Plantar Fasciitis Treatment: The Complete Guide 2017
Last updated Sep. 30, 2017
As the most common source of heel pain in adults, plantar fasciitis makes the search engines awash with articles and citations.
However, finding what will actually help you in treating the condition is another matter.
That is precisely what our mission is in this resource: to produce a comprehensive, step-by-step guidebook that will help you navigate through plantar fasciitis treatment options with confidence.
We'll include some recommended reading links below each section, which helps you to fully assimilate each sub-topic, then you can follow our specific guidelines to mitigate the symptoms and alleviate the pain.
Now, let's start the journey.
Introducing: The Ultimate Plantar Fasciitis Treatment Resource Book
To use our guidebook, simply click the chapter you wish to read below and you’ll be taken there (you can also use the quick navigation in the right sidebar while browsing the article on desktop). Just choose a chapter to get started or, better still, read our guidebook from start to finish.
- Chapter 1: What is Plantar Fasciitis (PF)?
- Chapter 2: Causes And Risk Factors of PF
- Chapter 3: Exercises, Stretches and Massage (Recommended Treatment Option)
- Chapter 4: How to Prevent and Accelerate PF Treatment (by Strengthening Your Foot Muscles)
- Chapter 5: Orthotics, Taping and Shoes (Best Tools to Relieve Your Heel Pain Quickly)
- Chapter 6: Other PF Treatment Options (that you Should Know About)
- Chapter 7: Recommended PF Home Treatment (Action Plan You Can Start With)
Chapter 1: What is Plantar Fasciitis?
Plantar fasciitis (PF) is the most common cause of heel pain. It is estimated that 1 in 10 people will develop this condition during their life span1.
The condition gets its name from plantar fascia, the name given for the ligament that extends from your heel to your toes. Plantar fascia thus provides support to your foot’s arches and act as a shock absorber.
A common misnomer for PF is the “heel spur syndrome”. It is a misnomer because PF and heel spurs are not the same thing (more on this later).
Symptoms: The most characteristic symptom of plantar fasciitis consists of a stabbing type of pain in your heels, especially as you get up in the morning and attempt to stand up.
Other symptoms include tenderness at the bottom of the foot, and worsening of the pain when you walk or exercise for some time, particularly on hard surfaces.
It is important not to confuse the type of pain you might get from PF with that of arthritis or conditions that affect the nerves that of an issue with one or more nerves. If you get pain when lying in bed, chances are this is not plantar fasciitis2.
Who does the condition affect? Mostly, it is middle-aged people who mostly develop PF3. It is thought that up to 7% of the general population experience the type of pain generated by PF at any given time, and of those, 80% of cases are due to PF45.
If you want to know more about the basic of PF, check out these 3 readable sources:
Chapter 2: Causes and Risk Factors of PF
If you’re suffering from plantar fasciitis, understanding the cause of your condition is after all essential to selecting the best treatment therapy, whether it’s physical therapy, exercises, orthotics or surgery.
But first, this Chapter 2 will examine several of the suggested causes of PF and the influencing factors that predispose people to acquire PF.
What is the causes of PF?
There is no simple answer to what causes PF, despite it being such a common condition and foot ache.
There have been several theories and studies associated with the probable root causes of the condition. And while some of those assertions hold weight, others have been plainly debunked.
The most talked about distinction between “old thinking” and modern research is in connection with inflammation which, as we discuss below, has been debunked as a root cause of PF.
Here's how PF develops:
Plantar fasciitis occurs when the plantar fascia becomes worn out or overburdened. In other words, PF is an injury of the overuse of the foot. Too much strain on the plantar fascia might cause it to stretch beyond its capacity and eventually become damaged.
Unlike what the name suggests, plantar fasciitis isn’t necessarily an inflammation of the plantar fascia. Although it was once believed to be just that, recent studies have however ruled out inflammation as being the root cause of PF.
In fact, current research findings suggest that the more appropriate term for PF is “plantar fasciosis” which emphasizes degeneration or cell death in the dense ligament that supports the arch6.
What Is The Difference Between "Fasciitis" And "Fasciosis"?
Any medical term that ends with ‘-itis' indicates an inflammatory condition. However, as we have already alluded to, researchers have so far failed to find any link to inflammatory cells in the plantar fascia ligament of a patient with PF.
