Fast Plantar Fasciitis Cure™

Fast Plantar Fasciitis Cure™

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Table of Contents
Introduction ........................................................................................................................... 6
What is plantar fasciitis? ....................................................................................................... 6
The problem.......................................................................................................................... 6
Anatomy and biomechanics of plantar fascia ........................................................................ 7
Risk factors for developing plantar fasciitis............................................................................ 9
Causes of plantar fasciitis ................................................................................................... 10
1. Bone spurs .................................................................................................................. 10
2. Flat feet ....................................................................................................................... 10
3. Over-pronation ............................................................................................................ 10
4. High arched feet .......................................................................................................... 11
5. Medical causes ............................................................................................................ 11
6. Change in the running surface ..................................................................................... 11
Clinical symptoms and signs ............................................................................................... 11
Diagnosis of plantar fasciitis ................................................................................................ 13
Treatment of plantar fasciitis ............................................................................................... 15
1. R.I.C.E......................................................................................................................... 15
2. Stretching .................................................................................................................... 17
a. Wall exercises .......................................................................................................... 19
b. Stretch using a block of wood or a brick ................................................................... 20
c. Stretch using a tin can or tennis ball ......................................................................... 21
d. Towel stretching ....................................................................................................... 22
e. Stretching using a wobble board .............................................................................. 23
f. Slant board stretches ................................................................................................ 24
g. Staircase stretches................................................................................................... 25
f. Towel curl ................................................................................................................. 26

g. Dorsiflexion of toe stretch ......................................................................................... 27
3. Strengthening exercises .............................................................................................. 28
a. Non-weight-bearing exercises .................................................................................. 28
b. Weight-bearing exercises ......................................................................................... 31
4. Stability exercises ........................................................................................................ 32
5. Cross friction massage ................................................................................................ 33
6. Arch raises .................................................................................................................. 34
7. Orthotic devices ........................................................................................................... 35
8. Dietary modifications ................................................................................................... 36
a. Zinc .......................................................................................................................... 36
b. Vitamin C ................................................................................................................. 37
c. Glucosamine ............................................................................................................ 37
d. Fish oils.................................................................................................................... 38
e. Bromelain................................................................................................................. 38
9. Chiropractic manipulation ............................................................................................ 39
10. Acupuncture .............................................................................................................. 39
Prevention of plantar fasciitis .............................................................................................. 41
a. Choose appropriate footwear....................................................................................... 41
b. Keep your weight ideal ................................................................................................ 41
c. Get your rest ................................................................................................................ 42
Prognosis of plantar fasciitis................................................................................................ 43
Conclusion .......................................................................................................................... 44
Bibliography ........................................................................................................................ 45
Introduction
Our feet undergo tremendous amount of stress and strain every day. From a light
walk to a hard run, climbing stairs, standing for long hours and variety of sports, our
feet are subject to various movements and stretches every day. It should therefore
come as no surprise that in some of us, these stresses and strains can cause a great
degree of pain in our feet.
Within our feet are a group of muscles, bones, connective tissues and nerve endings
that all undergo these stresses. One particular type of connective tissue within our
foot is a fascia called the plantar fascia. The plantar fascia lies over the muscles and
other structures within the foot and is in close contact to its under surface. It is
therefore prone to injury and inflammation, resulting in a condition called plantar
fasciitis.
In this booklet, we shall be talking about plantar fasciitis, the common causes,
clinical signs and symptoms and how exactly this condition can be prevented and
effectively treated using simple conservative home remedies.
What is plantar fasciitis?

Plantar fasciitis is a clinical condition that is characterised by inflammation and
thickening of the plantar fascia (in the medical world, the term ‘itis’ refers to
inflammation). It is caused due to excessive stress from constant trauma to the
plantar fascia. The plantar fascia is a layer of connective tissue that extends from the
heel bone (calcaneum) all the way towards the toes. The plantar fascia is also called
the plantar aponeurosis.
The problem
Plantar fasciitis is a well recognised clinical condition. It is one of the commonest
forms of injury of the foot. Studies have demonstrated that it represents 1 out of 10
injuries related to running. In addition, almost 80% of patients who present to a clinic
with heel pain have plantar fasciitis.
Before delving into the causes of plantar fasciitis, it is worthwhile taking a brief look
at the anatomy and biomechanics of this structure.
Anatomy and biomechanics of plantar fascia

If one were to take a close look at their foot, it is evident that the foot is designed to
not only support the body but also to deal with the shock of constant pressure on it.
The skin over the foot is thicker than anywhere else in the body and underneath the
skin is plenty of fat tissue, especially under the heel. This provides a padding affect
when the heel is placed on the ground when walking or running. Also evident is that
the inner aspect of their foot is arched upwards. This arch is called the medial arch.
There is a purpose for this arch and that is to absorb the shock that the foot
experiences when it is placed down on the ground during walking and other similar
activities.
Most of us place our heel on the ground first, followed by the outer aspect of the foot
and then the inner aspect. The inner aspect bears the brunt of most of the weight of
our body. When the pressure is transmitted to the inner aspect of the foot, the
structures that are present there are stretched, and the main structure that
undergoes this stretch and strain is the plantar fascia. It should therefore come as no
surprise that the plantar fascia can undergo injury due to this constant stress.
On assessing the biomechanics of the foot in a bit more detail, it is evident from
various studies that one of the causes for plantar fasciitis is over pronation of the
foot. Over-pronation has already been described above and refers to when the inner
aspect of the foot is pressed on the ground a lot more than it should do when walking
or running. The reason for this is laxity of the foot arches or other foot abnormalities
such as varus deformities or difference in the length of the limbs. Over-pronation
places a lot of stress on the central band (discussed below) of the plantar fascia,
ultimately resulting in small tears, inflammation and plantar fasciitis (Lester DK
1984).
If we look at the anatomy of the plantar fascia closely, it would be evident that it is a
triangular shaped structure that begins with a thin attachment to the calcaneum. It
consists of three bands - a central band, an inner medial band and an outer lateral
band. As it traverses from the calcaneum towards the toes, it spreads out like a fan
and attaches at five different points of the fore- foot skin (the part of the foot where
the toes begin). Often, the plantar fascia is inflamed at the point where it is attached
to the calcaneum as this is its weakest point.
Under a microscope, a sample of the plantar fascia pain from a patient with plantar
fasciitis will demonstrate a great degree of inflammation along with a large number of
inflammatory cells. In addition, there is fibrosis of the tissue along with changes
suggestive of degeneration and cell damage.
However, the root cause of plantar fasciitis is not necessarily just stress. There are
other causes that can result in a painful foot due to plantar fasciitis. In addition, there
are certain individuals who are more at risk of developing plantar fasciitis. Let's take
a look at these causes and risks.
Risk factors for developing plantar fasciitis

