The plantar fascia, which supports the arch of the foot and connects the heel bone to the toes, is the ligament that becomes irritated and inflamed in plantar fasciitis. This condition, pronounced fash-she-EYE-tis, is the leading cause of heel pain, impacting over 2 million individuals annually.
At the University of Michigan, we have discovered that a majority of individuals suffering from plantar fasciitis can improve without surgery by following a specialized stretching program designed specifically for the plantar fascia. In fact, 90 percent of our patients successfully alleviate their plantar fasciitis symptoms within 10 months of commencing treatment, indicating that surgery is not necessary for most cases.
Our team of foot and ankle orthopaedic experts, podiatry experts, and physical therapists work together to provide a thorough diagnosis and develop a customized treatment plan for you.
Who’s at Risk for Plantar Fasciitis?
Some factors that could increase your risk of developing plantar fasciitis include:
- A tight Achilles tendon or calf muscle
- A high-arched or low-arched foot
- Working on hard surfaces
- Running for exercise
Plantar Fasciitis Symptoms
- Plantar heel pain that is worse with the first few steps out of bed in the morning or after periods of inactivity.
- Pain tends to initially improve with activity or after you get “warmed up.”
- Pain may worsen with higher-impact activity, such as running.
Diagnosing Plantar Fasciitis
When you come to the office, take the following steps:
- We will take a complete health history, conduct a thorough physical examination to determine the exact origin of pain, and find out if there are other mechanical factors that may be contributing to your discomfort, such as a tight calf muscle.
- We will also take X-rays of your foot to evaluate your bone anatomy and rule out any other bony cause for your pain, such as a stress fracture.
- In most cases, further imaging, such as an MRI, is not required, but we will determine this during your visit.
Plantar Fasciitis Treatment
When developing your personalized treatment plan, various factors are taken into consideration, such as your prior treatment, your current level of discomfort, and any additional medical conditions you may have.
We are pleased to announce that within 10 months of commencing treatment, 90 percent of our patients recover without the need for surgery.
There are several treatment options available for plantar fasciitis.
- A stretching program – Specifically targeting the Achilles tendon and plantar fascia, the exercises are performed 3-6 times per day, depending on your individualized treatment plan. Continuation of the stretching program even after symptoms resolve is crucial to preventing reoccurrence.
- A soft, cushioning orthotic – A variety of orthotics, such as a heel pad, can help reduce pain. Custom orthotics are generally not required.
- A night splint – Wearing a night splint will keep the plantar fascia stretched while you sleep.
- Ice and anti-inflammatory medications – These may be given as needed to decrease symptoms.
- Physical therapy – Our Physical Therapy Division uses a team approach with specialized board-certified therapists along with the most advanced techniques for the best outcomes.
- Cortisone injections – Cortisone injected into the heel can reduce pain and swelling during a flare up.
- Surgical intervention – This is a last resort if all other treatments have failed. Your University of Michigan surgeon will inform you of the pros and cons of plantar fasciitis surgery, and will let you know why surgery is the best option.
Stretching and Strengthening
Wall stretches and curb or stair stretches are frequently used stretching techniques that are particularly important in increasing flexibility of the calf muscles. These stretching techniques are part of stretching and strengthening programs that play a crucial role in treating plantar fasciitis and addressing functional risk factors like tightness in the gastrocsoleus complex and weakness in the intrinsic foot muscles.
Additional effective techniques for stretching the calf include using a slant board or positioning a piece of wood measuring two inches by four inches in areas where the patient spends a significant amount of time standing (e.g., workplaces, kitchen or near stoves). Dynamic stretches, such as rolling the foot arch over a 15-ounce can or a tennis ball, can also be beneficial. Before getting out of bed, cross-friction massage above the plantar fascia and stretching with a towel can help to elongate the plantar fascia.
One study found that 83 percent of patients who participated in stretching programs achieved successful treatment. Additionally, 29 percent of the patients cited stretching as the most effective treatment, surpassing alternative methods such as orthotics, NSAIDs, ice, steroid injection, heat, heel cups, night splints, walking, plantar strapping, and shoe changes.
The focus of strengthening programs should be on the intrinsic muscles of the foot. Towel curls and toe taps are exercises that can be used. Picking up marbles and coins with the toes is also a useful exercise. For a towel curl, the patient starts by sitting with the foot flat on a smooth surface at the end of a towel. While keeping the heel on the floor, the towel is curled towards the body using the toes. Toe taps involve lifting all the toes off the floor and repeatedly tapping the big toe to the floor while keeping the heel on the floor and the other four toes in the air. The process is then reversed, with the outside four toes repeatedly tapped to the floor while the big toe is raised in the air.
In another study, 34.9 percent of the participants reported that strengthening programs were the most effective treatment, as opposed to exercise, night splints, orthotics, heel cups, NSAIDs, steroid injection, or surgery.
SHOES
In some patients, it may be beneficial to change to properly fitting and appropriate shoes. Foot pain can be worsened by wearing shoes that are too small. Many patients have found that wearing shoes with thicker, well-cushioned midsoles made of a material like high-density ethylene vinyl acetate, commonly found in running shoes, can help reduce pain associated with prolonged walking or standing. Research has shown that running shoes lose a significant portion of their shock absorption as they age. Therefore, obtaining a new pair of shoes may be a simple and helpful solution to alleviate pain.
Individuals with flat feet may experience relief from pain during long periods of walking or standing by wearing motion control shoes or shoes with improved support for the arches. Motion control shoes typically possess certain characteristics, including a straight last, board or combination lasted construction, an external heel counter, a wider flare, and additional medial support. As a treatment that yielded favorable results, 14 percent of patients with plantar fasciitis mentioned switching shoes.