Instead, there is evidence of collagen degeneration and pathological damage of the plantar fascia. ‘Fasciosis’, therefore, reflects the injury more accurately because the suffix ‘-osis’ depicts degeneration.
Other Myths About Root Causes Of PF
Let us first assert that some of the theories associated with root causes of PF are not all without merit. They are only ruled out when they claim to be root causes of PF.
- Heel Spurs: This is a good example and a fairly common misconception. Heel spurs are tiny bone projections that form in the heel of the foot in a small percentage of people.
There is no denying that people suffering heel spurs have shown a higher incidence of PF, but that’s only because heel spurs can be a risk factor of the injury and not its root cause7.
In fact, the pain afflicted by PF may not at all be associated heel spurs, which is why getting heel spurs removed surgically will not necessarily cure the PF.
- Arch Mechanics: Abnormal foot arches are often blamed to cause plantar fasciitis, despite the fact that that’s not really all true. Flat feet and high instep/arches might be regarded as contributing factors of the disease, but they don’t directly cause PF (more on this below).
More Reliable Facts About PF's Root Cause
The simple truth is that because the plantar fascia is a pretty thin sheet of connective tissue that provides our arches with support, it’s not the only entity in that buffering role.
In fact, when you stand up or exercise, most of the strain in your foot is transferred to the muscles of your feet.
Our foot muscles are layered to form intrinsic and extrinsic muscles. All of these are important in both moving the feet as well as bearing the stress of our weight.
Associated risk factors of PF
Here’s where science has managed to discern some reliable evidence, for there are various contributing factors that may increase the predisposition to plantar fasciitis. It is important to note though that these are risk factors and not root causes of PF.
- Overpronation: Over-pronation (moving the foot inwardly) is one of the major risk factors of plantar fasciitis. Over-pronating might cause the plantar fascia to stretch away from its attachment at the heel bone and result in injury.
Similarly, supination (moving the foot outwardly) is an equally important risk factor because in both of these conditions, the plantar fascia is stretched beyond its normal capacity.
- Abnormal Foot Arches: Flat feet and high arches have similar effects on the plantar fascia as do pronation and supination. In addition, a decreased angle of ankle dorsiflexion (the angle formed between your ankle and the dorsum/front of your foot when it is moved upwards towards the body) puts strain on the arches of the foot and may precipitate an injury of the plantar fascia10.
- Tight Calf Muscles: Tight calf muscles or a shortened Achilles tendon may yet be another important contributing factor. Tight muscles of the calf can be seen in athletes or women who are used to wearing high heels. Once again, it is the excessive strain on the plantar fascia that ensues from tight calves.
- Obesity: A notable risk factor that has nothing to do with the feet is obesity. Case studies have revealed that around 70% of PF patients have a high body mass index (BMI). That excess weight can naturally boost the level of tension on the plantar fascia 11.
Chapter 3: Exercises, Stretches and Massage (Recommended Treatment Option)
Although various treatment options are currently available, physical therapy is considered to be the most effective treatment of PF and the least intrusive. Physical therapy for plantar fasciitis has been around for some time now and has managed to produce dependable benefits1213.
As has already been mentioned, an over-strained plantar fascia, a stretched Achilles tendon, or tight calf muscles are all important risk factors of plantar fasciitis.
Physical therapy targets these underlying factors and helps alleviate symptoms like discomfort and outright pain.
Remember though, physical therapy (PT) is not a cure for the underlying pathology of the condition. We’ll discuss how to treat that a little later, but for now, let’s review some popular exercises and stretches for plantar fasciitis.
Plantar fascia stretch
This is a gold standard plantar fascia stretch that has been proven to be most effective for the treatment of PF14.
- STEP 1: For this exercise, you need to be seated with the leg you’ll be performing the stretch on crossed over the other leg.
- STEP 2: Hold your toes and pull them towards you slowly for 10 seconds and then let go.
- STEP 3: Repeat this stretch 10 times and do it at least thrice a day. This will help tense your plantar fascia and subsequently loosen it.
Do not exceed the 10 second mark or else you might make things worse.
This PF stretch is performed on a stepping block or stairs.
- STEP 1: With your back upright, position your foot on the step in a way that the heel dangles off the edge.