There are certain risk factors that place an individual at a higher risk of developing
plantar fasciitis. Below are the common risk factors.
1. Age - Plantar fasciitis is common in individuals between the ages of 40 to 60

years.
2. Physical activity - Athletes are particularly prone to developing plantar fasciitis,

and undoubtedly this is due to the constant stress that they place on their feet. In
addition, people who enjoy aerobics and dancing can also be at risk of developing
this condition. The reason is fairly straightforward and involves the different stretches
and stresses that the plantar fascia needs to undergo during these activities. Of
course, it is important to bear in mind that not every person who participates in these
physical activities develops plantar fasciitis.
3. Sex - Research has shown that women are more likely to develop plantar fasciitis
when compared to men. The exact reason for this is not very clear.
4. Obesity - Being overweight is a well recognised risk factor for the development of
plantar fasciitis. In fact, 7 out of 10 patients with plantar fasciitis are obese
(Mohammad Ali Tahririan 2012), though this number is likely to be higher. There
does not appear to be any relationship between plantar fasciitis and a person’s
height.
5. Occupation - Individuals whose occupation involves them standing for long hours
or on their feet for prolonged periods of time are at higher risk of developing plantar
fasciitis. This can include long hours of housework as well!
6. Poorly fitting shoes - This is a well recognised risk factor. The arches of the foot
require adequate support at all times. Wearing shoes that do not provide this kind of
support can place a great degree of stress on the plantar fascia, resulting in foot pain
due to plantar fasciitis. High heels are notorious at placing stress on the Achilles
tendon and plantar fascia, causing pain. Shoes that offer insufficient cushioning to
the heel are also a risk factor for the development of plantar fasciitis.
7. Recent change in activity - This is yet another well-recognised cause. Individuals

who are used to one routine who have changed their regular activities can
sometimes develop plantar fasciitis. One such example is an individual who decides
to take up running as an exercise, and starts out with a hard run rather than taking it
easy for the first few days.
Causes of plantar fasciitis

There is no simple way to classify the causes of plantar fasciitis as they do not occur
in just one category. Nevertheless, to make it simple, we have just described what
we think are the important causes that can result in plantar fasciitis.
1. Bone spurs
Bone spurs are tiny projections that arise from a bone. In the foot, the calcaneum
bone is the one where the bone spurs arise from. Calcaneum spurs is a fairly
common condition that is seen in a number of individuals across the globe. It is not
evident clinically on examination of the foot but is usually seen when an x-ray of the
foot is performed. Research has shown that there is a strong link between the
presence of calcaneum spurs and plantar fasciitis. Some have argued that the
relationship between these two conditions is purely one of association and a direct
causal effect is yet to be identified (Johal KS 2012). Be that as it may, studies have
shown that at least 50% of patients diagnosed with plantar fasciitis have heel spurs
(DeMaio M 1993).
Nevertheless, it is essential to bear in mind that bone spurs are closely related to
plantar fasciitis. However, there are a number of individuals who suffer from bone
spurs who do not have plantar fasciitis and vice versa.
2. Flat feet
The absence of the medial arch can result in flat feet. As has been previously
discussed, the medial arch is essential as a shock absorber when the foot is placed
on the ground. When the medial arch is not present, the brunt of the stress is placed
on the structures within the foot and the plantar fascia is the one that bears most of
it. This can result in tiny tears and inflammation in the plantar fascia, causing plantar
fasciitis.
3. Over-pronation
Pronation refers to inward movement of the foot. Studies have demonstrated that
nearly 85% of patients who suffer from plantar fasciitis over-pronate their foot
(Cornwall MW 1999). However, the scientific evidence available is rather conflicting.

Is it standing in one place for prolonged periods of time that is the cause of plantar
fasciitis or is it undue stress caused due to over-pronation that is the cause? The still
remains unclear but appears that both of them may contribute to some extent.
4. High arched feet

This may come as a bit of a surprise given that flat feet are also a cause for plantar
fasciitis. The problem with high arched feet is that the arch is unable to bear the
stress and does not absorb the shock experienced by the foot during walking and
other activities. The bottom line is the degree of stress that the foot experiences. It
does not matter if one has flat feet or high arched feet; the trauma can cause plantar
fasciitis in both conditions. It is for this reason that detailed assessments of the foot
are required when considering various forms of conservative treatment.
5. Medical causes
Certain medical causes such as osteoarthritis and rheumatoid arthritis can result in
plantar fasciitis. Osteoarthritis is accompanied by the formation of bone spurs which
in turn (as has already been discussed) can cause plantar fasciitis. Of course, not
everyone who develops arthritis will have plantar fasciitis.
6. Change in the running surface

Some patients report the onset of plantar fasciitis after they have commenced
physical activity on a new surface. For example, some individuals who have been
running on grass may find that going for a jog on a concrete surface can bring on
pain in the foot. A change in the running surface has been identified as a cause for
plantar fasciitis. In addition, the changing intensity of the exercise can be a
contributing factor as well.
Clinical symptoms and signs

