Plantar Fasciitis Definition: Painful condition which usually results in symptoms related to pain below the heel is known as Plantar Fasciitis. Most common cause for the pain is excessive or strenuous use of arch tendon or plantar fascia of the foot.

Plantar Fasciitis or Plantar Fasciopathy or Jogger's Heel

What is Plantar Fasciitis or Plantar Fasciopathy or Jogger's Heel?

Plantar fascia is a group of tissues which is thick and broad that traverses from the under-surface of heel. This extends to the front part of foot. Inflammation of this plantar fascia is known as Plantar Fasciitis.

Symptoms of Plantar Fasciitis or Plantar Fasciopathy or Jogger's Heel

  1. Painful stretching of the plantar fascia.
  2. Common symptoms would include pain under heel, on the heel, or on the inner surface of the fascia from where the attachment of the fascia originates.
  3. Worst pain usually in the early morning hours. This is because the fascia becomes tight or stiffens up overnight and starts relaxing in the morning hours. Once warming of the foot is done, then the pain dissipates.
  4. In rare cases, pain also persists on the outer surface of the heel.
  5. If any activity is continued when the pain persist, then condition may become worse as the day progresses.

Causes of Plantar Fasciitis or Plantar Fasciopathy or Jogger's Heel

Plantar fasciitis commonly occurs in sports injuries that involve activities like dancing, jumping or running. At the time of running, runners tend to over stretch or overpronate the plantar fascia thereby resulting in plantar fasciitis. In most of the cases, calf muscles get tightened leading to prolongation of the foot which will produce constant and repeated overstretching of the plantar fascia that will result in tendon thickening and inflammation of the fascia. The moment fascia gets thickened it will lose strength and starts showing effect on flexibility.

At times, pesplanus or pescavus (feet with low or high arch) also causes plantar fasciitis. Some other biomechanical abnormal conditions such as oversupination should be examined, assessed, and treated by biomechanist, podiatrist or physiotherapist.

In some cases, overrunning or walking excessively in footwear that does not have proper arch support leads to plantar fasciitis. Flat footwear with good cushions and arch support helps alleviate plantar fasciitis. Individuals with obesity are usually at increased risk of plantar fasciitis.

Treatment for Plantar Fasciitis or Plantar Fasciopathy or Jogger's Heel

Plantar Fasciitis cannot be treated with a single method and it is unlikely that it will be cured on its own. It is true that self-treatment is very dangerous as the outcome of the treatment may be worse. Consulting a podiatrist or physical therapist would be the first best step that anyone should adopt.

A physical therapist will recommend a full rehabilitation workup and under this physical therapist's guidance rehabilitation program will be setup and later based on the recovery status, home management program will be suggested.

In General, A Physical Therapist Would Work On The Following:

  1. Activity modification.
  2. Help decrease the severity of pain with the help of exercises.
  3. Help decrease inflammation.
  4. Will work on flexibility.
  5. Work on strengthening of the fascia.
  6. Will educate on how to prevent from future injuries.

Other Alleviating Factor Would Include:

  1. Avoid activities which cause excessive pain.
  2. To be off of feet as much as possible.
  3. Cycling and swimming can be helpful in reducing the pain.
  4. To work on reducing weight.
  5. If it is not possible to remain off of feet, then it is advisable to use taping technique. It is observed if this technique works, then usage of orthotics would mostly be effecting in alleviating pain and it is also helpful for correction of foot biomechanics.
  6. Cold pack massage with the help of ice for at least 10 minutes once an hour on the first day for a minimum of 4-5 times in a day for 2-3 days would be very helpful. If the pain persists or there is any increase in severity then should consult the podiatrist or physical therapist.
  7. Doctor will prescribe nonsteroidal anti-inflammatory drugs based on the condition. The course and dosage the medication will vary from individual to individual.

Massage Therapy and Flexibility for Plantar Fasciitis or Plantar Fasciopathy or Jogger's Heel

The moment pain becomes tolerable, patient should start slight manual massage on the first day. Along with this gentle massage process all other muscles of calf, tib-ant, etc., of the leg should be stretched as much as possible. This will help alleviate plantar fasciitis. This process should be continued as per the instructions set forth by the physical therapist during the rehab program. In case of the sports injuries, massage therapy should be started the moment pain allows to do so. Always, massage should be started gently and then can go deeper as per physical therapist's instructions.

As the pain subsides, massaging should be done on alternate days. This will allow fascia and muscles to relax a day and then massage the other day, so that plantar fasciitis can be treated effectively.

Strengthening of Foot and Muscles:

It is very important for a body part to regain strength after any accident or injury. Most importantly to regain strength to perform normal activities of daily living. One should always remember that strengthening of foot or muscles should be done when there is severe pain. Strengthening exercises should be started slowly as the pain subsides. These exercises will help foot to regain strength and also prevent from recurrence of future injuries.

When to Return to Normal Activities?

One would be eager to get back to normal activities and would like to walk/run as soon as possible. As part of the strengthening exercises, start walking slowly for short distances for half-an-hour and then increase the speed and distance over a period of 5-6 days. It is very important to start gently and then proceed gradually in order to avoid damage to the structures of the foot and muscles. Use orthotics as recommended by the podiatrist.

The following aspects should be considered before and after exercise:

  • Make sure to stretch before and after exercises. Example, holding stretches for 30 secs and repeating the same 4-5 times.
  • Increase exercises gradually.
  • Use proper sports shoes for running or jogging.
  • Use of appropriate orthotics or taping of the foot.

It is very important to start exercises only under the supervision of a physical therapist. Usually, physical therapist will suggest physical rehab program which will include short term goals and long term goals. Short term goals would include gentle massaging and initial walking for short distances. Long term goals would include jogging and running over period of time to regain normal functional activities.