- STEP 2: Lift your heel up slowly (over 3 seconds) so that your toes are stretched backwards. Hold the lift for 2 seconds, then release slowly again over 3 seconds.
- STEP 3: Repeat this stretch 3 x 10 times and do it again every other day. This will tighten not only the plantar fascia but the Achilles tendon as well.
Calf stretch with a strap
- STEP 1: Use a strap, towel or cloth to loop around your foot all the while keeping your knee straight.
- STEP 2: Pull the toes of one leg towards you with the strap and hold them there for about 30 seconds and let go.
- STEP 3: After some 30 seconds, pull the toes of the other leg towards you with the strap and hold them there for about 30 seconds and let go.
- STEP 4: Repeat this stretch 2 to 4 times. It stretch-targets the fascia, the tendon and the calf.
Wall push-ups for Gastrocnemius
- STEP 1: Put both hands on the wall and place one foot in front of the other (at least 30 cm of distance) with the front knee slightly bent.
- STEP 2: Lean towards the wall until you feel the Achilles tendon and calf muscles tighten.
- STEP 3: Repeat the push-ups by bringing the other foot to the front as well at least 10 times.
Wall push-ups for Soleus:
- STEP1: Place your hands on the wall with one foot behind the other with both knees this time slightly bent.
- STEP 2: Push down on the front knee slowly by maintaining an upright posture the entire time.
- STEP 3: Hold it there for 30 seconds and repeat the stretch for the other foot as well.
Deep Tissue Massage For Plantar Fasciitis
The degenerative changes in plantar fasciitis result in a build-up of scar tissue and adhesions at the bottom of the foot. One way to break up the scar tissue and encourage the healing process is referred to as cross-friction massage of the foot.
Moreover, it’s important to realize that plantar fasciitis is not just a fascia. The dense ligament has multiple muscle connections that give it a more robust role than merely supporting the arch.
While cross-friction massage helps to heal the fascia, it also provides a deep massaging action on the intrinsic muscles of the foot.
You can get your foot massaged professionally by a massage therapist, or you could massage it yourself at home.
Home Massage For Plantar Fasciitis
To perform a cross-fiction deep tissue massage, press your thumb on your plantar fascia going from the toes to the heels, making sure you massage all the different connective tissue bands of the fascia from left to right as well.
Alternatively, you can also use a massage ball, rolling pin or a bottle of ice and roll the arch or the heel of your foot by gently pressing down on it. This might hurt at first but as the condition of your plantar fasciitis improves, you will experience less pain.
Massage your foot with this technique for about five to ten minutes or until you feel the massage take effect.
For a detailed visual guide of how to perform common exercises and stretches for plantar fasciitis, check out the following PDF files for different exercise programs:
Chapter 4: How to Prevent and Accelerate Plantar Fasciitis Treatment (by Strengthening Your Foot Muscles)
As mentioned in chapter 2, having weak foot muscles is the root of PF pathology. Therefore, strengthening your foot muscles is a definite way to accelerate your PF treatment, as well as, preventing it from happening again in the future.
This chapter is your detailed guide on how you can do this by exercising your foot muscles and adjusting your running form.
How does this work? Let’s get to it.
Anatomy of the foot explanation - how do your foot muscles relate to PF?
Before you can know about the ways to strengthen your foot muscles, let’s first have a quick overview of the foot anatomy. Your feet have a layered and, somewhat, complicated structure.
It contains two main groups or layers of muscles:
- Extrinsic foot muscles: These muscles arise from the leg (extrinsic) and are associated with the movement of the ankle joint, i.e. plantar flexion and dorsiflexion.
- Intrinsic foot muscles: This group originates from within the bones of the foot itself (intrinsic). These muscles have functions like: stabilizing your foot arches, giving dynamic control to your feet, and regulating the rate of foot pronation.
And although both of these muscles are affected in a standard case of plantar fasciitis, their impact varies.
Here is how weak foot muscles and PF are related:
- Weak extrinsic muscles are associated with 3 PF risk factors: According to research, weak extrinsic muscles give rise to three main issues: impaired ankle dorsiflexion, reduced flexibility of plantar flexor muscles, and strong contraction of plantar flexors 3. As mentioned in Chapter 2, all of these are strong risk factors for plantar fasciitis.
