What is Plantar Fasciitis?
Simply put, it is inflammation ("itis") at the place where the tissue that forms the arch of your foot (the Plantar Fascia) attaches to your heel bone and extends the entire length of your arch, all the way to the base of your toes.

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What caused it to become inflamed?
With every step you take, your foot bones spread and move to absorb and soften the blow of your weight onto your, foot. The ligaments between the bones accomplish much of this "springiness" of the foot. However, some of it is buffered by the Plantar Fascia, which attaches to the heel and then to the front of the foot. With every step this tissue stretches and relaxes, tugging on its attachment to your heal bone. Over time a small area of inflammation may occur anywhere along the arch, most commonly at its attachment to the heel bone (calcaneous). When this area of inflammation gets large enough, it is felt as pain, occurring with each step.

Did I do something to cause this problem?

Not necessarily. Most people do not recall any specific event that led to the pain. Certain types of feet, especially
flat feet, are at a much higher risk of developing this problem, as are persons who do sports requiring a lot of "pushing off, including uphill running, running on sand, etc. Also, Step Aerobics and Stairmasters, when done just on the ball of the foot, may elicit Plantar Fasciitis.

Why does it hurt so much in the mornings?

This is most likely due to the area of inflammation shortening up as you sleep. When you take your first step in the morning, it suddenly stretches that shortened tissue causing renewed pain.

What can I do to make it get better?

The treatment for this problem has a number of components, some of which are directed at improving the pain and some directed at preventing recurrence. Those directed at pain relief might include such things as arch supports, ice, stretches, activity modification, medications, massage, and even injections. Therapy to prevent recurrence would include stretches, arch supports, good shoes. Let's go through each of these individually:

1.
ARCH SUPPORT!!
The single most important thing you can do to start getting better from Plantar Fasciitis is to start using an
arch support or Orthotic in your shoes (both shoes) at ALL TIMES. An alternative is certain brands of shoes with high arches built into the soles. Do not go barefoot at any time, if possible. Getting sandals with a built-in arch support, such as Birkenstock or ECCO (there are now many other brands as well), for use around the house. there are even "flip-flops" with some arch in the sole to use in the shower. Arch supports will start helping your discomfort very quickly in most cases. The reason for this is that this "external" support allows your own "internal arch support" (the Plantar Fascia itself) to rest and it can start to heal itself.

2.
Ice:
The use of ice can help relieve the pain of PFS in its early or late stages. Use the ice as a means of massaging the painful area of the heel or arch. Two novel approaches to ice massage include: Fill a small paper cup full of water, then freeze. Peel back the top inch or so of the paper, and use the exposed circle of ice for massaging the most painful/tender area of the foot. Don't use for more than 20-30 mins. each time, to prevent risk of tissue injury, but you can repeat numerous times in a day if desired. Another interesting technique is using a can of frozen apple juice or orange juice, laying it on the floor and rolling the can (still frozen) under the arch and heel, thereby both massaging and icing the tissue simultaneously.

3.
Stretches and Strengthening Exercises:
There are a number of ways to stretch the tissue involved in PFS. Refer to the last page of this sheet for examples. The sitting towel stretch is especially good before getting out of bed in the mornings to prevent that terrible "First Step" pain. Keep a towel next to the bed for this purpose. Pull gently on the towel, stretching the arch 4 or 5 times before arising from bed; you should feel the inflamed area "pulling". You should also do the Calf and Hamstring Stretches shown at the end of this sheet.

4.
Modifying Activities:
As this problem often occurs in athletes involved in sports requiring "pushing off' movements, such as tennis, uphill running, certain aerobics, football linemen, soccer, it is best to at least cut back on these activities during the healing phases of PFS. Those persons who are unable to change their activities, for whatever reasons, must protect their arches with either taping or arch supports discussed below. However, continued severe stress on the Plantar Fascia by continued high level activity may ultimately prolong the healing or even cause a rupture of the Plantar Fascia (although this is rare).

5.
Medication:
Many athletes are prescribed anti-inflammatory medications for PFS to relieve the pain. Although these medications can be helpful, they often fail to alleviate all the pain and if you find that the medications are not helping after an appropriate time (usually two weeks), or are causing side effects such as stomach upset, you should consider stopping the medicine.Do not take these medications if you have a history of stomach ulcers or allergy to aspirin.

6.
Injections:
Although there is some controversy over the efficacy or safety of giving Cortisone injections for this problem, it is a therapy that frequently gives the most immediate and complete relief. It involves injecting a small quantity of a cortisone-like medication with some novocaine-like solution into the area of maximal inflammation. Although the procedure is not painless, it is usually not as painful as it sounds. The things to remember are: this is a therapy to treat the immediate problem of pain, it does not replace the other, preventative, measures described, below; and, you should not undergo more than three of these injections in any 12 month period, as the risk of rupture of the plantar fascia rises somewhat with repeat injections, as does the incidence of soft tissue atrophy (shrinkage). Otherwise, it is a generally safe and well-tolerated procedure.

7.
Night Splinting:
Some podiatrists suggest using a molded plaster splint, which is held in place by an elastic bandage, applied every night before bed. This holds the foot in one position all night and may prevent the first step stretching and pulling of the shortened healing fibers that occurs each morning when you stand. Our Cast Room Technician makes these splints custom for your foot

8.
Casting the foot:
In the most stubborn of cases, where nothing else seems to work, it is occasionlly necessary to cast the painful foot in a plaster or fiberglass cast, much as if it were broken (fractured). Essentially, this relieves all the stress on the fascia and the shortening/stretching cycle that has been prolonging its healing.



PREVENTATIVE MEASURES:

1.
Stretches:
See above. Remember: once you return to your sports, do these stretches before and after each workout.

2.
Arch Supports