LAURA N. SCIARONI MD

Fellow of the American Academy of Orthopedic Surgery
Member of the San Francisco Multispecialty Medical Group,
Part of the IPM Medical Group family
Board Certified, Fellowship Trained in Sports Medicine

Plantar Fasciitis

Plantar fasciitis is the most common cause of heel pain.  The pain is on the bottom of the heel and is often described as feeling like stepping on a rock.  It’s common in runners but happens in many people who don’t run as well.   Typically, it is most painful in the morning when you first put your foot on the floor.  The plantar fascia is a tough band of connective tissue that supports the bottom of your arch.  When it becomes partially torn or inflamed through repetitive use, this is called plantar fasciitis.  The reason it hurts most first thing in the morning is that while you are sleeping your feet are relaxed and the plantar fascia shortens a bit.  The tissue is always trying to heal and when you first get up, you are stretching that healing tissue.

 

How to get rid of plantar fasciitis?   Of course staying entirely off your feet isn’t practical, and some activity is important for healing, but avoid things that inflame it greatly – such as running or jumping.  Anti-inflammatory medications like ibuprofen or naproxen can help relieve pain, but won’t impact healing time.  Icing can help.  Freeze a plastic water bottle and put it on the floor, then roll it back and forth with your foot.  This gives a good ice massage. A stretching and strengthening program along with supportive shoe wear is key.  Wear shoes with good arch supports.  Do not go barefoot.  Stretch your achilles tendon AND the bottom of your foot 4 times a day.  Hold each stretch for 30 seconds.  A shortened achilles tendon puts more stress on the plantar fascia.  Strengthen the small muscles of your foot with a towel scrunch exercise: put a towel on the floor and put your feet on it.  Scrunch it with your toes to pull it toward you, repeat.

 

Another thing that can be helpful is a night splint.  Night splints hold your ankle in a neutral position so the plantar fascia is in the same position as when you are standing, and prevents the night time shortening that usually occurs.  This puts you a bit ahead of the game first thing in the morning and is very helpful for cases that are not resolving with the other measures described above.  You can find a lot of different kinds of night splints for plantar fasciitis on Amazon and other online sites.  Many of them are hard to sleep in, but this style works pretty well.

 

Plantar fasciitis almost always gets better with this approach but if it does not, cortisone injection is sometimes used to relieve pain.  Short of surgery, another option is PRP injection, which can result in complete healing in many cases.  See my  blog post that includes PRP for details.

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