- Weak intrinsic muscles give rise to 2 PF risk factors: Similarly, having weak intrinsic muscles would cause problems for you like abnormal foot pronation (under-pronation or over-pronation) and abnormal foot arch height (flat or high arch)10. Again, as mentioned in Chapter 2, these risk factors are strongly related to PF.
Here’s the deal:
Weak foot muscles are strongly linked to an increased risk of PF. It means that if you have strong foot muscles, it will solve a lot of problems for you. This includes speeding up your PF treatment and preventing it from happening again.
How to exercise to strengthen your foot muscles
The good news is that there are several ways to strengthen your foot muscles.
The exercises discussed in the previous chapter aim to tense, strengthen, and mobilize the extrinsic (calf) muscles, and thereby counteract associated risk factors.
Let’s move on to the exercises strengthening the intrinsic foot muscles.
- Fanning the Toes
This exercise will work out the small foot muscles that control the spreading of the toes (abductor and adductors of the toes).
- Marble Pickup
Use your toes to pick up scattered marbles from the ground and transfer them to a bowl. It helps strengthen the flexors and extensors of your toes and the intrinsic muscles supporting your foot arches.
- Towel Curls
Spread a towel on the floor and pull it towards you by curling your toes around it. By doing this, you will be working out the small muscles of your toes and the sole.
- Toe Yoga
Can you lift your toes individually? You might not be able to do it now and it shows weak intrinsic muscle control. Once your intrinsic muscles are stronger, you will be able to lift each individual toe up intentionally.
- Other yoga techniques
You can try out some other yoga techniques for your feet that will help mobilize and strengthen your intrinsic foot muscles.
How to strengthen your foot muscles by adjusting your running form
Let’s start with the second part of the equation - strengthening your foot muscles by adjusting your running form.
Let’s clarify one thing here. When we say ‘running form’, we will essentially mean two things: the ground strike pattern (whether it is forefoot, midfoot or heel strike) and running barefoot vs. with padded shoes.
But why is running form so important? Here is why:
Research suggests that forefoot or midfoot strike patterns represent the natural and primitive ways of foot strike. These patterns are more common among experienced elite runners15.
It also proposes that forefoot or midfoot landing stances are associated with several benefits.
For instance, these stances lead to stronger foot muscles, greater ankle compliance, and reduced force of impact when striking the foot on the ground 15.
This might reduce the chances of injury, including PF. However, the evidence available till date is more of a hypothesis and no direct evidence is available. For it to become an established fact, it must be put to further testing.
Similarly, another important component of adjusting running form is choosing between barefoot and shod running.
Preliminary evidence suggests that barefoot running is beneficial as compared to shod running.
Facilitated by elevated and cushioned heels, around 85% of shod runners have a heel striking pattern, which increases the striking force.
However, the available data comparing the relative benefits of on barefoot running or running with minimalist shoes with shod running is still preliminary and not sufficient to make explicit recommendations.
So if you have PF, you may consider transiting from rare-foot shod running to bare midfoot/forefoot running patterns.
However, you have to be quite careful while making this transition as an abrupt and ill-informed transformation can do more harm than good.
For more tips on adjusting running form, check out these helpful resources:
- How Should your Foot Hit the Ground | Running Competitor
- Walking and Barefoot Running: Warm up Exercises, Principles & Techniques | Reddit
- Running Barefoot, Forefoot Striking & Training Tips | Harvard University
Chapter 5: Orthotics, Taping and Shoes (Best Tools to Relieve Your Heel Pain Quickly)
PF is a self-limiting condition16. It means that in most of the cases, the symptoms resolve itself after 8 -10 months.
However, the pain during this period can make the whole experience quite frustrating. So it is quite useful that you have some help dealing with the pain while you’re treating PF.
The reason why these tools are helpful is because they can provide a quick relief from PF pain.
Shoes make an important part of PF treatment. If you have PF, you would be troubled with questions like:
- Are minimalistic shoes better for my condition?
- Which shoes should I wear?
- How should I choose my shoes?
But before getting to that, here are a couple of other things that you could try. Let’s first talk about options like orthotics, braces, and foot taping.
1. How can you make the best use of orthotics?
To begin with, what are orthotics?