Now that we have taken a look at the risk factors and causes of plantar fasciitis, it
would be worthwhile discussing the different clinical symptoms that patients
experience and signs that can be elicited on clinical examination of patients with
plantar fasciitis.
The most common clinical symptom that patients complain of is heel pain. The pain
feels like a sharp knife is being pressed into the heel but some patients describe it as
a burning sensation. The descriptions throbbing, piercing and even searing pain
(Charles Cole 2005). On occasion, the pain can also extend through the rest of the
foot all the way up to the toes.
An important thing to recognise regarding pain in plantar fasciitis is the fact that it
often develops over a period of time. It is not something that occurs overnight.
Usually, it affects only one foot though in around 30% of cases both feet may be
involved (Roxas 2005).
Typically, the pain is at its worst in the early hours of the morning just after getting
out of bed. This is because throughout the night, the plantar fascia tends to contract
as the position of the foot is such that the tissues are not stretched (this is called an
equinus position). Patients may feel a sharp pain in the foot when they take their first
steps upon walking towards the bathroom (for this reason it is sometimes called ‘first
step’ pain). This can result in them having to hop or limp to the bathroom to avoid
placing any pressure on the heel. This specific feature of plantar fasciitis helps
differentiate it from conditions such as fracture of the calcaneum bone. Furthermore,
the pain in plantar fasciitis does not occur at night when the patient is asleep, which
differentiates it from clinical conditions such as infections and tumours.
The pain in plantar fasciitis usually resolves after a short period of time when the
muscles and the tissues in the foot have warmed up, but can return again later in the
day. Patients may also experience this pain when they have been stood for
prolonged periods of time. In addition, some individuals may develop symptoms
when they have been sat down for a while and decided to stand up.
The problem with pain in plantar fasciitis is that it can become a rather annoying and
distressing. In some individuals, it can have a significant impact on their activities of
daily living. Many have taken days off from work as well due to the pain. The onset of
symptoms can be related to certain triggers such as walking on an uneven surface or
prolonged periods of stress on the feet.
It is worthwhile bearing in mind that not everyone who suffers from heel pain suffers
from plantar fasciitis. When doctors have conducted a clinical examination, they
come up with what is called a differential diagnosis which is basically a list of
different conditions that could be the cause of the heel pain. Other causes of heel
pain can be injury to the bone such as a fracture, arthritis of the joints, inflammation
of the small pockets of fluid in the foot (called bursitis) and even injury to the muscles
and tissues. Rare causes of heel pain include bone tumours and calcaneum
apophysitis, though these conditions present themselves in younger age groups or
have different symptoms to the ones experienced by patients with plantar fasciitis.
The pain in plantar fasciitis can be rather stubborn. It is not unheard of where
patients with plantar fasciitis have had symptoms ongoing for a number of years.
This is mostly because they have either just lived with the pain or have spent most of
the time trying to figure out useless home remedies without seeking appropriate
guidance on managing the pain. Being well informed about this condition is key to
applying appropriate treatment strategies to ensure the pain from plantar fasciitis
bothers you no more.
On examination of the foot, it is possible to elicit pain on pressing the heel or the
middle of the foot. This is called tenderness and can be a rather characteristic
feature of plantar fasciitis. Some patients may find that the tenderness is worst on
the inner aspect of the calcaneal bone, and worse when the stands on their toes.
The Achilles tendon may also be quite tight, and any attempts to flex the ankle joint
in order to stretch the Achilles tendon maybe limited by 5° or more. This finding of
Achilles tendon tightness is seen in almost 8 out of 10 patients (Singh D 1997).
Diagnosis of plantar fasciitis

An accurate diagnosis of plantar fasciitis can aid timely and appropriate
management. In majority of cases, there is no need for any special tests to make a
diagnosis as the clinical history is often characteristic and unique. Obtaining detailed
history can help differentiate plantar fasciitis from other causes of heel pain such as
age-related fat pad degeneration of the heel, rupture on the plantar fascia and bone
tumours fairly easily.
Be that as it may, in some cases, further investigations may be required to ascertain

the cause and confirm the diagnosis of plantar fasciitis. An x-ray of the foot can help
identify the presence of any heel spurs, thickening of the plantar fascia or the
evidence of stress fractures or bone cysts in the foot. It can also help assess the
quality of the fat pad that lies beneath the heel. Ultrasound scans of the foot may
also be performed which can help determine the thickness of the plantar fascia. In
individuals who do not suffer from plantar fasciitis, the plantar fascia measures
between 2 to 3 mm in thickness. In plantar fasciitis, due to the accompanying
inflammation and swelling of the tissues, the plantar fascia is often more than 4 mm
in thickness (Hossain M 2011). Studies have shown a strong correlation between
improvement in symptoms from plantar fasciitis and a reduction in the thickness of
the plantar fascia (Wearing SC 2007). This is a fairly diagnostic feature of plantar
fasciitis.
Other complex investigation such as MRI scans are not particularly useful in making
a diagnosis of plantar fasciitis, but the instant helpful in ruling out other causes of
keeping such as bone tumours, stress fractures and osteomyelitis. Advanced
scanning methods such as isotope scanning have reported an increase in the uptake
of isotope dye by the affected plantar fascia. However, this test did not effectively
differentiate plantar fasciitis from fracture of the calcaneum bone (Williams PL 1987).
Treatment of plantar fasciitis

Many patients who suffer from plantar fasciitis often wonder whether or not there is a
suitable treatment that will get rid of their symptoms completely. Many are even
concerned that plantar fasciitis requires complicated treatment regimes such as
surgery. It is good to know that most cases of plantar fasciitis tend to resolve
themselves over time. However, this time period varies between patients and can
take up to 18 months or even longer to resolve completely (Craig Young 2001). The
best way to treat plantar fasciitis effectively is to recognise the condition early on and
commence treatment strategies at home that are easy to perform and are safe and
effective.
The key to any home remedy is determination and perseverance. It is

