Pain in the bottom of the heel at the first step in the morning is a common sign of plantar fasciitis. The plantar fascia is a band of connective tissue which supports the arch. It starts at the heel bone and extends to the toes. Excess stress on the plantar fascia results in tearing and inflammation and the development of plantar fasciitis. The pain is usually localized at the bottom, inside of the heel, but can extend through the arch.
The pain may be sharp, dull, achy, burning or feel like a “stone bruise”. The pain is generally worse when walking barefoot and after activity. Side to side sports, such as soccer and tennis, impact sports such as running and jogging and simple activities such as gardening will all aggravate plantar fasciitis.
Identifying the factors which contribute to the development of plantar fasciitis is the key to treatment. There is almost always a change in activity, a change in shoes, a change in job or walking surface that has preceded the development of the condition. A traumatic event or twisting injury rarely causes the condition, but a simple activity such as walking through an airport in a poor quality shoe can easily cause the condition in individuals prone to development. Those with faulty foot mechanics, collapsing arches and over-pronation have a higher chance of developing plantar fasciitis. The following are steps for treatment:
1. Identify the cause: The most important step. There is most likely a certain activity or pair of shoes which contributed to the development.
2. Avoid impact activities: Impact activities such as jogging and running and sports such as soccer, baseball, and tennis will stress the plantar fascia. Cycling and swimming are great ways to maintain fitness without aggravating the plantar fascia.
3. Eliminate aggravating activities: Activities which place excess stress on the plantar fascia will aggravate the condition. Reduce the use of stairs, avoid hills, minimize squatting, lifting heavy items and avoid walking on uneven terrain.
4. Water bottle ice massage: Freeze a sports water bottle and roll your foot over it for 20 minutes, twice a day. Icing is most effective the first few weeks after the fasciitis develops. You can also ice directly on the heel for 20 minutes twice a day.
5. Roll your arch over a ball: Using a softball, tennis ball or rolling pin, roll your foot over the ball to stretch the plantar fascia. Do not do this if it causes pain.
6. Contrast between hot and cold: Ice for 5 minutes and then use a heating pad for 5 minutes and alternate between the two for a total of 30-40 minutes.
7. Avoid massaging the heel: It’s tempting to press and push on the sore area of the heel. Many individuals like to rub and massage the area, but this will only aggravate the heel, increasing inflammation and pain. Once the inflammation has decreased, a physical therapist can perform a friction massage on the plantar fascia. But, this should be avoiding during the early stages of the condition and when the heel is inflamed.
8. Morning calf stretch: Stretch the calf in the morning, before you step down. Use a stretch band, or belt and wrap it around the ball of your foot. Keep your knee extended and pull back on the foot, stretching the calf. Hold for at least 1 minute.
9. Plantar fascia stretch: A stretch specifically for the plantar fascia can be performed by placing the affected foot on the opposite knee. Grab the toes and pull back, stretching the arch.
10. Stretch every hour: Stretch the calf and the plantar fascia for 1-2 minutes every hour. The more often you stretch, the faster the healing process.
11. Take anti-inflammatory medications: Medications such as naproxen and ibuprofen will decrease the inflammation. They can work well in the early stages of plantar fasciitis and should only be used in conjunction with other treatments. Do not take if you have a stomach ulcer.
12. Lose Weight: The more weight on the body, the more force and stress through the feet and the plantar fascia. Even a small amount of weight loss will decrease the stress on the plantar fascia and help with the healing process.
13. Wear supportive shoes: This is one of the most important steps. Soft flexible shoes will only cause more problems, despite how comfortable they may feel. Shoes should be worn from the time you get up in the morning until you go to sleep at night. Avoid going barefoot.
14. Use a heel cup: In the early stages of fasciitis, when the heel is tender, heel cups can increase shock absorption and add comfort to the shoes when walking. They should only be used in conjunction with other therapies and are not helpful in the later stages of the condition.
15. Use heel lifts: A heel lift placed in the shoe, or a heel on the shoe (up to 1 inch) will decrease stress on the plantar fascia.
16. Use anti-fatigue mats: If you stand in one place for an extended amount of time at work or at home, an anti-fatigue mats will add shock absorption and decrease stress through the heel.
17. Strengthen the foot muscles: While seated, place a thin towel on the floor in front of your feet. Grab the edge of the towel with your toes and pull the towel under the foot. This exercise strengthens the small muscles in the bottom of the foot.
18. Foot strapping: Taping the arch with sports tape in a fashion to support the arch can reduce stress through the plantar fascia and accelerate healing.
19. Use a night splint: A night splint will stretch the arch and the plantar fascia. Although they are called night splints, the splints can be worn in the evening or during the night. Night splints can be rigid or soft and are a simple, affordable, effective therapy.
20. Wear off the shelf orthotics: Prefabricated orthotics are designed to control abnormal foot motion which places excess stress on the plantar fascia. They are not soft and flexible, but semi-rigid and supportive. Certain foot types may require custom made orthotics, but most will do well with an off the shelf orthotic.
If your symptoms persist, make an appointment with your podiatrist.