Orthotics are insoles or shoe inserts that you can either get over-the-counter or get your own custom-made versions.
How do they work?
The rationale of using orthotics sprang from the idea that plantar fasciitis is the result of abnormal running dynamics causing an increased stress over the plantar fascia.
In other words, it was believed that plantar fasciitis caused a load reduction in the heel region (rare foot) and caused an increase in load over the other parts of the feet (like mid foot, forefoot, and fingers).
However, the study by Riberio et al. produced totally different results. Researchers did not notice any changes in load bearing across different regions of the feet17.
So if changes in load bearing are not important then how else do orthotics work?
Turns out, the pain reduction due to orthotics is due to their ability to provide additional support to the foot arches. This support reduces the tension over the plantar fascia and, therefore, reduces trauma17.
While the proponents are almost certain that orthotics work and they seem to have a fairly good explanation of how they think orthotics work, but critics have their own stand.
According to Dr. Niggs, professor of biomechanics and co-director of the Human Performance Lab at the University of Calgary in Alberta, while orthotics might work for some individuals but the data available so far is not so convincing, neither are we sure on how do they pull this feat.
For how long should you use orthotics?
Orthotics seem to work great when used for short-term (up to 3 months)18. However, the long term benefits of orthotics are still unclear. Again, while proponents and critics almost agree on the short-term use of orthotics, there is still controversy over the benefit of their long-term use.
Finally, what kind of orthotics are we talking about here?
According to research, the material and the kind of shoe insole or insert do not make a huge difference.
In fact, there is little evidence to support the use of custom made insoles for managing PF. The off-the-shelf type insoles and inserts seem to do just fine as well19.
2. How do braces help with PF?
There are two main types of braces when it comes to PF:
- Night splints
- Compression socks
Night Splints - Is This What You Need?
Night splints are braces for your ankle that provide additional support to your ankle and feet.
How do these splints work? Here is the rationale for their use.
The use of night splints put your feet in a neutral or slightly dorsiflexed position. Normally, most of us sleep with our feet contracted, which puts strain over the plantar fascia for five to eight hours every day.
Night splints, by putting your feet in a dorsiflexed position, can help reduce that strain.
Moreover, researchers also speculate that night splints should theoretically reduce the nighttime contraction of extrinsic and intrinsic foot muscles.
This should further reduce the strain over plantar fascia 20.
Are splints sure to work? Now, here is what we know so far.
Just like orthotics, the evidence for the use splints for PF is mixed. Some studies have found a significant reduction in PF symptoms with the use of splints21, while others have found a limited evidence to support their use 22.
Despite this disparity, you might get benefits with the short-term use of these splints.
Here is one interesting source on this subject:
Night Splint Treatment of Plantar Fasciitis Pain | Ler Magazine
Compression Socks - What Does Evidence Say About Their Use?
Compression socks work quite well in the theory. Theoretically speaking, compression socks work by decreasing the pooling of blood in the feet. This way, they improve the circulation in the feet, which should improve recovery 23.
However, is there scientific proof to support the use of compression stock? Now, here’s where things do not sound so promising.
While athletes frequently use compression socks and quite a few claim that it helps them recover better and reduce fatigue, but there is actually very limited evidence for the use of these socks23.
To the best of our knowledge, there is no research on the use of compression socks for plantar fasciitis.
Most of the data in the favor of compression socks is anecdotal. In other words, most of the individuals using these socks say that they experience a significant reduction in pain while wearing these socks.
Also, these socks are quite famous among athletes and runners and they say that these socks not only relieve the pain but help improve their performance as well.
3. Taping - how can it benefit PF?
Taping, as the name suggests, is a technique uses tapes to improve the natural healing of the body.
This effect is believed to be due to the effects of kinesiology taping on body muscles, joints, soft tissues, and circulation24.
However, the evidence for the use of taping is not compelling.
In one systematic review, researchers evaluated the results of twelve Randomized Control Trials (RCTs) testing the effectiveness of taping. Unfortunately, in most of the trials, taping failed to show positive effects on pain, recovery, and mobility improvement25.
Does that mean taping is a no-go for PF too? Here is the bright side of the picture.
In one study, researchers applied taping over the gastrocnemius and the plantar fascia for a period of one week. The results obtained were indeed encouraging! The treatment group experienced a reduction in pain and the thickness of plantar fascia compared to the control group26.
