Plantar fasciitisPatient information

Specialist Support Services and Integrated Therapies -Physiotherapy and Podiatry

What is the plantar fascia?The plantar fascia is a strong band of tissue in the arch of the foot.

What is plantar fasciitis?An injury or strain to the plantar fascia.

What causes the strain?

SymptomsPain in the bottom of the heel and/or arch of the foot that is usually worse on standing up after long periods of rest, especially when first getting out of bed.

This is because while you rest, the plantar fascia starts to heal. When you stand up, you suddenly stretch the sole of the foot causing stress and strain on the plantar fascia.

Pain can get easier after a few minutes walking but might get worse after walking for longer periods of time.

ManagementReduce the stress and strain on the plantar fascia in one or more of the following ways:

• Calf stretches.

• Plantar fascia stretches (or rolling pin exercises if you struggle with the leg position).

• Wear suitable footwear.

• Reduce the amount of running, walking and high impact activity you do until the tissues have a chance to heal. The plantar fascia heals slowly and you need to reduce the risk of re-injury as the healing takes place.

• Weight management.

• Shoe inserts, strapping and/or steroid injection may be discussed if your clinician feels it is appropriate.

ExercisesFor video demonstrations of these exercises please click ‘video link’ next to the exercise. Alternatively, if you have a hand held device such as a smart phone or tablet, download a free ‘QR code reader’ app from your app store and scan the ‘QR code’ next to the exercise.

• Tight calf muscles.

• Flat feet.

• Lots of walking, running or standing when you are not used to it.

• A sudden increase in exercise intensity / distance.

• A change in job.

• Exercising on a different surface.

• Poor footwear.

• Being overweight.

Plantar fascia stretch

Place the affected foot onto the opposite knee (Fig A).

Use one hand to gently pull your toes back until you feel a stretch across the sole of the foot (Figs B and C).

Use your other hand to feel the tension of the stretch across the sole of the foot (Figs B and C).

Hold the stretch for 10 seconds and repeat 10 times.

This stretch should be done at least three times daily.

The first set of 10 stretches should be done before taking your first steps in the morning (or after a long period of sitting/resting). Do at least two more sets of 10 stretches during the rest of the day.

VIDEO LINK

If you struggle with this exercise you can try using the rolling pin method as follows.

Rolling pin stretch

Sit on a seat with your hips and knees square (Fig A).

Roll your foot on a rolling pin or a tin (Fig B).

Initially, roll across the central part of the sole of the foot, then across the instep. Alternate the position of your foot throughout the exercise.

Do this exercise for about 5 mins (or during the ad breaks if you are watching TV) little and often throughout the day but especially

after you sit down for a long time.

VIDEO LINK

Fig A. Fig B.

Fig C.

Fig A.

Fig B.

Calf stretch for plantar fasciitis

Stand facing a wall with your affected foot pointing slightly inward (fig A).

Step forward with the unaffected leg (Fig B).

Bend the front knee, but keep the back knee straight keeping the heel of the back foot pressed down into the floor (Fig C).

Make sure that you point the toes of the back foot towards the heel of the front foot.

Hold the stretch for a slow count of 30 seconds, do not bounce.

Do three stretches, three to four times daily. VIDEO LINK

Author: Middlesbough Redcar and Cleveland Community Outpatient Physiotherapy and Podiatry teams

South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough, TS4 3BW. Tel: 01642 850850 Version 1, Issue Date: December 2016, Revision Date: December 2018 M

ICB

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Fig A.

Fig B.

Fig C.

During leisure activitiesMake sure you always wear good supportive footwear at least until the plantar fascia has a chance to heal.

FootwearWear shoes with cushioned heels and good support. A laced sports shoe is best. Avoid old worn shoes and open sandals.

At homeDo not walk around in bare feet or flip flops even in the warm weather. This can quickly cause the plantar fascia to become re-injured.

If you sit for a long time, try to do some plantar fascia stretches before you get up.

How long does it last?If you follow the advice, you should start to see improvements in around 8 weeks but it can take up to six months or longer to fully resolve. It is a long process because the plantar fascia heals relatively slowly. If you do not follow the advice given, there is a good chance that you will have long term pain with difficulty walking.