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Plantar fasciitis is a very common and surprisingly debilitating condition that may take 12 to 36 months (typically 2 years) to resolve spontaneously.
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Avoid standing for long periods if possible.
Rest from long walks and running.
Try to cope without injections.
Keep the heel ‘cushioned’ by wearing comfortable shoes and/or inserts in shoes.
Surgery is rarely required and is not usually recommended. Excision of the calcaneal spur is advised against.
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Obtain good, comfortable shoes with a cushioned sole (e.g. Florsheim ‘Comfortech’; sporting ‘runners’).
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Examples of orthotic pads:
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Viscospot® orthotic
Rose insole
an insole tailored by your podiatrist
a pad made from sponge or sorbo rubber placed inside the shoe to raise the heel about 1 cm. A hole corresponding to the tender area can be cut out of the pad to avoid direct contact with the sole (Fig. 7.7).
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The following tips have proved very useful for patients.
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Hot and cold water treatment
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The patient places the affected foot in a small bath of very hot water and then a small bath of cold water for 20 to 30 seconds each time. This is continued on an alternating basis for 15 minutes—preferably twice a day and best before retiring at night.
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Therapeutic foot massage
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Commercial electrical foot hydro-massagers are available at low cost and are recommended for patients with plantar fasciitis.
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Most foot surgeons now recommend regular stretching exercises as the basis of effective treatment. The aim is to allow the plantar fascia to heal at its ‘natural length’. Stretching should be performed at least 3 times or more if manageable a day. It is recommended to perform at least 2 of the following exercises.
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Exercise 1: sitting position stretch
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Sit on a bed with both legs straight out in front of you and your hands on your knees.
Using a rope towel or cord looped around the foot, pull the foot back and point your toes towards your head, bending the foot upwards at the ankle (Fig. 7.8a). The more effort you put into the motion, the better the stretch will be.
Hold the position for as long as possible (at least 30 seconds). Repeat several times.
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Stand on a stair, with the ball of your foot (or feet) on the edge of the stair, and keep your knees straight.
Holding the rails for balance, let your heels gently drop as you count to 20. Do not bounce (Fig. 7.8b). You should be relaxed, and no active muscle contraction should be necessary in your leg.
Lift your heels and count to 10.
Repeat the cycle twice. You will feel tightness both in the sole or heel of the foot, and at the back of the leg (as the Achilles tendon is also stretched).
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Stand against a solid wall with your painful foot behind you and the other foot closer to the wall (Fig. 7.8c).
Point the toes of the affected foot towards the heel of the front foot. Keep the knee of the painful foot straight and the painful heel on the floor.
Bend the front knee forward—you will feel the Achilles tendon in the painful foot grow tight.
Count to 20, then relax for a count of 10.
Repeat the cycle twice.
Change over the position of each foot and repeat the program to stretch the opposite Achilles tendon.
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You must be wearing flexible sole shoes for this exercise.
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Stand against the wall with your good foot behind you and the painful foot jammed into the juncture of the wall and floor (Fig. 7.8d).
Bend the knee of the front leg, which will bring it towards the wall. You will feel that both the Achilles tendon and the tissue on the sole of the foot (plantar fascia) are being stretched by this exercise.
Count to 20, then relax for a count of 10.
Repeat the cycle twice.
Change over the position of each foot and repeat the program to stretch the opposite side.
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Strapping for plantar fasciitis
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Strapping of the affected foot can bring symptomatic relief for the pain of plantar fasciitis. A few strapping techniques can be used but the principle is to prevent excessive pronation, create a degree of inversion and reduce tension on the origin of the plantar fascia by compressing the heel. Use non-stretch sticking tape about 3–4 cm wide.
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Start with the tape on the lateral side of the dorsum of the foot (Fig. 7.9a).
Run the tape in a figure-of-eight configuration to include the sides of the heel but squeeze the heel from the sides to make a ‘pad’ immediately before applying and fixing the tape.
Repeat twice (Fig. 7.9b).
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If reinforcement is desired, a U-shaped strip of tape can be applied to the sides of the foot—from the neck of the metatarsals on one side to the other. Also, a strip of holding tape can encircle the foot.
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Massage the sole of the foot over a wooden foot massager, a glass bottle filled with water, or even a golf ball for 5 minutes, preferably 3 times daily.
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It is worthwhile to conduct a trial of a 3-week course of NSAIDs during the time when there is most pain (about 4 to 7 weeks after the problem commences). It can be continued if there is a good response.
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An injection of corticosteroid mixed with local anaesthetic can be very effective during the period of severe discomfort. (See Fig. 3.26.) The relief usually lasts for 2 to 4 weeks during this difficult period. However, injections are generally avoided.