Physical Therapy for Plantar Fasciitis

Plantar fasciitis is a condition that causes pain in the heel, and sometimes in the arch of the foot. It is an inflammation of the plantar fascia, which are sheets of tough tissue that run along the bottom of the foot, connecting the heel to the toes. The pain is usually worse first thing in the morning or the first few steps after standing up. The condition can become chronic and can be painful enough to interfere with daily activities.

Diagnosis

• A physician diagnoses plantar fasciitis by talking to the patient about his symptoms, examining the feet and ankles and watching how the patient walks. The doctor may order a test, such as an x-ray, to rule out other causes of heel pain.

Treatment

• The first treatment for plantar fasciitis is rest. Reducing activities like walking, running or jumping can help the fascia to heal. Massaging the bottom of the foot with ice for 5 minutes or placing an ice pack on the area for 20 minutes, four times a day, can help reduce pain and inflammation. Anti-inflammatory medicines such as ibuprofen can help.

  If rest and ice are not enough, see a podiatrist. A podiatrist can evaluate your feet and the way you walk to look for any problems such as overpronation (excessive rolling inward of the foot while walking or running) or arch problems. If necessary, your podiatrist can make you an orthotic to wear in your shoes to support your feet properly. The doctor may also prescribe physical therapy.

Physical Therapy

• Physical therapy for plantar fasciitis usually includes strengthening and stretching exercises. Because tight calves and Achilles tendons are common problems with plantar fasciitis, stretches will target these areas. Stretches should target the gastrocnemius and the soleus (muscles in the calf). Some people use wedges or moon-shaped devices to stretch their calves, while others do the stretches using no equipment. There are also stretches for the muscles in the feet and for the plantar fascia. Night splints are also available to stretch the calves; these use a strap between the toes and the top of the shin to gently pull back on the toes while you sleep at night, and have been proven successful in scientific studies for treating plantar fasciitis. Exercises that strengthen the muscles in the feet can also be helpful with plantar fasciitis.

  Physical therapists may also use ultrasound therapy or galvanic therapy. Ultrasound therapy uses sound waves to produce heat and relax the muscles of the foot, and galvanic therapy uses gentle muscle stimulation to relax the muscles and relieve spasm. These methods are usually most effective when used twice a week. Between 80 to 90 percent of plantar fasciitis sufferers will get relief within 6 months using these conservative methods (Weil, DeHeer, Offutt, Trent, Baker, 2003).

  For patients whose pain does not respond after 6 months or more of traditional physical therapy, extracorporeal shock wave therapy (ESWT) is sometimes used. This therapy was originally developed to break up kidney stones, and it uses sound waves to break up scar tissue and calcifications within the plantar fascia. It is used as a noninvasive alternative to surgery (Weil, DeHeer, Offutt, Trent, Baker, 2003).

Prevention/Solution

• Runners may need to change their shoes. Pay attention to any activities that lead to heel pain either during the activity, just after or the next day. A workout journal can help determine any activities that cause heel pain. Cross-training for runners is also a good idea, along with regular stretching of muscles in the backs of the legs.

Warning

• Any stretches must be done regularly and gently. Stretches are only effective when done regularly, and stretches that are too vigorous can irritate the tissues and make plantar fasciitis worse. Stretches should be comfortable, not painful.