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Damage to the fascia- plantar fasciitis is the commonest cause for pain in the heel and various synonyms are used to describe it like “jogger’s heel”, “heel spur”, “policeman’s heel” and “tennis heel”.

What is plantar fasciitis?

Plantar fascia is a tendon like structure running along the bottom of the feet starting from the heel. This fascia provides cushioning effect to the foot by acting like a rubber band. It can limit an individual’s ability to perform daily activities. Plantar fasciitis accounts for up to 10% of sports related injury (running related) and 15% of foot problems. 

The commonest cause for plantar fasciitis is the tight calf muscles causing over stretching of the tissues covering these muscles. Wear and tear associated with aging also leads to loss of cushioning effect of the tissues in the feet. The other risk factors for plantar fasciitis are:

  • Obesity
  • Diabetes mellitus
  • Flat foot
  • Active participation in sports within a short period with no previous routine practice
  • Long working hours while standing

A few varieties of footwear can also cause fasciitis like sandals, loafers and worn out shoes and those with no arch support. 

Imaging studies such as ultrasonography, radiography and magnetic resonance imaging can all be used for identifying any abnormality, edema and causes for heel pain. Pain usually occurs on the inside portion of the heel as well on the arch.

Types and treatment of plantar fasciitis

Types of plantar fasciitis

Generalized plantar fasciitis: The predominant finding of this kind is pain in arch of the foot on activity. This type of pain usually is associated with extended duration of activity like running, walking and standing. The pain in the arch presents as a very sharp tearing pain and is usually relieved by rest.

Localized plantar fasciitis: This type of heel pain usually occurs in the morning and affected individuals are unable to get down from bed after awakening. They usually limp to get a stable footing till pain eases. This type of pain occurs because of tightening of fascia during the night. Weight bearing activities also lead to this type of pain. It commonly affects middle aged people.

How is plantar fasciitis treated?

The first step is to take adequate rest to relieve the pain. All stressful events and activities should be avoided till symptoms subside.

Applying hot or ice therapy can be beneficial to decrease inflammation and pain. These procedures should be continued till all the symptoms resolve.

The other commonly used treatment aids are tapes, splints etc. Taping of plantar fascia is done to give support to the fascia and takes care of excess load on the foot. A night splint is available which when used at nights, stretches the plantar fascia and calf muscles preventing their tightening. Anti inflammatory agents like ibuprofen can be used for immediate pain relief. Walking barefoot paves way for further pain and injury, therefore, it should be avoided. Steroid injections are advised for severe cases of pain and inflammation.

Other treatment options include certain specialized methods such as injection of autologous blood and extracorporeal shock wave therapy.

Rehabilitation tips and exercises in managing plantar fasciitis pain 

The following are some of the tips which can help in managing pain due to plantar fasciitis.

  • Before participating in exercises, a warm up stretching exercise for plantar fascia should be done
  • Appropriate shoes for the type of activity should be selected
  • Footwear should be comfortable with adequate cushioning and arch support
  • High intensity exercises will further aggravate pain so they should be avoided when injured
  • Barefoot walking should be shunned
  • Weight reduction by proper dieting will help in pain relief
  • Get you gait assessed by physiotherapists to determine the weight bearing positions
  • Use of insoles or orthotics for shoes can prevent heel pain
  • Sports massage may be helpful for relieving the stress and tightening surrounding fascia

Rehabilitation exercises

Rehabilitation exercises in plantar fasciitis are advised:

  • To decrease pain and inflammation in the affected regions
  • To improve flexibility
  • To bring back complete fitness
  • For rectifying the improper postures during standing or participating in sports
  • To prevent further injury

Stretching exercises decreasing symptoms associated with plantar fasciitis

These kinds of exercises help in decreasing symptoms associated with plantar fasciitis. The stretching exercises are also useful in preventing further injury and inflammation occurring due to fasciitis. It makes the calf muscles flexible as well as strengthens foot and ankle muscles. Stretching exercises are very useful for those who suffer from pain when getting up in the mornings as it relieves tightening. Usually stretching type of exercises might cause a pull in the leg but not pain. 

Types of stretching exercises commonly advised include:

  • Towel stretch
  • Calf stretch
  • Hamstring stretch
  • Achilles stretch
  • Stair stretch
  • Can roll

These stretching exercises improve the range of movement of the foot while performing different actions such as rotation, up and down motions and side to side movements. These movements are particularly employed while running and stretching the muscles adequately makes them flexible enough to handle the stresses that arise during running.

Strengthening exercises to reduce pain associated with plantar fasciitis

Muscles of the foot needs strengthening to reduce pain associated with plantar fasciitis. These exercises are useful in improving balance and stability. Strengthening the muscles of the feet also prevent further injury and recurrence of plantar fasciitis. These exercises must be performed after adequate stretching exercises have relieved the stress and tension in the muscles of the feet.

  • Toe walking: helps to build strength and mobility in the muscles of the foot and calf, in addition to those in the plantar fascia.
  • Toe grasping helps in supporting the arch of the foot by developing coordination, flexibility and strength of foot muscles.
  • Towel curls and marble pickups are also some forms of strengthening exercises done to relieve plantar fasciitis.
  • Calf raises strengthens the calf muscles helping it to take adequate amounts of loads while performing day to day activities or sports specific activities.