understandable that as a patient you find it very hard to cope with plantar fasciitis at
home. It is important to believe in yourself that you will manage this condition
effectively at home and the rest will eventually fall into place.
In this book, we shall concentrate particularly on the remedies and exercises that
can be performed at home by individual suffering from plantar fasciitis. However, we
recommend that before performing any form of exercise, you visit your doctor for a
full health check up to ensure it is safe for you to go ahead.
1. R.I.C.E
This form of treatment stands for Rest, Icepack application, Compression and
Elevation. It forms the most basic management step of plantar fasciitis at home and
should be the first step of management in acute cases of plantar fasciitis.
In the event of pain occurring when walking or when exercising, the individual must
stop and take rest until the pain subsides. Studies have shown that a quarter of the
patients who suffer from plantar fasciitis find that the rest is the best treatment
(Wolgin M 1994). It can take a few minutes for the pain to subside and if one is out
running, patients are asked to walk back home so that they can rest their feet on
their return.
Patients who have significant symptoms from plantar fasciitis are advised to take 3
to 5 days of continuous rest. Your body will tell you whether or not you require more
rest so if the pain is continuous and has not subsided despite rest and icepack
application, a further period of rest may be required. Any activity that can cause
stress of the calf muscles and plantar fascia must be avoided. Given that plantar
fasciitis is a common condition in athletes and people were constantly on their feet, it
is understandable for them to have difficulty in taking prolonged periods of rest as
recommended. Remember, without rest, the plantar fasciitis will continue to get
worse to a point where individuals might find it difficult to even walk short distances
or more around the house. So make sure you make time and get the rest you
deserve.
If available, an icepack must be applied to the under surface of the foot to help
relieve inflammation and reduce pain. Ice packs are best used by applying them on
the plantar fascia at least 20 to 25 times a day for 3 to 5 days. This high-frequency is
recommended as many people live an active life and cannot afford to take prolonged
periods of rest. Try not to apply the ice directly to the skin as this can cause damage
to the skin. Instead, wrap ice in a towel on place it in plastic cup and apply this to the
painful plantar fascia. Do not apply the ice packs for prolonged periods of time either.
Some individuals find that applying an icepack first thing in the morning can help
reduce the pain from plantar fasciitis. If your symptoms are bad, try and ensure that
you carry ice with you or have easy access to it so that you can ice your foot at any
time you wish.
Applying a tight compression bandage around the foot places the plantar fascia
under constant stress and in a stretched state, making it less likely to hurt when
walking. Compression bandages must be applied carefully so that they stretch the
plantar fascia but do not compromise the flow of blood to the foot. Sometimes, it is
worthwhile asking a physiotherapist to apply the compression bandage first so that
you get an idea as to how it is done.
If there is any accompanying swelling, patients are asked to keep their foot elevated
above the level of their hip for a short while as this can help bring down the swelling.
This can be done fairly easily at home by using a couple of pillows under the feet
when asleep.
2. Stretching
Stretching is an important and useful exercise in managing plantar fasciitis.
Stretching can involve just the plantar fascia or even the calf muscle. In fact, clinical
research has confirmed the benefits of calf stretches in managing patients with
plantar fasciitis (Shazia A 2011).
There are a variety of exercises that can be performed that can adequately stretch
the both the plantar fascia and the calf muscle. Research by Porter et al has
suggested that stretching the calf muscles three times a day for 3 minutes at a time
can be very effective (Porter D 2002). This is because the Achilles tendon, which is a
continuation of the calf muscles, is directly attached to the plantar fascia at a
common point on the calcaneum bone. Stretching the calf muscle will stretch the
Achilles tendon and consequently stretch the plantar fascia. In fact, in the early
stages of plantar fasciitis, stretching has been found to be more effective than
subjecting the plantar fascia to other treatment measures such as extracorporeal
shockwave treatment (Rompe JD 2010).
The main benefit of stretching is that it helps reduce the tightness of the calf muscle
complex (consisting of the gastronemius and soleus muscle). Studies have shown
that over 80% of patients who undergo stretch therapy for complete relief of their
symptoms, with many of them finding it better than using painkillers, ice application,
night splints and even a change in shoes (Wolgin M 1994). Stretching also
strengthens the deeper muscles within the foot. Some simple exercises that can help
stretch the calf muscle and plantar fascia are discussed below.
a. Wall exercises
Stand facing the wall and using it as support, extend the leg backwards. Lunge
forwards and when doing so make an attempt to touch the heel to the ground. This
stretches the calf muscle and the plantar fascia.
Hold this position for at least 30 seconds and perform this exercise 4 to 5 times for
each foot. The good thing about this exercise is it can be performed anywhere as
long as there is a wall to support you.
b. Stretch using a block of wood or a brick

Place a 2 to 3 inch thick block of wood or brick in front of your legs on the ground.
With your heels firmly on the ground, lift your toes up and placed them on the block
of wood or brick. Once you have done this, gently lean forward ever so slightly. This
will stretch the calf muscle and the plantar fascia.
Hold this position for 30 seconds and perform 4 to 5 sets of this. The benefit of this
exercise is that the calf muscles of both the legs can be exercised simultaneously.
c. Stretch using a tin can or tennis ball

If you have a tin of soup or baked beans lying around, place it on the ground
horizontally so that you can roll it using the under surface of your foot. This offers a
dynamic stretch to the plantar fascia, balancing pressure across its entire length.
Move your foot back and forth on the surface of the can to ensure adequate
stretching. This can be done when sitting down at an office desk or in the comfort of
your own home.
10 to 15 repetitions i.e. back and forth motions will help relieve pain and offer
adequate stretch of the plantar fascia. The same exercise can be performed by
placing the foot on a tennis ball rolling the tennis ball forwards and backwards while
applying pressure on it.
d. Towel stretching
Set yourself on the ground or on a long sofa with your legs stretched out pass
it around the under surface of your foot. Grab both the ends of a towel and pass it
around the under surface of your foot. Gently pull the towel towards you and this
should pull the foot towards you as well.
In doing so, the plantar fascia and the arch muscles and tendons are gently
stretched. Hold this position for at least 30 seconds and perform 5 to 10 repetitions
of this.
e. Stretching using a wobble board

Place a wobble board on the ground and rest your foot on it. Gently rock the
wobble board to the left and right and this should offer a good deal of stretching of
the ankle.
Make sure that the foot is held in each position for at least 30 seconds. For
best results, anywhere between 5 - 10 repetitions of this must be conducted.
f. Slant board stretches

A slant board is similar to using a brick or piece of wood to stretch the calf
muscle and plantar fascia. Place a slant board by the wall and the rest your feet on
it. When you do this, the foot is in a position where the calf muscles are under
continuous stretch as is the plantar fascia.
Hold this position for 30 seconds and perform 10 - 15 repetitions of this.

