Plantar Fasciitis

Kelly Anne Spratt, D.O., Director of Women's Cardiovascular Health at the University of Pennsylvania Presbyterian Medical Center, answers your questions.

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Q. I have been "slowed down" recently due to plantar fasciitis in my right foot. I have now been fitted with corrective orthotics which help a great deal. Any other exercise and stretching tips that could further improve my discomfort? How long does rehab take once orthotics are being worn?

A. Plantar fasciitis is a painful inflammation of the bottom of the foot between the ball of the foot and the heel. There are several possible causes of plantar fasciitis, including high heels, weight gain, and increased walking, standing, or stair climbing. If you wear high-heeled shoes, including western-style boots, for long periods of time, the tough, tendon-like tissue of the bottom of your foot (the plantar fascia) can become shorter. Pain occurs when you stretch fascia that has shortened. This painful stretching might happen, for example, when you walk barefoot after getting out of bed in the morning.

If you gain weight, you might be more likely to have plantar fasciitis, especially if you walk a lot or wear shoes with poor heel cushioning. Normally there is a pad of fatty tissue under your heel bone. Weight gain can break down this fat pad and cause pain.

Runners may get plantar fasciitis when they change their workout and increase their mileage or frequency of workouts. It can also occur with a change in exercise surface or terrain, or if your shoes are worn out and don't provide enough cushion for your heels.

You may need to stay completely off your foot for several days when the pain is severe. Your health care provider may recommend or prescribe anti-inflammatory medications, such as aspirin or ibuprofen. Resting your heel on an ice pack for a few minutes several times a day can also help.

Try to cushion your foot by wearing athletic shoes, even at work, for a while. Heel cushions also can be used. The cushions should be worn in both shoes. They are most helpful if you are overweight or elderly.

An orthotics sole support, specially molded to fit your foot, is a helpful part of your treatment. These supports can be particularly important if you have flat feet or high arches.

I recommend seeing a physical therapist who can guide you in stretching the plantar fascia and strengthening the lower leg muscles, which stabilize the ankle and heel. Sometimes therapists recommend athletic taping to support the bottom of the foot or splints that may be fitted to the calf of your leg and foot, to be worn at night to keep your foot stretched during sleep.

Another possible treatment is injection of cortisone in the heel, which again decreases inflammation. Surgery for plantar fasciitis is rarely necessary.

The best way to prevent plantar fasciitis is to wear shoes that are well made and fit your feet and to get new athletic shoes before your old shoes stop supporting and cushioning your feet.

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