Plantar fascitis pain, or pain at the bottom of the heel or foot, is very common and if managed appropriately, it can get better fairly quickly. Patients with this most commonly complain of heel pain for the first few steps when they get up in the morning or after sitting for a long time. At times, the pain will even increase if people are on their feet for a long time, but usually it is better while moving. So what does “managed appropriately” mean? Should you rest your foot by staying off of it as much as possible or should you work your foot to help it recover faster?
Well, the answer really depends on how long you have had it. If it is just starting, some simple solutions might be all you need to get over it. These might include getting a new pair of shoes if the ones you normally wear are older, using a shoe insert or orthotic temporarily to help the pain decrease, or even some simple stretching of the tissues on the bottom of your foot. See picture to the left.
For the short term, you may even have to try and back off on how much you are on your feet if possible. If you are a runner, this might include decreasing your mileage for a bit.
Now, if these short-term solutions do not work or if you have been having your heel pain for a longer time, a different approach is likely needed. I see many people who have been dealing with heel pain for a long time who have tried these initial treatments and may have already been”treated” with ultrasound or iontophoresis, only to find no benefit. In these cases, moving on to something different is needed and we have some research to support the treatment.
In a 2015 study by Rathleff and colleagues, high load strengthening exercises were found to be more beneficial in the long term than stretching exercises in people with a longer history of plantar fascitis. Both groups received shoe inserts, but then one group did stretching only and the other group was progressed through a high load strengthening program for the foot and calf musculature. The strengthening consisted of standing heel raises with a towel under the big toe. Weight for the heel raises was gradually progressed to make sure that the exercises were challenging and loaded the tissues appropriately. Specific directions were also given regarding pain as some pain was ok to experience during the exercises, but not so much that it limited progression. Guidance by a physical therapist for loading progression and pain education was needed.
What this study showed was that people assigned to the strengthening group had a quicker reduction in pain and improved function at 3 months than the group that did the stretching. The other outcome of the study was that those participants assigned to the strengthening program tended to be more satisfied with the results.
You will notice that eventually (at 6 and 9 months) both groups did the same. The authors did not track compliance to the exercise program beyond 3 months so it is possible that the results leveled off as people felt better and stopped doing their exercises. Irrespective, if you have plantar fascitis, I am sure that you would want it to get better quicker, rather than wait 6 to 9 months.
So in conclusion, initially maybe some rest and passive treatment (stretching, shoe inserts) might be enough. But, if symptoms are not getting better, taking a more active approach and working the tissues that are painful is probably the better option to recover more quickly. For information on how to progress these exercises and what amount of pain is acceptable during and after, feel free to contact me.
Thanks for reading.
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