g. Staircase stretches
This is a simple stretching exercise that can be performed at home. Place
your toes at the edge of a staircase that and gently allow your heel to drop below the
level of your toes. This will gently stretch the calf muscles and Achilles tendon along
with the plantar fascia.
Hold this position for 30 seconds and perform 5 to 10 repetitions of this. Both
calf muscles and plantar fascia stretches can be performed simultaneously with this
exercise. It is probably the easiest to perform as it can be done literally anywhere
there is a staircase. If there is no staircase nearby, a suitable replacement is using a
brick or wooden block or even the edge of a sidewalk.
f. Towel curl
Another form of stretching exercise is the towel curl. In this exercise, the
patient places a small towel on a smooth floor. Keeping the foot flat, the toes are
placed on the towel and an attempt is made to grasp the towel and pull it towards the
patient using the toes alone. The heel should be kept firmly on the ground.
This exercise helps not only stretch the plantar fascia but it also helps contract
the plantar fascia and the muscles within the foot, thus warming them up and
preventing any pain when walking. This exercise is best performed first thing in the
morning as soon as a patient gets out of the bed. Only around 5 to 10 repetitions of
this exercise is required to sufficiently warm up the plantar fascia and allow the
patient to walk comfortably in the morning.
g. Dorsiflexion of toe stretch

This is another form of stretching of the plantar fascia that is fairly effective.
Sit comfortably on a chair and cross your legs so that you have easy access to your
foot affected by plantar fasciitis. Gently grasp your toes and pull them in an upward
direction toward your shin, keeping the foot fixed in position. This will stretch the
plantar fascia adequately. Keep this stretch for at least 30 seconds and perform 5 to
10 repetitions of this in each foot.
The main benefit of stretching exercises is that they can be performed literally
anywhere. It does not matter if the individual has a busy job but is just out for a walk,
there are a variety of different stretching exercises that they can perform that can
adequately stretch the calf muscles and the plantar fascia and relieve the pain they
are experiencing due to plantar fasciitis.
In some patients, stretching of the plantar fascia can be achieved by a gentle

massage. This type of massage treatment is called cross-friction massage
(discussed later). This is a simple technique where two fingers are placed on the
under surface of the foot against the plantar fascia and the fingers and run up and
down along the course of the plantar fascia with considerable pressure being applied
on it. This stretches the plantar fascia and also massages it at the same time, thus
increasing the amount of blood that flows through it and promoting healing.
As is seen above, there are a number of different stretching exercises that

can be performed in the comfort of your own home. It is ultimately up to you which
one of them you wish to perform. It is recommended that you perform at least two or
three different varieties of stretching exercises in combination with strengthening
exercises described below. Doing so will keep the plantar fascia guessing, keep the
blood flow to the plantar fascia and intrinsic muscles of the foot active and will
effectively reduce inflammation and pain within the foot. Ultimately, this will help the
patient mobilise normally without the worry of a stinging or sharp pain in the foot.
3. Strengthening exercises
Within our foot are tiny muscles called intrinsic muscles of the foot. These
muscles are responsible not only for the various movements but also to maintain the
structure and integrity of neighbouring tissues. There is a close relationship between
the intrinsic muscles of the foot and the plantar fascia. In order to keep the foot
muscles active and functioning within normal limits, strengthening exercises are
important. Strengthening exercises are essential to build up the strength the muscles
within the foot in order to prevent them from getting injured. Broadly classified,
strengthening exercises can be either non-weight bearing or weight-bearing.
a. Non-weight-bearing exercises
Circumduction refers to a rotatory motion. Ankle circumduction is a commonly
performed non-weight-bearing exercise. Here, the individual is asked to move the
ankle in every direction possible, ordinarily in a circular manner. This range of motion
exercises should be conducted three times a day. It strengthens the ankle joint and
reinforces the foot muscles, also reducing the amount of stress and tightness that
the muscles and tissues may inherently have.
Another non-weight-bearing exercise is attempting to write the alphabet in the

air using the toes. This stimulates the foot muscles and tissues to move in different
directions, thus strengthening it.
An additional way to strengthen the inner muscles of the foot and the plantar fascia
is to perform a ‘toe squeeze’. Here, the individual is asked to sit on the ground with
their legs stretched out in front of them. All the five toes are then squeezed together
and held for five seconds. The toes are then relaxed and fanned out for another five
seconds. This is repeated 10 times and is performed at least three times a day. This
exercise primarily strengthens the intrinsic muscles of the foot.
Finally, another strengthening exercise is marble picking. Patients are asked to pick
up marbles that are on the floor using only their toes and put them into a small
container. Doing so increases the strength of the foot muscles and the plantar fascia,
making it less susceptible to injury and inflammation.
As is the case with stretching exercises, it is always best to perform more than
one type of strengthening exercise at a time. Doctors recommend combining both
stretching and strengthening exercises in the same sitting as this can have a more
beneficial effect on reducing inflammation and pain in plantar fasciitis.
b. Weight-bearing exercises
We have already briefly touched upon weight-bearing exercises above. It
does not involve lifting weights of any sort but in fact involves stimulation of the
muscles of the foot by exercises that would make the muscles feel like they were
lifting a weight. The staircase stretches are weight-bearing exercise that can help
strengthen the intrinsic muscles of the foot and the plantar fascia. Similarly, the towel
curl is another exercise that can help strengthen the muscles.
4. Stability exercises
Stability exercises help strengthen the plantar fascia and also the abdominal
wall muscle groups. It offers consistent and constant pressure on the plantar fascia,
thus helping strengthen it and reduce inflammation. The exercise is very simple and
involves the individual attempting to stand on one leg with the opposite knee bent
and the body kept in a straight and upright position. It may be worthwhile standing
close to a wall or some form of support just in case of loss of balance.
Hold this position for up to 30 seconds and perform anywhere between 5 to

10 sets of this. Attempting to close the eyes can make this a bit harder but is worth
trying once you have got used to the exercise.
5. Cross friction massage

