Physical Therapy Can Relieve Heel Pain From Plantar Fasciitis
Steven Kavros, D.P.M.

DEAR MAYO CLINIC:

Are there any tried-and-true treatments for plantar fasciitis?

ANSWER:

Plantar fasciitis is a common foot problem that involves tiny tears in the thick band of tissue (plantar fascia) that connects the heel bone to the toes. Although there's no one-size-fits-all approach, the heel pain that results from plantar fasciitis usually can be successfully treated with physical therapy and special equipment that gives the foot extra support.

The purpose of the plantar fascia is to support the arch of the foot and to act as a shock absorber when you're walking, running, jumping, or otherwise using your feet. If the strain on the plantar fascia becomes too great, small tears can develop in the tissue. Those tears can lead to inflammation and pain.

Plantar fasciitis has many possible causes. Certain types of exercise that put a lot of stress on the feet can lead to this disorder. For example, it's often seen in long-distance runners or ballet dancers. Excess weight can be a factor, particularly in overweight people who've been sedentary and then begin an exercise program.

Shoes can be part of the problem, too. Loose, thin-soled shoes, and shoes without enough arch support or flexible padding to absorb shock can increase strain on the plantar fascia. Regularly wearing shoes with high heels can also cause strain on the tissue around the heel and lead to plantar fasciitis.

To effectively treat plantar fasciitis, the extra stress on the plantar fascia must be relieved so the tears can heel. That can be accomplished in several ways. First, and probably most important, is to meet with a physical therapist who can show you a series of exercises to stretch the plantar fascia and strengthen your lower leg muscles, which stabilize your ankle and heel. Doing these stretching exercises regularly and consistently is critical to successful long-term treatment of plantar fasciitis.

Second, a variety of equipment is available that can help provide extra support the foot needs as it heals. In some cases, wearing athletic tape to support the bottom of your foot during the day may be useful. At night while sleeping, you may need to wear a splint that stretches your calf and the arch of your foot. Regularly using arch supports that fit into your shoes or wearing shoes with built-in extra support may also be helpful.

Although it may take several months or more, in many cases these approaches are enough to relieve the symptoms of plantar fasciitis. Depending upon what caused your plantar fasciitis, you may need to continue wearing arch supports or special footwear long term to help ensure that the condition doesn't return.

A cortisone injection may also be considered in chronic or acute cases with associated bursitis. An ultrasound guided technique can be considered to ensure accurate placement of the medicine in the area of the tear.

Rarely, in severe cases of plantar fasciitis or in chronic cases that aren't helped with more conservative treatment, surgery may be an option. One procedure involves detaching the plantar fascia from the heel bone. But surgery is typically only used when the pain is severe and all other treatments have failed. Extracorporeal shock wave therapy, which uses sound waves directed at the area of heel pain to stimulate healing, may also be used to treat chronic plantar fasciitis. But research clinical trials have not found this procedure to be consistently effective.

Once plantar fasciitis has been effectively treated, follow a few self-care tips to help keep it from coming back. Consistently wear shoes that have good arch supports. Avoid high heels and don't go barefoot, especially on hard surfaces. Replace athletic shoes regularly; don't wait until they lose their foot support and cushioning. Finally, maintain a healthy weight. All of these steps will minimize the stress and strain on your plantar fascia and help keep it healthy. -- Steven Kavros, D.P.M., Podiatric Medicine, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minn.

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