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Plantar fasciitis, sometimes called a heel spur, is a condition that causes pain on the bottom of the heel when putting weight on the foot. There can be many underlying causes of heel pain, and sometimes finding the precise reason for the pain can be difficult. Even so, several options are available for treatment.
plantar fasciitis anatomy
The plantar fascia is a band of tissue, similar to a tendon, which runs from the front of the heel bone (calcaneus) to the ball of the foot. This dense strip of tissue helps to support the arch of the foot.
When the foot is on the ground the full weight of the body is concentrated on the plantar fascia. This force stretches the tissue as the arch of the foot tries to flatten from the weight of the body. This leads to stress on the plantar fascia where it attaches to the heel bone. Small tears of the fascia can happen. However, the body normally repairs these tears.
As this process of injury and repair repeats itself over and over again, a bone spur (a pointed outgrowth of the bone) sometimes forms as the body’s response to try to firmly attach the fascia to the heel bone.
Heel pain from plantar fasciitis can have several causes. In rare cases, the heel spur can be so big it causes pain. The chronic inflammation of the fascia itself may be the source of pain. As we age, the fat pad that makes up the fleshy portion of the heel becomes thinner and degenerates. This can lead to inadequate padding on the heel and chronic pain in this area. The small nerves that travel under the plantar fascia on their way to the forefoot can also become irritated and may contribute to the pain.
The symptoms of plantar fasciitis include pain in the centre of the heel when weight is placed on the foot. This is usually most pronounced in the morning when the foot is first placed on the floor.
Patients sometimes describe that they feel a “ripping” sensation under the heel, others describe the pain as if being “kicked” in the underside of the foot.
High impact activity such as running.
Trauma to the heel such as jumping from a height.
Increase in training levels.
Increased hill training.
Lack of shock absorbency in the trainers worn.
Worn running shoes.
plantar fasciitis treatment in the acute phase
Ice packs and compression bandages are excellent to reduce pain and swelling
to restore normal function
baked bean tin stretch
using a baked bean tin roll the foot backwards and forwards as in the diagram below
2 minutes in the morning before putting the foot to the floor
5-10 minutes every evening
Contrast foot baths
10 minutes warm water
10 minutes cool water morning and evening (morning may be missed if time is restricted).
(a) (b) (c)
Start with 10 stretches per day as in diagram (a) holding the stretch for 30 seconds, then relax and then repeat.
Continue this stretch daily until you can no longer feel it pulling on the heel, then progress to stretch in diagram (b). Do 10 per day holding for 30 seconds per stretch. When you can no longer feel it pulling on the heel proceed to stretches as in diagram (c). Do 10 per day holding for 30 seconds on every stretch.
1. Check your footwear
Are your running shoes worn and in need of replacing? If so change them. Plantar fasciitis can be caused by high impact forces so a good shock absorbing shoe is a must. For more advice on running trainers our running shoe advice page is worth reading. Read more->
Below are a selection of trainers that are ideal for athletes.
Trainers for a neutral or under pronating foot type
Trainers for over pronators
The way your foot strikes the ground and the forces that are placed on it can have a direct effect on causing plantar fasciitis and also delaying healing times. Check our biomechanics page for detailed information. Read more->
3. Improve shock absorbency
Plantar fasciitis is severely irritated by high impact forces. Purchasing some shock absorbing heel pads or insoles is a cheap and effective way of vastly improving shock adsorbents under the heel and foot.
4. Night splint
Consider a night splint. Excellent for improving symptoms and preventing the condition from returning.
Taping can help take the stress of the plantar fascia.
Plantar fasciitis prevention checklist summary
- Rectify Biomechanics if necessary
- Check Running shoes
- Improve shock absorbency
- Night splint
Returning to Activity
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your plantar fasciitis injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. How soon you return to your activity is determined by how soon your plantar fascia heals, not by how many days or weeks it has been since your injury occurred.
You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:
You have full range of motion in the injured leg compared to the uninjured leg.
You have full strength of the injured leg compared to the uninjured leg.
You can jog straight ahead without pain or limping.
You can sprint straight ahead without pain or limping.
You can do 45-degree cuts, first at half-speed, then at full-speed.
You can do 20-yard figures-of-eight, first at half-speed, then at full-speed.
You can do 90-degree cuts, first at half-speed, then at full-speed.
You can do 10-yard figures-of-eight, first at half-speed, then at full-speed.
You can jump on both legs without pain and you can jump on the injured leg without pain.