Plantar Fascia pain
What is it?
The plantar fascia is a strong fan-like band of connective tissue that runs from the ball of your foot and attaches to the heel bone. Its main purpose is to support the arch of your foot when it is placed under load.
Plantar fascia pain is a common condition (sometimes known as Policeman’s Heel or plantar fasciitis), whereby this fascia gets irritated and pain is often felt under the heel and sometimes along the arch of the foot.
The picture is a right foot and ankle:
- Retinaculum (soft tissue band on the inside)
2. Abductor halluces (one of the muscles that move the big toe)
3. Plantar fascia (band of connective tissue on the sole of the foot)
What are the common symptoms?
You will often feel pain when you first start to walk after sleeping or prolonged rest, which eases to a manageable ache as you get moving.
People often describe that the pain feels better during exercise but returns after resting. It can sometimes be painful to raise your toes off the floor.
What causes plantar fascia pain?
It often occurs after extended periods of walking on hard surfaces or in different shoes (flip flops for example).
A gradual build up to new activities is recommended.
There is sometimes no apparent reason as to why you have developed plantar fasciitis however some other possible causes include:
- being overweight
- loss of range of movement in the ankle – this can be either due to joint stiffness or tight calf muscles
- very high foot arches or the opposite – flat feet. Both of these can put strain on the plantar fascia
- poorly fitting shoes
- often diabetics get this condition
- Bony spurs commonly seen on x-rays are NOT a common cause of plantar fascia pain. You do not need a x-ray to diagnose plantar fascia pain
How to manage it
The average plantar heel pain episode lasts longer than 6 months and it affects up to 10-15% of the population. However, approximately 90% of cases are treated successfully with conservative care.
Although it can be very painful there are a number of things you can do to help the symptoms.
Footwear
Try to avoid walking barefoot on hard surfaces. Wearing supportive shoes with a cushioned heel is advisable. Some people find ‘soft spot’ heel inserts help in the acute phase, giving local cushioning to the heel.
See the footwear section for further advice.
Morning Routine
Some people find warming the sole of your foot first thing in the morning helps to get you started (e.g. rub the sole of your foot or rest it on a heat pack/ wheat bag/ warm water from the shower).
Stretch the sole of your foot before standing, after sitting or lying down. Firmly hold all the toes and bend them back until you feel a stretch in the arch of your foot.
Don’t go barefoot for the first hour of the day and gently stretch your calf once you are up and moving around.
Exercises
Many people find simple exercises for the calf and foot very helpful in helping plantar fascia pain.
Plantar fascia Stretch in Sitting
Sit with your lower leg on the other knee.
With your ankle bent, hold your heel with one hand and, using your other hand, pull your toes back towards your shin.
Hold for 15-20 seconds repeat 3 times
Stretching exercises
Reducing the tightness in your calf muscles can help the management of plantar fascia pain. Stretches for your calf muscles can be found below.
Stand in a walking position with the leg to be stretched straight behind you and the other leg bent in front of you. Take support from a wall or chair.
Lean your body forwards and down until you feel the stretching in the calf of the straight leg.
Hold approx. 30 secs. relax. Stretch the other leg. Repeat 3 times.
Stand in a walking position with the leg to be stretched behind you. Hold on to a support.
Bend the leg to be stretched and let the weight of your body stretch your calf without lifting the heel off the floor.
Hold approx. 30 secs. – relax. Repeat 3 times.
Click ‘Exercises to stretch tight Gastrocnemius muscles’ and ‘Stretches for tight Soleus muscles’ for a video of the exercises
Sitting or standing rest the arch of your foot on a round object, such as a tin of beans or a tennis ball. Roll the arch in all directions for a few minutes.
Repeat this exercise at least twice a day.
Strengthening exercises
Strengthening of the muscles around ankle has been found help plantar fascia pain. Try some heel raises, as shown below, as your pain allows. Start with a small number and gradually build up.
Heel and toe tapping 3 minutes 3 times / day 20 second hold three times 3 minutes 3 times / day.
Stand tall, with your weight distributed evenly on both feet, and take support if needed.
Rise up onto your toes and in a controlled manner return to the starting position.
Repeat 10 times x 3
Doing all these exercises regularly can help you recover more quickly – remember it may take some months for this condition to settle down.
Keep up your fitness levels by switching to lower impact activity such as swimming or cycling.
Weight loss
Losing weight will reduce the amount of pressure through your foot, improving your symptoms and reducing of the chances of recurrence.
Massage
As seen in the exercise above, massaging the plantar fascia can help relieve some of the discomfort. You can use a tennis ball or even better, a firm spikey massage ball to massage under your foot, rolling it along the arch to your heel.
Ice Therapy
Using ice on the sole of your foot can help to ease the pain, especially towards the end of the day. Use a damp cloth containing an icepack (or bag of frozen peas) over the painful area to help numb the pain. Leave it on for 10-15 minutes.
You may also roll your foot over a frozen bottle of water in a similar way to the golf ball massage above
When using ice therapy as a treatment:
- You should be cautious using these treatments if you have altered skin sensation or circulatory problems.
- Check the skin regularly
- Stop if there is excessive pain, numbness or tingling
- Do not put ice directly on to the skin as this may cause a burn.
Medication
Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.
Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Topical (applied directly on the affected body area) anti-inflammatories are recommended initially. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions
However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.
Up to date guidelines can be found on the NHS website:
Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.
Physiotherapy
If you find that you are not improving, some advice or treatment from a physiotherapist can be helpful in managing plantar fascia pain. Click here to self-refer to a physiotherapist.
How to prevent and manage future flare ups
As with all MSK conditions it is important to keep active. Keeping in a routine of activity will help. If you are starting something new, then is it advisable to gradually build up the activity.
Footwear is nearly always a factor in influencing plantar fascia pain. Old worn out shoes or trainers may not give your foot the support it needs during your activity. If you are a runner, it is advisable to change your trainers after about 500 miles of use.
Remember to tie your shoelaces up properly to maximise the support around the arch. Avoid just slipping trainers on and off.
Occasionally an orthotics or insoles placed in your shoe can make a difference. Please discuss this with a health care professional to see which one is suitable for you.