However, we are yet not sure about the long-term effects of using taping.
Also, just like compression socks, the data favoring the use of taping for PF is anecdotal. It is quite popular among athletes and they confidently suggest its use. They see taping as a technique to relieve pain and improve performance.
Moreover, taping is also quite a common practice among different doctors, chiropractic specialists, podiatrists, and kinesiologists. All of these experts favor the use of taping for pain and improving muscle, ligament, and tendon recovery.
Here are some tutorials on how to tape for PF:
4. How to choose your shoes wisely for PF?
Now let’s come to the main topic - using shoes for PF. We touched this topic in the previous chapter. Now, let’s get to the detail of it here.
Before recommending what kind of shoes you need, let’s get a few things straight here.
Barefoot Running is Better, But…
As explained in the previous chapter, barefoot running or running with minimalistic shoes is better than running with padded shoes; but, that’s just not it!
While it’s true that wearing padded shoes make you more likely to land on your heels and barefoot running might help change that to forefoot or midfoot landing, but:
- It is more about running form: It is more about landing than barefoot vs shod running. That’s because even barefoot runners who land on their heels experience higher striking force than when they land on their midfoot/forefoot27.
- Go easy with the transition: For the most us who have been using normal shoes for most of our lives, making an abrupt transition to barefoot or minimalist running can do more harm than good. So give yourself time to undergo a successful transition.
Here are some useful readings on how to undergo this transition and comparison of barefoot running vs. shod running:
- THE first big study on barefoot running in Nature : Death to Heel striking | The Science of Running
- Barefoot running, shoes, and born to run | The Science of Sport
- Vibram FiveFingers Injury Study Confirms the Body Needs Time to Adapt | Birthday Shoes
Motion Control, Neutral, Cushioned - Do These Shoe Types Mean Anything?
Let’s start with describing what these shoe types mean:
- Motion control or stability shoes are meant to prevent over-pronation
- Neutral shoe type is for normal pronators
- Cushioned shoes are for under-pronators
As explained in previous chapters, abnormal pronation patterns represent a risk factor for PF. So theoretically speaking, these shoes should help with these risk factors and PF as well.
But there is a problem. These shoes do not work as well as the manufacturers might claim. Here is what research says.
- Motion control or stability shoes: Results of a systematic review showed that while motion control review might reduce pronation but the data available is of low quality28.
- On the other hand, as explained in Chapter 4, according to the research by Prof. Lieberman, only minimalist shoes and not pronation control shoes help manage pronation.
- Cushioned shoes: As explained, cushioned shoes increase the risk of heel strike and force of impact.
Here are suggested readings on this:
How to Choose the Right Shoes?
This is perhaps the most sought-after question. But there is no absolute answer to this question.
Here is why:
- You and everyone else have a unique set of feet and a different set of problems.
- What might suit others might just not be right for you.
So you have to find something that is suitable and comfortable for you. There is no one-word answer to this question. You have to experiment with a number of shoes to find what suits you best.
Chapter 6: Other PF Treatment Options (that you Should Know About)
Since PF has different risk factors and causes, the treatment options vary too.
You always need to have a couple of options in your arsenal because what works for others might just not work for you.
So do not feel down.
There is always something for everyone! You just have to find the way that suits you!
This chapter will walk you through some additional treatment options for PF, with the science behind them, and pros and cons of each method.
Let’s get to it.
1. How can extracorporeal shock wave therapy (ESWT) soothe PF?
The principle of ESWT is quite simple but the results are indeed surprising. This therapy stimulates your tissues with high-pressure sound waves, which:
- Improves the supply of blood to your tissues
- Induces slight injury to your body tissues so that it can trigger the natural healing processes
- Calm down the nerves leading to a reduction in pain
Here are the good things about this therapy.
It is actually backed by sufficient scientific research. One meta-analysis studied the results of seven RCTs where researchers studied the effects of ESWT on PF treatment. Interestingly, on an average, the heel pain improved by 60 percent. These effects were observed after an average 3 months of therapy29.
Moreover, this method is non-invasive and does not require you going under the knife. Also, you do not have to worry about complications like wound pain, bleeding, and chances of infection- some commonly encountered side effects of surgery.
