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  • Dr Jeff Ling - Sydney Foot & Ankle Surgeon
  • Foot & Ankle Surgeon Sydney
  • Dr David Lunz - Foot & Ankle Surgeon

Plantar Fasciitis

Dr Jeff Ling & Dr David Lunz


Sydney Orthopaedic Specialists: Foot & Ankle Institute

Plantar Fasciitis is a repetitive stress injury due to overuse and is very common. It responds well to treatment and almost never requires surgery.

The plantar fascia is a tough fibrous structure, on the bottom of your foot connecting the heel to the base of the toes. It helps maintain the arch of your foot. Repeated stress or pressure on the fascia where it attaches to the heel can cause microtears and inflammation. With time calcium can be deposited in the area leading to new bone formation and a “spur” - this is the result of the condition and NOT the cause. About half of people with plantar fasciitis will have a spur but so will a third of people without heel pain. The spur is not the source of pain. Plantar fasciitis can arise in anyone but is more common in women, in people with tight Achilles tendons, if you are overweight, if you walk or stand a lot on hard surfaces and in people with high arches or flat feet. The pain is usually worse first thing in the morning and after resting or sitting for a period. It usually settles after the first few steps only to return towards the end of the day.

Treatment consists of:

  1. Stretching exercises – THE KEY to treatment
  2. Shoes with well-cushioned heels
  3. Inserts / heel cups / orthotics for flatfeet
  4. Anti-inflammatories – for 2 weeks at a time, stop for 1 week, repeat if still symptomatic
  5. Walking cast or boot
  6. Steroid injections – can have up to three over a 6 month period
  7. Nocturnal Splints
6 & 7 are second-line treatments used after a solid trial of 1 – 5.
Stretching exercises are the mainstay of therapy and must be performed 3 times a day

20 sets of 10 seconds for each exercise each time, and continued for 6 – 8 weeks.

90% of patients will get relief of their symptoms by adhering to this regime for 2 months.

Exercise 1. Calf stretch

Lean forward against a wall with one knee straight and heel on the ground behind you. Your other knee is bent. Your heel cord and foot arch stretch as you lean. Hold for 10 seconds, relax and straighten up. Repeat 20 times for each sore heel. It is important to keep the knee fully extended on the side being stretched.

Now repeat but this time with the back knee slightly bent till you feel a nice stretch in your heel cord.

Exercise 2. Plantar Fascia Stretch

1. Cross your affected leg over your other leg.

2. Using the hand on your affected side, take hold of your affected foot and pull your toes back towards shin. This creates tension/stretch in the arch of the foot/plantar fascia.

3. Check for the appropriate stretch position by gently rubbing the thumb of your unaffected side left to right over the arch of the affected foot. The plantar fascia should feel firm, like a guitar string.

4. Hold the stretch for a count of 10.

Repeat 20 times.

Images

Plantar Fasciitis

Plantar Fasciitis

Calf Stretch

Exercise 1. Calf stretch

Calf Stretch

Exercise 2. Plantar Fascia stretch