Plantar Fasciitis and Heel Pain

Plantar Fasciitis (PF) means inflammation of the plantar fascia, a thick band of connective tissue that spans the arch of the foot from the calcaneous (heel bone) to the bases of the toes. The function of this tissue is to support the arch and stabilize the foot as the heel comes off the ground during push off. Individuals with true “plantar fasciitis” have pain and tenderness along the entire longitudinal arch and the discomfort is worse at push off.

Heel Pain may be associated with plantar fasciitis but is more frequently seen in isolation. Patients with pain and tenderness localized to just the center or inner aspect of the heel and pain on heel strike are described as having “Heel Pain Syndrome (HPS)”. Although in many instances HPS is likely due to inflammation of the plantar fascia at its attachment to the calcaneus (heel bone), it may also be due to a number of other pain processes. These other possibilities include nerve entrapment, stress fracture, bone inflammation, and bursitis.

An X-ray of the heel is usually taken (If a previous film is not available), to rule in or out the possibility of a bone problem causing the pain. Although a heel spur may be identified on this X-ray, it remains unclear whether this spur contributes to the pain or not. The facts that many people with this type of spur have no pain and that removing the spur often does not relieve the pain in patients with HPS casts doubt on its role as a cause of the discomfort.

Because surgery for HPS and plantar fasciitis has inconsistent results, alters normal foot mechanics, and a significant risk of secondary foot pain, non-operative treatment is recommended. Surgery is considered only as a last resort. This hand out is a guide to the stretching exercises we have found most effective in treating HPS. Stretching decreases pain in more than 90% of our patients with heel pain.

We are offering an advanced, minimally invasive treatment – enabled by the Tenex Health TX™ technology – to treat chronic plantar fasciitis and achilles tendonosis disease lasting 3 months or more.

Pre-Stretching

Many people with HPS and PF have what is referred to as “start-up” pain. This means that when they first start to walk after lying in bed or sitting they experience moderate to severe discomfort with the first few steps. This phenomenon is caused by tension suddenly developing in the inflamed fascia as it is initially stretched with weight bearing and push-off. Pre-stretching the fascia before standing will reduce start-up pain.

Begin with pre-stretching exercises for two weeks. Gently add stretching exercises after this two week period, stretch more aggressively as symptoms allow.

Pre-stretch #1


Step #1

In the sitting position fully extend your knee (i.e. straight out) and place both hands on your knees.

Step #2

Point your toes towards your head, bending your foot upwards at the ankle. (Fig. 1) The more effort you put into this motion, the better the stretch. You may want to use a towel or belt to pull the foot towards you.

Step #3

Hold this position for 5 seconds. Repeat exercise 10 times.

Pre-stretch #2

Step #1

Place the ball of your foot on the edge of a stool while seated with knee flexed. (Fig. 2)

Step #2

Exert downward pressure on the knee with your hands. Hold this position for 5 seconds. Repeat exercise 10 times.

Stretching

The following program is designed to stretch the plantar fascia. These stretches should be done at least 3 times per day.


Stretch #1

Step #1

Roll a towel tightly so that its diameter is 1 to 1-1/2 inches.

Step #2

With your toes of the leg to be stretched approximately 1-1/2 feet away from a table or a wall, place the towel under your toes but allow the ball of your foot to rest on the floor. (Fig. 3)

Step #3

Place your opposite leg straight back for balance.

Step #4

Keeping your heel on the floor, force your knee towards the wall, as illustrated (Fig. 3). DO NOT BOUNCE. Hold this position for 5 seconds. Now perform the stretch keeping the knee straight. Hold this position for 5 seconds. Repeat these stretches 10 times each.

Note: Minimum time for each stretch should be 5 seconds. Total stretching time of 2 or 3 minutes should suffice.

 

Stretch #2

Step #1

Position yourself with the ball of your foot on the edge of a stairstep. (Fig. 4)

Step #2

Holding the rails for balance, allow your heels to sink downward. You should be relaxed and no active muscle contraction in your legs should be necessary. Do not bounce.

Step #3

Hold this position for 5 seconds. Repeat this exercise 10 times.
Note: If this stretch makes your heel pain worse, wait a few weeks, then try it again.