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Written by Michael Lukowsky, Certified Pedorthist Mike Lukowsky
Plantar fasciitis (pronounced PLAN-tar fashee-EYE-tiss) heel pain is the most common foot problem and one of the hardest to overcome. The plantar fascia is a thick fibrous band of tissues that attaches to the heel bone (calcaneus’s) and spans across the bottom of the foot and arch and attaches to the back of the toes. It acts like a bowstring to maintain the arch of the foot and it is the body’s main shock absorber.
Contributing factors
Flat (pronated) feet
High arched rigid feet
Poor shoe support
Short shoes
Walking/running uphill
Soft terrain (sand)
Increasing age
Sudden weight increase
Tight calf muscles

When the calves are tight, the Achilles tendon pulls the heel bone up, thus pulling the fascia tight (above Left). When the calf muscles are stretched the less pull on the heel bone, thus less pull on the fascia (above Right).

The Injury
The fascia endures tension that is at least 2 times the body weight during walking at the moment when the heel of the trailing leg begins to lift off the ground. This moment of maximum tension is increased and “sharpened” (it increases suddenly) if there is lack of flexibility in the calf muscles. The problem starts when the fascia is overused, and micro tears within the fascia become inflamed, usually at the insertion at the heel, resulting in pain. The fascia may tear at the midsole and near the toes as well. Plantar fasciitis is an ongoing injury process, since it is difficult to rest the foot, it gradually becomes worse. When sleeping or at rest, the fascia is shortened and tight, as well as the calf muscles. Thus upon rising, a painful re-injury occurs. Heel spurs are the body s way of helping the fascia to re-attach to the heel. The heel bone calcifies toward the torn tissue to help it heal. Heel spurs do not cause the initial pain, nor do they cause the problem, they are a result of the problem. Spurs do not hurt unless they are very large, fractured, or if there is fat pad atrophy. The medical code (ICD-9) for plantar fasciities is 728.71.
What to expect
For most patients, the time period for complete resolution of plantar fascia pain is equal to the time period from when the pain started until the treatment begins. However, most people find significant relief, usually 70% to 80%, 4 to 6 weeks after treatment starts. For example if the pain stated 6 months ago and treatment just began, it may take 6 months for the pain to disappear totally but significant relief will come in 4 to six weeks.
Medication: Most physicians will prescribe an anti-inflammatory to relieve pain. Over the counter drugs such as Ibuprofen, Alieve, and Motrin could be used.
Do not go barefoot while having plantar fasciitis symptoms. If you walk of run for exercise do not walk or run uphills. Keep your treadmill flat, no incline.
Rest: Listen to your body. If the pain is so bad you may have to stay off your feet for a period of time.

Stretching: It is absolutely necessary to do the stretches at least 2 times a day to find relief from plantar fasciitis. Stretching the calf muscles without re-injuring the fascia twice a day and especially before getting out of bed in the morning is very helpful for plantar fasciitis. Take a towel and toss it across the ball of your foot and pull gently to stretch your calves before getting out of bed. Step directly into a supportive sandal or a pair of shoes with your orthotic upon rising. Do not get out of bed barefoot.

1. 2.

Calf Stretches

1. With your toes pointed straight foward lean against a wall and bend the knee of the unaffected foot. Keep that foot forward. While keeping your heels on the ground and the back knee straight, lean forward toward the wall. You will feel a mild pull in your calf area but NO pain. Hold for 10-15 seconds and relax. Repeat 10 times.

2. With shoes on, place the balls of your feet on the edge of a stair, curb, phonebook, or ideally an incline board. Keep both legs straight and allow the heels to lower toward the ground. This is a prolonged stretch. Hold this position for 1 minute and gradually increase to 5 minutes. Once again, you should feel a mild pull but no pain.

The incline board is available at Office Max or other office supply stores.

Orthotics: For most people an orthotic device is necessary to maintain the long arch to keep the plantar fascia as short as possible and prevent further injury. An over the counter orthotic device may be tried for 6 to 8 weeks, but if no relief is found, a custom orthoses is required. A prescription is needed from a physician to produce custom foot orthotics. The insurance code for custom foot orthotics is L3020. Orthotics are sometimes misspelled ortodics. Still others call the orthotics foot plates or inserts.

Shoes: According to a survey of 356 people done by the International Orthopaedic Foot and Ankle Society 90% of the US population unknowingly wear their shoes at least one size too small. And 80% of those had chronic foot problems. The fascia attaches to the backsides of the toe bones and short shoes cause the toes to contract, which pulls fascia tighter and causes micro tears while walking. Your shoes need at least 3/8″ to 1/2″ from the end of the shoe to the longest toe while standing to allow your foot to spread out when walking. Make sure your shoes are in good shape and replace them as needed. Weak unsupportive shoes could be part of the initial problem or part of the continuation of the problem. Click here to learn about proper shoe fit.

Keep a pair of supportive shoes or sandals that are easy to get on (like NAOT, Birkenstock, Klogs, and Haflinger) and keep them next to your bed. Put them on before standing up. This will hold your arch up and lessen the chance of injury upon rising. Do not go barefoot while having heel pain. Cklick here for more shoe information.
Ice: Icing the area for 30 to 60 minutes is very helpful to reduce the inflammation. It is also important to ice the area 15 minutes after activity.
Night Splints: In chronic cases, a dorsiflexion night splint is used. This is a brace that holds the front of your foot pointed slightly toward your knee and keeps your calf muscles stretched while sleeping. This prevents re-injury upon rising. The insurance code for a plantar fascia night splint is HCFA code L4396.
Shockwave Therapy: When the condition does not respond to conserative treatments, patients may opt for shockwave therapy, in which sound waves are directed at the area of heel pain to tear the facsia worse to stimulate healing. Shock wave therapy is painful, expensive, requires multiple treatments and is not always effective. Complications may include bruising, swelling. pain, numbness, burning and rupture of the plantar fascia.
Surgery: Surgery is rarely required for plantar fasciitis. It would only be considered if all other treatments fail and could lead to other foot pathologies.

Other helpful tips: Toe Curls: Place a towel on the ground and using your toes, grab the towel and pull it toward you. Resistance can be increased with a weight at the end of the towel. Rub your arch and heel back and forth across over a frozen bottle of water. Deep massage and ultra sound can also be helpful. For other toe exercises click here.

Sole Control footwear and orthotics for plantar fasciitis (heel pain) releif in St. Louis.

9712 Watson Road

St. Louis, MO 63126