But there is a downside too. Here are the cons of this procedure:
- Slight pain/discomfort during the procedure
- Skin reddening
- Swelling at the treatment site
2. How can old fashioned icing and rest do the trick?
The old-fashioned icing and rest work here too. Here is how.
Icing, especially after an acute injury, limits the supply of blood to the affected area, reduces inflammation, and mitigates pain30.
As for the rest, it works best after acute injury. Limiting your movements can prevent further injury and can give your body adequate time to heal on its own. In one study, around 25% of participants found rest to be the most effective treatment for plantar fasciitis31.
3. NSAIDs and Corticosteroid Injections
Here are 2 types of medications you could use for PF:
- Non-Steroidal Anti-inflammatory drug (NSAIDs)
- Corticosteroid injections
NSAIDs - An Over-The-Counter Solution to Your Problem
NSAIDs, as the name suggests, limit the inflammatory processes that trigger injury and pain.
Research suggests that it is an effective way that not only controls the pain but prevents it from happening in the future as well.
In one research, around 79% of individuals found NSAIDs to be highly effective in reducing PF-related pain31. Moreover, it is a cost-effective way of treating PF-associated pain as well.
Although this method is effective but beware!
You should not use this medicine without the recommendation of your doctor. Also, try avoiding it if you have:
- Stomach issues
- Stomach ulcers
- Kidney problems
Corticosteroid Injections- If NSAIDs Do Not Work
Corticosteroids, like NSAIDs, function by reducing the level of inflammation. It is an alternative if NSAIDs are contraindicated or if NSAIDs do not work.
Corticosteroids injections are quite effective, especially when used during the early stages of PF. In addition, they provide symptomatic relief that might last several weeks32.
In one study, the participants experienced a reduction in pain for up to four weeks and reduction in swelling for up to 12 weeks after getting steroid injections32. Some studies have shown a staggering 70 percent improvement in symptoms of PF with steroid injections33.
Although this method might do wonder for your pain; but there are significant risks associated as well. Here is what you should expect:
- Changes in skin color and texture
- Soft-tissue injury
- Wound infection
- Rupture of plantar fascia
4. How surgery works when other things do not?
Surgery is the last resort when the symptoms are either too severe or when other options do not work.
In this procedure, the plantar fascia is surgically removed from the heel bone. This procedure can be done through an open surgery or a key-hole surgery (laparoscopic surgery). This procedure is called the plantar fasciotomy.
Here, the results of research do not come from RCTs but from retrospective studies (which rank lower than RCTs in terms of authenticity).
From the five retrospective studies retrieved from the literature, results show that up to 75 % of patients experience long-term benefits with plantar fasciotomy20.
But the wide range of side effects is why surgery is the last resort. Here are some side effects that you might experience with surgery:
- Wound infection
- Nerve damage
- Damage to the surrounding muscles, bones, and tendons
- Flattening of plantar arch
- Long recovery time
Chapter 7: Recommended PF Home Treatment (Action Plan You Can Start With)
By now we have covered almost all the aspects related to PF treatment. However, your questions might still be the same.
How do I embark on my journey to rehabilitation?
It is quite normal to think that especially when you are unsure where to start. So let’s make the whole thing easy for you!
This chapter is divided into three actionable steps that can help you recover at the comfort of your home.
What are these steps? Let’s find out!
Step 1- Find out how much rest do you need
As mentioned in the previous chapter, the first thing you should start with is rest. Getting adequate rest gives your body enough time to heal on its own.
But the question here is; how much rest do you need?
The first thing you need to do is to assess the level of your injury.
For that, use T.O.T.A.P.S injury assessment tool.
Read more about this tool here: PHDPE.Net, TOTAPS
Here is how much rest you need based on the level of injury as assessed by TOTAPS.
- Mild injury: In case of mild injury, you might need only a couple of days of rest before you could start with your routine activities.
- Moderate injury: If you fall in this category, you may have to rest for days to weeks.
- Severe injury: If you have suffered severe injury, you may have to rest for weeks to months.
Step 2- How to deal with the intial symptoms
After figuring out how much rest you need, you need to do something about the pain. The pain is not going to go away on its own unless you do something about it.
Here is what you can try.