Cross friction massage is a special type of massage that is useful in
managing plantar fasciitis. The technique is simple and just involves using two
fingers to rub the plantar fascia up and down.
When starting out the massage, be gentle; if the plantar fascia is inflamed,
then cross friction massage can cause pain. As you get used to the initial massage,
try and become a little more aggressive, increasing not just the pressure but also the
speed at which you are massaging the plantar fascia. Relief does not occur
immediately and can take a few days, as long as the procedure is performed on a
regular basis. If the pain is unbearable then try and avoid performing cross friction
massage and attempt to perform other stretching exercises instead.
6. Arch raises
An arch raise is a procedure where an attempt is made to elevate the arch of
the foot using the fingers.
As we have already discussed previously, one reason why plantar fasciitis

occurs is because the arch fails to support the foot and offer the required shock
absorbing capacity that it normally should do.
Arch raises are fairly simple to perform at home. In a seated position, place
your foot firmly on the ground and use your fingers to reach under the arch of the
foot. Using the force of your fingers, attempt to lift the arch upwards while keeping
the toes and heel firmly in place. Hold this position for a few seconds and then
release slowly. Ideally, this exercise must be repeated at least 10 times to be of
some benefit.
Arch raises can be also performed with the help of arch supports. These are
supports that help keep the arch elevated and reinforce its shock absorbing capacity.
However, these have to be custom made in order to obtain the maximum benefit.
That being said, many patients have found those orthotics sold over-the-counter at
pharmacies that are not custom-made are of benefit to them and can relieve their
symptoms in most cases. It is worthwhile trying these over-the-counter arch supports
initially to see whether or not they can help with the symptoms. If no relief is
obtained, it may be worthwhile getting custom-made ones as these can raise the
arch sufficiently and prevent all the force that is placed on the foot during running or
walking from falling directly on the plantar fascia. Custom-made heel inserts are
available from podiatrists or from healthcare professionals. They require foot
measurements to be taken and can take a short while to be manufactured.
7. Orthotic devices
While conservative treatment options are the best way to manage plantar
fasciitis, in some cases additional options may need to be considered. One such
treatment that is available to patients with plantar fasciitis is orthotic devices. Orthotic
devices are specific devices that can help alter the biomechanics of the foot in a way
that the functioning of the foot muscles and the plantar fascia returns to the normal
physiological state. They are readily available these days, though in many cases
custom made orthotic devices may need to be considered as every patient’s
requirement is different. In particular, orthotic devices are believed to be more useful
for patients who are overweight as they not only help absorb the shock but also help
redistribution of weight over the entire plantar fascia (Batt ME 1996).
Foot orthotic devices are primarily designed to prevent them from over-
pronating. By doing so, they reduce the amount of force and trauma that the plantar
fascia experiences during movements such as walking and running. Orthotics can be
designed to support the heel or can be fabricated to support the foot arches. They
are made of a viscoelastic polymer or foam. Research that has been conducted in
patients with plantar fasciitis has shown that custom made orthotics can reduce the
amount of pain experienced in the heel and can improve the overall function of the
foot (Lee SY 2009). However, additional studies have also shown that orthotic
devices may be of additional benefit when used along with night splints. In athletes,
studies have shown that the use of orthotic devices for plantar fasciitis improved their
symptoms in more than 7 out of 10 cases (Gross ML 1991).
There are various kinds of food orthotics that are available these days. Heel
cups are over-the-counter orthotic devices that provide cushioning to the heel and
reduce the amount of pain and inflammation by decreasing the degree of trauma the
heel experiences when walking. Full length shoe insoles are now available which
have an elevated inner edge. This elevation helps increase the medial arch of the
foot, thus returning it to its natural position. In this position, any stress that is placed
on the foot will be transmitted through the arch in an appropriate manner so as to
absorb the shock and prevent any damage to the plantar fascia.
As previously mentioned, orthotics can be combined with the use of night

splits. Night splints are prefabricated splints that are worn by the patient at night
when asleep. They hold the foot in a position where the plantar fascia is under
constant stretch. This prevents the plantar fascia from tightening thus reducing the
pain that the patient may experience first thing in the morning. It is recommended for
patients who have plantar fasciitis to wear a night splints at night and wear custom
made orthotics during the day. This combination can keep inflammation at bay and
can promote healing and prevent plantar fasciitis from developing again in the future.
Despite the availability of orthotic devices, it is essential that conservative

