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According to the American Orthopedic Foot and Ankle Society, 97% of the time, Plantar Fasciitis cases will resolve after six months of consistent, conservative treatment. With no treatment at all, it will usually resolve itself in six to eighteen months.
If you have ever had plantar fasciitis, however, six months can seem like a lifetime. Eighteen months? Forget about it. Conservative treatment for plantar fasciitis is not difficult, and it does not increase the pain. In fact, it feels good. Albeit, it "hurts so good," but you can definitely feel it working.
We don't even think about our feet until they hurt. However, we should treat them with care, considering just one foot has twenty-eight bones, thirty-three joints, and more than one hundred muscles, ligaments, and tendons. That's a lot of joints to keep functioning correctly on both feet.
The plantar fascia is a broad ligamentous band that runs from the heel bone up to the toes. Its job is to support the arch of your foot and provide shock absorption. The word plantar refers to the sole of the foot, and fasciitis means "inflammation of the fascia of a muscle or organ."
Inflammation of anything causes pain, but when every step you take pushes your body weight onto the inflamed tissues that can be agonizing. That is what makes treating plantar fasciitis such a lengthy process because you are walking on the problem every day. Some people are walking on the problem all day, every day.
Plantar fasciitis happens when the fascia that covers the foot is over-stressed from standing or walking for extended periods on hard surfaces. The fascia sustains small micro tears that become inflamed, which causes pain in the heel and bottom of the foot. Approximately 2 million people per year are treated for this condition each year.
People most at risk for plantar fasciitis are those who:
- Have flat feet or high arches
- Don't wear supportive footwear
- Are overweight
- Are athletes (particularly runners and jumpers)
- Work or exercise on hard surfaces
- Stand for long periods throughout the day
- Have tight heel cords
- Walking barefooted on hard surfaces
- Excessive pronation or turning in of the ankle
If you have a job that keeps you on your feet all day, proper footwear is imperative. If you are going to spend money on anything, make sure you have a good, supportive pair of shoes. Your feet are going to be carrying around your body weight for the rest of your life, so don't take good foot care for granted.
Unfortunately, there isn't one shoe type recommended for plantar fasciitis sufferers, and that is because everyone has a different kind of foot. There is a separate issue causing stress on the plantar fascia for each person. The consensus, however, is to find a shoe that minimizes the impact of the heel of the foot hitting the ground when you take a step.
-Burning, aching pain near the heel and along the arch of one or occasionally both feet
- Increased pain when getting out of bed in the morning or being off your feet for an extended period.
- Increased pain after exercising or activity (it hurts but not as bad during activity)
- Ankle pain
- Foot pain
- Heel pain
One hallmark symptom of plantar fasciitis is severe pain when your feet hit the floor in the morning. This is because while you are sleeping, the plantar fascia shortens a little bit—the minute you take a step in the morning, the fascia starts to stretch out, creating tension and pain. The more you walk, the better it feels as it gets stretched out.
According to the Journal of Athletic Training, there are an estimated 23,000 ankle sprains per day in the United States. About 20% of those patients will go on to develop chronic problems related to lateral ankle instability.
Lateral ankle instability often leads to increased ankle/foot pronation (which would cause your shoe to wear down on the inside). Increased pronation creates a force on the arch of the foot, which puts tension on the plantar fascia. This muscle imbalance of the ankle often causes recurring plantar fasciitis. In this case, it's the ankle problem that causes the plantar fasciitis, so the ankle issue will need to be addressed to control the recurring fasciitis plantar.
The opposite is true when the plantar fasciitis creates inflammation of a nerve root, which then causes pain to radiate up into the ankle. Treating the inflammation and decreasing the irritated nerve root will alleviate the ankle pain.
Conservative treatment works most of the time for plantar fasciitis. However, if you are getting recurring episodes of plantar fasciitis and you notice that your one or both of your shoes are wearing down on the inside, you should seek medical advice. Your recurring plantar fasciitis could be due to an instability in your ankle.
Ice is a natural anti-inflammatory, and it can be very helpful in controlling pain. Apply a cloth-covered ice pack to the painful area for 20 minutes at a time, 3 to 4 times a day.
Over the counter medication such as ibuprofen can provide pain relief and decreased inflammation. Some people benefit from taking NSAIDs regularly for a few weeks to keep the inflammation controlled. However, if you are taking prescription medications, you may want to speak with your physician or a pharmacist before adding anything new regularly.
Calf Stretches -
Lean forward with both hands on a wall, bring the foot that is not painful forward and place it on the floor with your knee bent, leaving the painful foot flat on the floor with the knee straight behind you.
Lean forward onto the front leg to control the amount of stretch in the heel and calf muscle. Hold for 10 seconds, repeat 5 times.
Rolling Stretch -
Sitting up tall in a chair, put a tennis ball, frozen water bottle, rolling pin, foam roller, or anything that you can roll and stretch the bottom of your foot on.
Push the bottom of your foot down and roll back and forth and side to side to loosen and stretch the fascia. Do this for 2-minute intervals.
Place a small towel on the floor, and use your toes to scrunch up the towel, spread the towel back out and scrunch with your toes again. Do this for 2-minute intervals.
Sit on a chair and cross your painful leg over your opposite knee in a figure 4 position.
Pull the toes and the ball of the painful foot up toward your ankle until a stretch on the bottom of the foot is felt. Hold for 10 seconds, repeat 5 times.
There are several over the counter shoe inserts that provide extra arch support and relieve stress on the plantar fascia. Adding some extra padding to your shoes can help reduce pain in the foot, heel, and ankle. They can also be a proper treatment for supporting weakened arches in the foot.
Heel lifts or cups are also recommended to reduce the tension on the plantar fascia and decrease heel pain and foot pain. They are inserted inside the shoe under the heel.
These splints keep your foot splinted at a 90-degree angle to prevent your heel cord and plantar fascia from shortening during the night while you sleep.
They can be very bulky, but they are an effective treatment. The good news is once the pain resolves, you can stop wearing it.
For stubborn cases of plantar fasciitis or if ankle pain persists after the fasciitis has resolved, your doctor may recommend Physical Therapy. Your therapist can address ankle instability by prescribing exercises to strengthen the weakened muscles and stretch the shortened ones.
Ultrasound may also be used to treat heel pain, and pain in the plantar fascia.
Passive stretches, massage therapy, and joint mobilization can also be performed by the therapist to ease pain and restriction in the plantar fascia, loosen up the joints of the heel and arch of the foot, and decreased inflammation.
Any pain that affects your feet is going to have an impact on the quality of your daily living. Wearing supportive footwear and replacing your shoes when they get worn down is vital to good foot and ankle health. Keeping your feet healthy and pain-free is key to avoiding days of painful suffering.
However, sometimes even despite the best of care, things can go wrong. The plantar fascia can become inflamed; it can cause foot, ankle, or heel pain and make your life miserable. Refer to the measures listed above for conservative care and perform them regularly.
Decreasing inflammation, increasing flexibility, and improving foot support should provide relief of your symptoms over six months. However, if you find that conservative measures are not providing relief, then talk to your doctor about other treatment options such as physical therapy, cortisone injections, extracorporeal shockwave therapy (EST), or acupuncture.