Start with R.I.C.E
R - Rest: Rest your feet as described above.
I - Icing: Icing helps reduce pain and inflammation. You can wrap ice in a towel and apply it to the painful area for 10-15 minutes, 2-3 times every day for the first 7-10 days.
C - Compression: Compression reduces inflammation and helps with the swelling following the injury. However, make sure you do not apply compression socks too tightly as it might affect recovery. You can use compression for a couple of days to around a week23.
E - Elevation: Elevating your legs can prevent the pooling of blood in the affected areas and can prevent inflammation and swelling. You can elevate your leg for 10-15 minutes several times a day.
In addition, a few more things that you can try to control your pain and swelling include:
Over-the-counter pain killers: You can try over-the-counter pain killers like ibuprofen and paracetamol if RICE is not enough to control the pain.
Heating: Heating the affected area with a heating bottle or wrap is another effective way to soothe the pain. However, make sure not to heat the affected area for the first week or so because heating during this phase can worsen the swelling.
Step 3 - How to speed up the recovery
Now that you have worked on fixing the pain, you need to do something to speed up the recovery process.
There are four key components of recovering from plantar fasciitis.
Here is what you need to do.
# 1: Make Changes in Your Diet
In the overall management of PF, although the studies of nutrition are still limited and unclear, we yet can not deny completely the role of it as an effective supporting tool36.
A healthy diet helps you lose weight, the importance of which is discussed in the later text. Moreover, it also provides the raw materials needed for boosting recovery.
What nutrients do you need to consume?
We've selected 2 comprehensive sources below for you to discover more about nutrition for pf.
They will give you the ideas of what kind of nutrition you should focus on, how these nutrients works, and their key sources.
- Plantar Fasciitis: Overcoming Heel and Arch Pain Naturally | Huffingpost
- Plantar fasciitis: diagnosis and therapeutic considerations | Alternative Medicine Review
# 2: Strengthen Your Foot Muscles
The next most important thing you should do on a daily basis is working out your plantar fascia and deep intrinsic and extrinsic foot muscles.
# 3: Work on Your Body Weight
As mentioned in Chapter 2, obesity is one of the biggest risk factors for PF. In fact, research suggests that obesity is related to 70% PF cases in non-athletic population.
Therefore, it is extremely important that you get your weight under check.
But, how does body weight link to plantar fasciitis?
Well, there are a number of explanations for this link.
First, your feet support all of your body weight. So if you weigh more, your feet would naturally be more stressed.
Second, research suggests that greater body weight causes permanent changes in your foot anatomy like increasing the foot pronation and collapsing foot arches.
Finally, and most interestingly, researchers also hypothesize that greater body fat - as in individuals with obesity - leads to greater fat deposition in plantar fascia as well. This makes the fascia less flexible and more prone to injury 3738.
So if your Body Mass Index (BMI) is more than normal (>25) then you are more prone to have plantar fasciitis. In that case, you should attempt to bring your body weight within normal limit of the BMI, that is, between 20 and 25.
# 4: Go Barefoot or Choose The Right Footwear
If you have plantar fasciitis, you have to change the way you walk or run. Barefoot running or running with minimalist shoes might be better than with normal padded shoes.
Step 4 - Seek advice from a healthcare professional
All of the steps mentioned above might work great for you. Still, it is never a bad idea getting expert opinion. Or you might want to check in with a specialist because things might not be working well for you.
Whatever the case, it is always advisable that you get in touch with a healthcare professional for expert advice.
What will the experts do? How will they treat you? You can refer to Chapter 6 for details on that.
PF is a cumbersome condition that can cause a lot of distress and is the source of great pain.
But don’t let the pain take over! Take control and beat PF once and for all! While the journey might be long and arduous, but if you stick to the plan, you can get moving again.
You might ask; For how long do you need to continue with this regimen mentioned in this guide?
To be honest, there is no telling that. It would depend on several factors like the extent of your injury, your compliance to the treatment regimen, how well your body responds to the treatment, and so on.
But, one thing is for sure; if you follow all of the advice mentioned in this guide, you can beat plantar fasciitis despite all the odds!
All the information given in this book is for informative purposes only. It should not be used as a substitute for the advice of a professional healthcare provider. Consult with your healthcare provider before trying anything on your own.
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