Plantar Fasciitis (Heel Spur Syndrome)

with Rehab

The plantar fascia is a fibrous, ligament-like, soft-tissue structure that spans the bottom of the foot. Plantar fasciitis is a condition that causes pain in the foot due to inflammation of the tissue.

SYMPTOMS

  • Pain and tenderness on the underneath side of the foot.

  • Pain that worsens with standing or walking.

CAUSES

Plantar fasciitis is caused by irritation and injury to the plantar fascia on the underneath side of the foot. Common mechanisms of injury include:

  • Direct trauma to bottom of the foot.

  • Damage to a small nerve that runs under the foot where the main fascia attaches to the heel bone.

  • Stress placed on the plantar fascia due to bone spurs.

RISK INCREASES WITH:

  • Activities that place stress on the plantar fascia (running, jumping, pivoting, or cutting).

  • Poor strength and flexibility.

  • Improperly fitted shoes.

  • Tight calf muscles.

  • Flat feet.

  • Failure to warm-up properly before activity.

  • Obesity.

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow for adequate recovery between workouts.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Maintain a health body weight.

  • Avoid stress on the plantar fascia.

  • Wear properly fitted shoes, including arch supports for individuals who have flat feet.

PROGNOSIS

If treated properly, then the symptoms of plantar fasciitis usually resolve without surgery. However, occasionally surgery is necessary.

RELATED COMPLICATIONS

  • Recurrent symptoms that may result in a chronic condition.

  • Problems of the lower back that are caused by compensating for the injury, such as limping.

  • Pain or weakness of the foot during push-off following surgery.

  • Chronic inflammation, scarring, and partial or complete fascia tear, occurring more often from repeated injections.

TREATMENT

Treatment initially involves the use of ice and medication to help reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity, especially stretches of the Achilles tendon. These exercises may be performed at home or with a therapist. Your caregiver may recommend that you use heel cups of arch supports to help reduce stress on the plantar fascia. Occasionally, corticosteroid injections are given to reduce inflammation. If symptoms persist for greater than 6 months despite non-surgical (conservative), then surgery may be recommended.

MEDICATION

  • If pain medication is necessary, then nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication within 7 days before surgery.

  • Prescription pain relievers may be given if deemed necessary by your caregiver. Use only as directed and only as much as you need.

  • Corticosteroid injections may be given by your caregiver. These injections should be reserved for the most serious cases, because they may only be given a certain number of times.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or massage the area with a piece of ice (ice massage).

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or soak the injury in warm water.

SEEK IMMEDIATE MEDICAL CARE IF:

  • Treatment seems to offer no benefit, or the condition worsens.

  • Any medications produce adverse side effects.

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Plantar Fasciitis (Heel Spur Syndrome)

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

RANGE OF MOTION - Toe Extension, Flexion

  • Sit with your right / left leg crossed over your opposite knee.

  • Grasp your toes and gently pull them back toward the top of your foot. You should feel a stretch on the bottom of your toes and/or foot.

  • Hold this stretch for __________ seconds.

  • Now, gently pull your toes toward the bottom of your foot. You should feel a stretch on the top of your toes and or foot.

  • Hold this stretch for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

RANGE OF MOTION - Ankle Dorsiflexion, Active Assisted

  • Remove shoes and sit on a chair that is preferably not on a carpeted surface.

  • Place right / left foot under knee. Extend your opposite leg for support.

  • Keeping your heel down, slide your right / left foot back toward the chair until you feel a stretch at your ankle or calf. If you do not feel a stretch, slide your bottom forward to the edge of the chair, while still keeping your heel down.

  • Hold this stretch for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH – Gastroc, Standing

  • Place hands on wall.

  • Extend right / left leg, keeping the front knee somewhat bent.

  • Slightly point your toes inward on your back foot.

  • Keeping your right / left heel on the floor and your knee straight, shift your weight toward the wall, not allowing your back to arch.

  • You should feel a gentle stretch in the right / left calf. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH – Soleus, Standing

  • Place hands on wall.

  • Extend right / left leg, keeping the other knee somewhat bent.

  • Slightly point your toes inward on your back foot.

  • Keep your right / left heel on the floor, bend your back knee, and slightly shift your weight over the back leg so that you feel a gentle stretch deep in your back calf.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRETCH – Gastrocsoleus, Standing

Note: This exercise can place a lot of stress on your foot and ankle. Please complete this exercise only if specifically instructed by your caregiver.

  • Place the ball of your right / left foot on a step, keeping your other foot firmly on the same step.

  • Hold on to the wall or a rail for balance.

  • Slowly lift your other foot, allowing your body weight to press your heel down over the edge of the step.

  • You should feel a stretch in your right / left calf.

  • Hold this position for __________ seconds.

  • Repeat this exercise with a slight bend in your right / left knee.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Plantar Fasciitis (Heel Spur Syndrome)

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress the resistance and repetitions only as guided.

STRENGTH - Towel Curls

  • Sit in a chair positioned on a non-carpeted surface.

  • Place your foot on a towel, keeping your heel on the floor.

  • Pull the towel toward your heel by only curling your toes. Keep your heel on the floor.

  • If instructed by your physician, physical therapist or athletic trainer, add ____________________ at the end of the towel.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Ankle Inversion

  • Secure one end of a rubber exercise band/tubing to a fixed object (table, pole). Loop the other end around your foot just before your toes.

  • Place your fists between your knees. This will focus your strengthening at your ankle.

  • Slowly, pull your big toe up and in, making sure the band/tubing is positioned to resist the entire motion.

  • Hold this position for __________ seconds.

  • Have your muscles resist the band/tubing as it slowly pulls your foot back to the starting position.

Repeat __________ times. Complete this exercises __________ times per day.