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Let's Get Physical ... Therapy! Ouch! Why Does My Foot Hurt?

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If you have any questions about muscles and bones, musculoskeletal issues you’ve had or would like to know more about, or anything under the sun related to physical therapy, send them to Ilka.Felsen@ucsf.edu.

By Ilka Felsen
Staff Writer

Are your first steps in the morning painful? Does your heel hurt?  If so, you may have plantar fasciitis, an inflammation of the plantar fascia on the underside of the foot.

You are not alone!  Plantar fasciitis is the most common foot pathology treated by health care providers, and 10 percent of Americans get plantar fasciitis over a lifetime.  There is no known cause of plantar fasciitis, but long days on your feet, high BMI (body mass index), decreased ankle dorsiflexion (raising the foot upwards), flat feet and rapid increases in activity contribute to this condition.

Plantar fasciitis occurs in both athletes and non-athletes, and is characterized by microscopic tears in the plantar fascia from too much strain over time. 

The plantar fascia is an important supporter of the bones and arch of the foot during weight bearing, and is basically a thick band of connective tissue that runs from the calcaneus (heel bone) to the metatarsals (long bones in the foot) and toes.  When you flex your toes upward, it tenses into a palpable band under your arch. 

How do I know if I have plantar fasciitis?

Most commonly, this painful condition presents with the following symptoms: heel pain or pain in the mid-portion of your arch; gradual onset of heel pain; heel pain with the first steps after waking or inactivity; or heel pain that worsens throughout the day.

Is there a treatment for plantar fasciitis?

Yes!  Eighty percent of individuals treated for plantar fasciitis are symptom-free within 12 months.  Treatment, however, is not always an easy, quick fix.    

Treatment options range from steroid injections, NSAIDs (non-steroidal anti-inflammatory drugs), iontophoresis (a modality in which dexamethasone is electrically driven into the skin), ankle joint mobilizations, taping, stretching and orthotics.

So what can I do?

Ice:  Icing can help slow the inflammatory process, and provide pain relief.  Freeze a water bottle, and roll your arch on the bottle for 20 minutes.  Repeat up to five times a day.  You can also roll your arch on a tennis ball to decrease adhesions in the plantar fascia.

Stretching:  Fibers of the plantar fascia are continuous with the gastrocnemius (calf muscle), and stretching your calves or plantar fascia may reduce pain.

  • Calf stretch:To stretch your upper calves, place just the soles of your feet on a stair and let your heels drop towards the floor.  To stretch your lower calves, bend your knees slightly in this position.  Hold both positions for 30 seconds each, and repeat three times.
  • Plantar fascia stretch:  Flex your foot upwards, grab your big toe and pull it towards you.  You should feel a stretch along the underside of your foot.  Hold for 30 seconds and repeat three times as well.  Stretch before you get out of bed in the morning or take your first steps.

Foot mechanics:  Look at your feet in the mirror when you stand, and have a friend watch you walk.  If your feet are rolling inward at all during standing and walking, your arches need some extra support.  Consider placing an arch support or cushion in your shoes, and note that running shoes should be replaced every six months to a year.

Exercise:  Warm up before exercise, and gradually increase your exercise intensity.  Runners are at risk when increasing their mileage too quickly, which doesn’t allow the plantar fascia to build fibers accordingly.  You can supplement your workouts with the following exercises:

Toe curls:  Place your foot on a towel and curl your toes.  This will strengthen the intrinsic muscles of your foot to support your arch.

Heel raises:  Stand next to a counter and raise your heels off the floor.  Do this 20 times on both feet, and 20 times on each foot.

Footwear:  Avoid those sandals!  Wear shoes with an arch support, so that your plantar fascia does not have to bear as much stress from holding up your body. 

Sleeping:  Make sure that your feet are not pointed downwards when you sleep.  Maintain your foot in a neutral position (foot oriented 90 degrees to your lower leg), with your toes pointed slightly upwards. To allow for this, keep your sheets and blankets loose at the end of your bed.

For more information:

See the following clinical practice guidelines:  “Heel Pain—Plantar Fasciitis,” published by the Journal of Orthopedic Sports Physical Therapy. (J Orthop Sports Phys Ther. 2008:38(4):A1-A18. doi:10.2519/jospt.2008.0302)

Ilka Felsen is a second-year physical therapy student and enjoys watching people walk, palpating joints and muscles and talking about physical therapy. 

 

 

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