Have you ever had severe heel pain or painful arches? Have you ever had trouble putting your weight through your foot first thing in the morning? More than likely you or someone you know has experienced plantar fascitis. Plantar fascitis means pain or inflammation on the bottom of the foot. The plantar fascia is the band of tissue that connects your toes to your heel. Consequently, when this area is strained, weakness, swelling or inflammation occurs which then presents as heel or arch pain. For most people, the worst time of day is taking those first few steps out of bed in the morning or after sitting for a prolonged period of time. Prolonged standing or climbing stairs can also produce pain in the foot or arch. What causes heel or arch pain to happen? There are several things that can strain this tissue: "Poor shoes/footwear is one example. Yes, those cute flip flops that have absolutely no arch support can cause a lot of pain. Maybe your running shoes are worn out. It is recommended that you get a new pair every six months if you run regularly. Maybe you have a pair of shoes that just don't fit you very well. "High arches/ flat feet or a rigid forefoot are also factors that could lead to plantar fascitis. Again, good footwear is essential. "Being over weight causes undue stress through the arch of your foot. It is your basis for support. "Poor hip alignment can lead to poor knee alignment which can cause you to improperly distribute your weight through your foot. You know the old saying, "The leg bone is connected to the knee bone. The knee bone is connected to the ankle bone, etc." So, realigning your hips or pelvis can change the stress through the rest of your leg. Fascial tightening in the body can also cause the body to not be aligned properly and thus cause undue pressure/stress through the leg and foot. At Hands on Physical Therapy, our manual therapy, whole body approach, stresses finding the cause for your symptoms. Address the problemâ€..decreases the strain for a better long term effect. Now that we have established what can cause this pain, what can be done about it? A proper evaluation will target the areas causing undo stress and plantar fascitis symptoms. In addition to correction of muscular imbalances, the standard home treatment is ice, anti-inflammatories (Advil/Motrin, Aleve), custom arch supports or new shoes with good arch supports and stretching. Sometimes a night boot is recommended that will keep the foot in a flexed or stretched position throughout the night. Other times the foot can be taped to help support the strained fascia. Some specific stretches that are helpful to follow: "Gastrocnemius/soleus (calf muscle) stretches - Loop a towel or belt around the ball of your foot and gently pull towards you. When you first feel a stretch, stop and hold it for at least 90 seconds. This can be done in sitting or lying down. Try it with your knee straight and then with it bent. You can also stand in front of a wall and put one foot in front of you and one behind you. Bend the front leg and lean into the wall while keeping the heel of the back leg on the floor. You should feel a mild stretch in your calf. Then, slightly bend the back knee. "Forefoot/arch stretches - sit or stand with a tennis ball or golf ball under the arch of your foot. Push foot slowly into ball until mild stretch is felt. Hold 90 seconds. "Anterior tibialis stretch - sit in a chair and put your foot under your chair with your toes/toenails against the floor. Hold 90 seconds. "Other stretches which are not as direct but are often related to this problem are as follows: "Psoas release- lye on your stomach on the floor and place the 4" yellow ball between the belly button and the hip bone. Hold for 90 seconds. Do both sides. "Quad release- lye on your stomach on the floor. Place either the 4" yellow ball or a tennis ball under your thigh. Hold for 90 seconds. Hamstring release - sit with your legs out in front of you. Place the ball under your hamstring (back part of your upper leg). Hold for 90 seconds. In addition to the above stretches, walking in water and cushioned surfaces such as a running track will decrease the stress through the arch of your foot. Overall general health is the best way to prevent pain. Drink plenty of water. That means approximately 64 oz. a day. If you are outside a lot during the day, you will need to drink more. Also, eat a well balanced diet. Raw fruits and vegetables are essential to good health. Finally, exercise/stretch every day. Even if you only have time for a few minutes, they count. Put yourself and your health first. You will feel better and you will set a great example for others. Don't hesitate to ask any therapist at Hands on Physical Therapy if you have specific questions or concerns about plantar fascitis. The staff at HOPT is here to help you better understand the nature of your injury and what you can do to eliminate your pain. Danica Sims, PT
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