treatments such as stretches and strengthening exercises be the first line of
treatment. These have been proven to be effective in many cases and should not be
discarded in any way.
8. Dietary modifications
It may be surprising to hear that there are certain nutritional aspects relevant
to the development of plantar fasciitis. In fact, ensuring that the body gets the
required vitamins and minerals in the right proportions can help treat plantar fasciitis.
Here, we shall take a quick look at this.
a. Zinc
Zinc is an essential mineral that plays an important role in numerous
enzymatic reactions within the body. Studies have shown that when a tissue is
wounded, zinc plays an important role in preparing and regenerating the tissue,
helping it heal fast and bringing its strength back to normal (Kaplan B 2004). Low
levels of zinc in the bloodstream can be seen in individuals who are highly stressed
and who have suffered from a number of different injuries throughout their lifetime. In
addition, individuals who over exert themselves by performing too much exercise
tend not to be able to use the zinc that is there in their body appropriately. While
specific research has not been conducted in plantar fasciitis, the concept that zinc
supplementation can in fact help heal tissues would imply that taking zinc
supplements in the recommended doses can regenerate the plantar fascia and
reduce inflammation, thus relieving pain. These days, supplements are readily
available in pharmacies. Always make sure that you speak to your health care
professional before taking any type of supplements.
b. Vitamin C
Vitamin C is a powerful antioxidant and is present in citrus fruits in good
quantities. Within the body, vitamin C acts as a catalyst in the formation of
procollagen, which is a precursor of collagen. Collagen is a major component in
various tissues. Low levels of vitamins C can affect the structure of collagen, making
it weak and reducing its strength. Collagen is present in plantar fascia and in the
presence of low vitamin C levels the plantar fascia can become weak and prone to
injury and inflammation. Studies have demonstrated that regular consumption of
vitamin C at doses of 1 to 3 g per day can help repair tissues (Kelman Cohen 1992).
Vitamin C supplements can be obtained at supermarkets or in pharmacies or natural
vitamin C can be got from consuming citrus fruits.
c. Glucosamine
From the available research regarding plantar fasciitis, glucosamine seems to have
benefits in patients. In particular, a number of different studies have compared
glucosamine to painkillers such as non-steroidal anti-inflammatory drugs. However, it
is important to bear in mind that these comparative studies did not look at plantar
fasciitis alone but also studied the effects on osteoarthritis, which is a known risk
factor for the development of plantar fasciitis. The underlying principle is fairly simple
and involves the effect of glucosamine in promoting repair and regeneration of the
tissues. Glucosamine forms an important part of hyaluronic acid, which is present in
joints and tissues all over the body. In addition, it promotes the synthesis of collagen
as well. Taken at a dose of 500 mg three times a day, it has been shown to be of
benefit in managing plantar fasciitis. Once again, before taking any form of
medication, please make sure that you consult your healthcare professional and
obtain the right advice to ensure that this is the right treatment for you.
d. Fish oils
Oily fish such as salmon, sardines, tuna and mackerel are rich in omega-3 fatty
acids. These fatty acids have been shown from numerous studies to have anti-
inflammatory effects. They exert these effects by blocking the production of
inflammatory molecules in the body such as leukotrienes and tumour necrosis factor.
In simple terms, omega-3 fatty acids present in fish oils prevent inflammation of the
plantar fascia that can occur in plantar fasciitis. Recommended doses are between 2
to 3 g per day. In those individuals who do not consume fish, omega-3 supplements
are now readily available in the form of soft gelatin capsules at pharmacies or in
supermarkets.
e. Bromelain
Bromelain is a type of enzyme that breaks down proteins. It is useful in promoting
healing when there is damage to blood vessels and formation of bruises and
haematomas (Blonstein 1969). In particular, they have powerful anti-inflammatory
properties which make them very useful in treating plantar fasciitis. The
recommended dosage lies between 500 mg to 2 g a day, taken in divided doses
(Roxas 2005).
While supplements are readily available these days, it is always better to try and
obtain the above nutrients through regular diet. For example, obtaining omega-3 fatty
acids can be fairly straightforward if one were to consume at least three portions of
oily fish every week. Case studies have been published where patients have
developed features suggestive of plantar fasciitis due to the development of bone
spurs. These patients have low levels of vitamin D in their body. Vitamin D is
essential for maintaining the structure and integrity of bones and cartilage in the
body. The underlying mechanism is believed to be that low vitamin D levels can
result in softening of bones; a condition called Osteomalacia. Osteomalacia can
cause weakening of the small muscles within the food and can soften the calcaneum
bone, making it more vulnerable to excessive stress. This stress is then transferred
onto the plantar fascia, resulting in inflammation and injury and subsequent plantar
fasciitis (EW Paice 1987).
Instead of taking zinc supplements, foods that contain zinc can be consumed. Zinc is
rich in foods such as red meat, pumpkin seeds, turkey, green peas and yoghurt.
Mushrooms and spinach are also an excellent source. Vitamin C is present in high
quantities in citrus fruits such as orange and grapefruit, red sweet peppers,
strawberries and brussels sprouts. There do not appear to be natural sources of
glucosamine as the ones that are available are inedible (e.g. shells of crustaceans).
However, there are products available that are fortified with glucosamine these days
such as fruit juices. It would be best to take over-the-counter supplements of
glucosamine once you have consulted with your physician.
It is important to recognise that supplements by themselves do not treat plantar

fasciitis. Individuals require combination treatments to include stretching and other
treatment modalities that can help work in conjunction with each other and offer relief
from symptoms and recovery from inflammation.
9. Chiropractic manipulation
When it comes to alternative treatments that adopt a conservative approach to
managing plantar fasciitis, chiropractic manipulation comes to mind. Chiropractics is
the practice of manipulation of tissues and bones in order to realign them and restore
normal functioning. In patients with plantar fasciitis, a chiropractor can manipulate
the position of the calcaneum bone in order to relieve the amount of stress that the
plantar fascia undergoes on a regular basis. Its benefit has been reported in case
studies but not in large randomised controlled trials. A chiropractor will still offer
advice such as ice application, wearing the right footwear and performing different
stretches and strengthening exercises so it may well be that the chiropractic
treatment options are similar to the conservative treatment options described above.
There are some reports that manipulation of the spine can help improve the flow of
nervous impulses down to the foot and the plantar fascia and this can help relieve
pain and reduce inflammation. However, this is mostly based on anecdotal reports
and is not backed by scientific studies as such.
10. Acupuncture
Some believe that acupuncture plays a role in the management of plantar fasciitis.
However most of the evidence that is available to support this is only anecdotal and
is not backed by solid scientific studies. However, whatever evidence is available,
though limited, has shown promising results. In most cases, acupuncture needs to
be combined with more complex therapies such as electrical stimulation in order to

be effective.
Prevention of plantar fasciitis

So far, we have touched upon the various home remedies and conservative
management strategies that can be used to treat plantar fasciitis. However, the
prevention is better than cure. There are certain steps that can be followed that can
help prevent plantar fasciitis or can even help prevent recurrence once the condition
has been treated. Below are some of the ways that this can be achieved.
a. Choose appropriate footwear

It is well recognised fact that wearing high heels can result in plantar fasciitis.
Instead, make sure that you wear footwear that supports the arches of the foot and
provides comfort and cushioning to the heel of the foot. This is particularly important
if you have a job that requires you to stand for long hours. Making sure that the foot
is relaxed and not under constant stress is probably the most important step to take
to prevent plantar fasciitis. Also, try not to walk barefoot on hard surfaces.
It may be interesting to hear that our feet swell to their largest size later on in the
day. It is therefore advised that when purchasing footwear, try and buy them in the
afternoon. It is also important to bear in mind that our feet are not typically
symmetrical; one foot may be slightly larger than the other. It is therefore not
uncommon when trying on shoes that one shoe feels a lot more comfortable than the
other one. Make sure that the shoes you purchase are comfortable for the larger
foot. The tips of your toes should be able to move comfortably within the shoe and
the soles of the shoe need to be very flexible. These days, sports shoes are
specifically designed to offer medial arch support and heel cushioning. If required,
custom-made insoles are available to offer additional support.
Many sports shops now have system where they monitor the way the foot is placed
on the ground in order to assess whether or not there is over pronation. If it is clearly
evident, custom shoes can be offered to the individual that will provide sufficient arch
support. This can prevent trauma to the plantar fascia and subsequent plantar
fasciitis. Using laced sport shoes is better than wearing open sandals (Singh D
1997).
b. Keep your weight ideal

