weight of the body. This leads to stress on the plantar fascia where it attaches to the heel bone. Small tears of the fascia can happen. However, the body normally repairs these tears.

As this process of injury and repair repeats itself over and over again, a bone spur (a pointed outgrowth of the bone) sometimes forms as the body's response to try to firmly attach the fascia to the heel bone.

Heel pain from plantar fasciitis can have several causes. In rare cases, the heel spur can be so big it causes pain. The chronic inflammation of the fascia itself may be the source of pain. As we age, the fat pad that makes up the fleshy portion of the heel becomes thinner and degenerates. This can lead to inadequate padding on the heel and chronic pain in this area. The small nerves that travel under the plantar fascia on their way to the forefoot can also become irritated and may contribute to the pain.

The symptoms of plantar fasciitis include pain in the center of the heel when weight is placed on the foot. This is usually most pronounced in the morning when the foot is first placed on the floor.

Patients sometimes describe that they feel a "ripping" sensation under the heel, others describe the pain as if being "kicked" in the underside of the foot.

 

P - R - I - C - E

Protection - Your ankle may be splinted, taped or braced to prevent further injury.
Rest - You should rest from all activities that cause pain or limping. Use crutches/cane until you can walk without pain or limping.
	Ice - Place a plastic bag with ice on the ankle for 15-20 minutes, 3-5 times a day for the first 24-72 hours. Leave the ice off at least 1 1/2 hours between applications.
	Compression - Wrap an elastic bandage from the toes to mid calf, using even pressure. Wear this until swelling decreases. Loosen the wrap if your toes start to turn blue or feel cold.
Elevate - Make sure to elevate the ankle above heart level (hip level is acceptable during class).

baked bean stretch

using a baked bean tin roll the foot backwards and forwards a in the diagram below

2 minutes in the morning before putting the foot to the floor

5-10 minutes every evening

contrast foot baths

10 minutes warm water

10 minutes cool water morning and evening (morning may be missed if time is restricted).

calf and plantar fascia stretches

(a) (b) (c)

Start with 10 stretches per day as in diagram (a) holding the stretch for 30 seconds, then relax and then repeat.

Continue this stretch daily until you can no longer feel it pulling on the heel, then progress to stretch in diagram (b). Do 10 per day holding for 30 seconds per stretch. When you can no longer feel it pulling on the heel proceed to stretches as in diagram (c). Do 10 per day holding for 30 seconds on every stretch.

Remember that virtually all achilles tendon problems  occur at contact phase of gait (when the foot hits the ground) due to increased biomechanical stress at this point. No amount of exercising will influence what happens at the point of heel strike, mid-stance and toe off phases of gait. It is therefore vital to improve your biomechanics with orthotics designed for your chosen sport.

Golden rule- Don't ignore the problem, it won't go away!

The way we function biomechanically is predominantly controlled by genetics, its hereditary (runs in the family). The way you function is set and cannot be cured. What you can do however is control lower limb biomechanics by altering foot position during the contact phase of gait. This can only be done by wearing a good shoe (see our shoe guide) and with orthotics  (foot beds). This is the cheapest and most cost effective way for any athlete to reduce the risks of injury from occurring and from helping to prevent re-injury. Overall costs for the average athlete will run into pennies per mile/hour of sport. Orthotics are designed to alter the biomechanics during the time the foot is on the ground. They are also used to provide increased shock absorbency working in harmony with the sport shoe worn.

The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your ankle recovers, not by how many days or weeks it has been since your injury occurred.

You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:

You have full range of motion in the injured leg compared to the uninjured leg.

You have full strength of the injured leg compared to the uninjured leg.

You can jog straight ahead without pain or limping.

You can sprint straight ahead without pain or limping.

You can do 45-degree cuts, first at half-speed, then at full-speed.

You can do 20-yard figures-of-eight, first at half-speed, then at full-speed.

You can do 90-degree cuts, first at half-speed, then at full-speed.

You can do 10-yard figures-of-eight, first at half-speed, then at full-speed.

You can jump on both legs without pain and you can jump on the injured leg without pain.

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