Common Short Term Goal For First One Week Would Be:

  1. Gentle massage for 10 minutes and walking for 2 minutes and should repeat this 3 times.
  2. Gentle massage for 10 minutes and walking for 3 minutes and should repeat this 3 times.
  3. Gentle massage for 5-7 minutes and walking for 3 minutes and should repeat this 3 times.
  4. Gentle massage for 5 minutes and walking for 4 minutes and should repeat this 4 times.
  5. Gentle massage for 5 minutes and walking for 4 minutes and should repeat this 4 times.
  6. Gentle massage for 5 minutes and walking for 5 minutes and should repeat this 5 times.
  7. Gentle massage for 5 minutes and walking for 5 minutes and should repeat this 5 times.

This process should be discontinued if there is increase in pain or discomfort and should consult the doctor immediately. If there is no pain, can continue this program to help regain normal walking.

Common Long Term Goal For First One Week After Achieving Short Term Goal Would Be:

  1. Walking for 2 minutes and jogging for 2 minutes and should repeat this 2 times.
  2. Walking for 2 minutes and jogging for 3 minutes and should repeat this 2 times.
  3. Walking for 3 minutes and jogging for 3 minutes and should repeat this 2 times.
  4. Walking for 3 minutes and jogging for 3 minutes and should repeat this 3 times.
  5. Walking for 3 minutes and jogging for 4 minutes and should repeat this 3 times.
  6. Walking for 4 minutes and jogging for 4 minutes and should repeat this 3 times.
  7. Walking for 5 minutes and jogging for 5 minutes and should repeat this 4 times.

This process should be discontinued if there is increase in pain or discomfort and should consult the doctor immediately. If there is no pain, can continue this program to help regain normal walking.

Exercises for Plantar Fasciitis or Plantar Fasciopathy or Jogger's Heel

As discussed earlier, plantar fasciitis exercises plays important role in treatment of plantar fasciitis especially stretching exercises. To reduce severity of the pain in a short period of time, stretching of the calf muscles and plantar fascia can be done to achieve good result.

It is always recommended to seek advice from the physical therapist before working on any exercise regimen. Some simple and common exercises that physical therapist would suggest are:

Stretching of the Plantar Fascia:

  1. Stretching of the toes and foot by pulling them and holding them for 30 secs and repeat this for five times. This can be done three times in a day.
  2. Rolling of the plantar fasciitis over an object which is round like rolling pin, ball, can or weight bars. The procedure is rolling the foot repeatedly with increasing pressure pointing downwards.
  3. Use of cold therapy.
  4. Stretching of the gastrocnemius muscle by standing with legs spread apart face facing to the wall and stretching of the leg at the back and leaning forward; hold this movement for ten seconds and keep the heel back down, continue this for 4-5 times. This exercise can be done three times in a day. Then can continue this stretching process for 40-50 seconds.
  5. Stretching by standing on the step.
  6. Stretching of the soleus muscle.
  7. Wearing of night splint to support the foot overnight will be helpful in treating plantar fasciitis.

In any case, if there is any feeling of pain or discomfort, then stop the exercises and approach medical care provider immediately.

Assessment and Diagnosis for Plantar Fasciitis or Plantar Fasciopathy or Jogger's Heel

Plantar fasciitis can be diagnosed and assessed by the physical therapist. The therapist will ask some questions related to patient's medical history, past injuries and present injury, how the incident occurred, etc. Basically, these questions are asked to assess the causes of pain and to come to conclusion as to what type of treatment will be suitable. Later, the therapist will try to further assess by performing some tests such as:

Stance and Gait: Therapist will keenly observe how the patient is walking and standing. By doing this, the therapist will observe whether there are any fallen arches, overpronation, oversupination or for look for high arch.

Therapist will palpate the area under the foot such as arch and feet. If there is pain on palpation on the inner aspect of the heel then that clearly indicates that the patient has plantar fasciitis.
ROM (Range of motion): If the ROM is decreased at the ankle, then that can lead to plantar fasciitis. The therapist will look for symptoms especially by performing dorsiflexion and if there is decreased ROM in this case it will indicate that the calf muscles are tight. In normal ROM, the patient will be able to exhibit 90 degrees angle in between the foot and lower leg.

Some investigations will be done to rule out heel spur such as x-rays and diagnostic ultrasound will be suggested in cases where fascia is thick and some swelling present.

In some cases sports massage is also recommended to treat plantar fasciitis.

  1. Smooth massage oil or lubricants are applied on top of the foot.
  2. Applying gentle stroking movements on top of foot. In this state, the sole of the patient rests on the hand of the therapist. The therapist will apply pressure with thumb and finger and massage from backward to forward direction.
  3. Placing of the thumbs on the metatarsal area and pressing the ball with fingers and foot.

Simple Self-treatment for Plantar Fasciitis or Plantar Fasciopathy or Jogger's Heel

Before approaching the doctor, simple treatment can be tried at home. Rolling of the foot with a roll of around 2.5 centimeter tape will relieve the pressure off the painful foot. However, in any case, the patient should visit the podiatrist or physical therapist for further care and management.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: May 14, 2014

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

Symptom Checker

Slideshow:  Home Remedies, Exercises, Diet and Nutrition

Chakra's and Aura's

Yoga Information Center

Find Pain Physician

Subscribe to ePainAssist Newsletters

By clicking Submit, I agree to the ePainAssist Terms & Conditions & Privacy Policy and understand that I may opt out of ePainAssist subscriptions at any time.

Copyright © 2016 ePainAssist, All rights reserved.

DMCA.com Protection Status