Obesity is a risk factor for the development of plantar fasciitis. Following a strict diet
and exercise plan can help keep the weight down and maintain an ideal body weight.
Keeping the body weight within the recommended limits can reduce the amount of
stress that the plantar fascia undergoes when walking or during physical activity.
While a discussion regarding bringing the weight down seems rather straightforward,
it is not surprising patients who are overweight and suffer from plantar fasciitis find it
difficult to perform exercises that will help reduce their body weight. However,
exercises such as swimming, cycling and cross training do not place any stress on
the plantar fascia and can be easily performed. As long as the exercise routine is
accompanied by a healthy diet, achieving weight loss goals should be fairly easy.
The American Heart Association recommends at least 150 min of exercise a week.
The type of exercise should be of moderate intensity and they do recommend
aerobics as one form of exercise. However, it is understandable that in patients with
plantar fasciitis, this may not be possible due to the pain they experience in their
feet. As mentioned above, there are a variety of other exercises that one can
perform in order to obtain the required weekly recommended exercise.
c. Get your rest

This is very important. If you find that your heel is painful when you are exercising, it
could be that you have plantar fasciitis. Make sure that you take adequate rest to
allow this to heal. During that time, you can take up different exercises that do not
place as much strain on the foot. Some of these include swimming and cycling. If
your body tells you that you need to take some rest to get rid of the pain, there is a
wise decision to listen to what your body is telling you! Make sure you get sufficient
amount of sleep at night as this is the time when the muscles relax and any injured
tissues regenerate. If using night splints, make sure you wear them every night
before you retire to bed. Rest is one of the most important treatments along with
stretching. Without rest, the plantar fascia does not have sufficient time to heal and
the constant stress can only make the symptoms worse. If you are having trouble
sleeping due to the pain, have a chat with your health care professional to see if any
painkillers can be prescribed to help manage the pain.
Prognosis of plantar fasciitis

The general prognosis of plantar fasciitis is very good. If left untreated, most cases
resolve within a year or two years. However, waiting this long can be rather
distressing to the patient and commencing conservative treatment options will
dramatically reduce healing time. In most cases, as long as adequate stretches and
conservative therapies are followed as prescribed, the likelihood of plantar fasciitis
returning is low. Once treated, patients can return the normal lives and lead a good
quality of life.
Conclusion
Plantar fasciitis is an extremely common condition. Unfortunately, it brings with it

symptoms that can be rather distressing to the individual. Pain is the most common
symptom and is typically described as a stabbing or sharp pain going through the
foot. The majority of cases of plantar fasciitis are self-limiting; meaning that over 80%
of them resolve by themselves within a year to 2 years, regardless of therapy.
However, in patients in whom the symptoms are troublesome, there are various
conservative treatment options that can be utilised to help relieve the symptoms and
hasten healing time. Rest is the most important aspect of treatment, followed by
various exercises that can stretch the plantar fascia, increase its blood supply and
relieve the inflammation by promoting healing. A combination of rest along with
stretching and strengthening exercises can effectively reduce inflammation and
manage pain in plantar fasciitis. However, various lifestyle modifications need to be
observed as well in order to reduce the amount of strain that the plantar fascia
undergoes during daily activities. While painkillers may help, there are alternative
supplements that can be used that can offer similar benefits.
At the end of the day, there are always options available to patients with plantar
fasciitis and many of these options come down to the patient's willingness to stick
with the different treatments. By following the advice given in this book, along with
the advice offered by your healthcare professional, it is possible to get over plantar
fasciitis completely and get back to leading the life you enjoyed in a very short time
span.
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What is plantar fasciitis? ....................................................................................................... 6

Anatomy and biomechanics of plantar fascia ........................................................................ 7

Risk factors for developing plantar fasciitis............................................................................ 9

Causes of plantar fasciitis ................................................................................................... 10

1. Bone spurs .................................................................................................................. 10

2. Flat feet ....................................................................................................................... 10

4. High arched feet .......................................................................................................... 11

5. Medical causes ............................................................................................................ 11

6. Change in the running surface ..................................................................................... 11

Clinical symptoms and signs ............................................................................................... 11

Diagnosis of plantar fasciitis ................................................................................................ 13

Treatment of plantar fasciitis ............................................................................................... 15

a. Wall exercises .......................................................................................................... 19

b. Stretch using a block of wood or a brick ................................................................... 20

c. Stretch using a tin can or tennis ball ......................................................................... 21

d. Towel stretching ....................................................................................................... 22

e. Stretching using a wobble board .............................................................................. 23

f. Slant board stretches ................................................................................................ 24

f. Towel curl ................................................................................................................. 26

g. Dorsiflexion of toe stretch ......................................................................................... 27

3. Strengthening exercises .............................................................................................. 28

a. Non-weight-bearing exercises .................................................................................. 28

b. Weight-bearing exercises ......................................................................................... 31

4. Stability exercises ........................................................................................................ 32

5. Cross friction massage ................................................................................................ 33

6. Arch raises .................................................................................................................. 34

7. Orthotic devices ........................................................................................................... 35

8. Dietary modifications ................................................................................................... 36

9. Chiropractic manipulation ............................................................................................ 39

10. Acupuncture .............................................................................................................. 39

Prevention of plantar fasciitis .............................................................................................. 41

a. Choose appropriate footwear....................................................................................... 41

b. Keep your weight ideal ................................................................................................ 41

c. Get your rest ................................................................................................................ 42

Prognosis of plantar fasciitis................................................................................................ 43

What is plantar fasciitis?

Anatomy and biomechanics of plantar fascia

Risk factors for developing plantar fasciitis

1. Age - Plantar fasciitis is common in individuals between the ages of 40 to 60

2. Physical activity - Athletes are particularly prone to developing plantar fasciitis,

7. Recent change in activity - This is yet another well-recognised cause. Individuals

Causes of plantar fasciitis

(Cornwall MW 1999). However, the scientific evidence available is rather conflicting.

4. High arched feet

6. Change in the running surface

Clinical symptoms and signs

Diagnosis of plantar fasciitis

Be that as it may, in some cases, further investigations may be required to ascertain

Treatment of plantar fasciitis

The key to any home remedy is determination and perseverance. It is

b. Stretch using a block of wood or a brick

c. Stretch using a tin can or tennis ball

e. Stretching using a wobble board

f. Slant board stretches

Hold this position for 30 seconds and perform 10 - 15 repetitions of this.

g. Dorsiflexion of toe stretch

In some patients, stretching of the plantar fascia can be achieved by a gentle

As is seen above, there are a number of different stretching exercises that

Another non-weight-bearing exercise is attempting to write the alphabet in the