Plantar Fasciitis
Orthopaedic Department
www.yeovilhospital.nhs.uk
What is plantar fasciitis?
The plantar fascia is a band of fibrous tissue in the sole of the foot,
running from the heel bone to the bases of the toes. It helps
support the arch of the foot and acts as a shock absorber when
walking.
Literally, plantar fasciitis is inflammation of the plantar fascia. With
excessive stress on the plantar fascia, and or loss of its usual
elasticity, small tears can occur in its fibres. This can result in pain
and localised inflammation. Sometimes a spur of bone will form on
the heel as a response to the repetitive pulling on the plantar
fascia. This is a result of the condition rather than the cause of the
pain.
Heel bone
(calcaneus)
Area
of pain
Plantar
f ascia
What are the causes?
The causes include:

Excessive weight

Unaccustomed increase in activity

Inappropriate footwear

Excessively high arched or flat feet

Calf muscle tightness
What are the symptoms?

Pain in the heel on the sole of the foot, sometimes also
felt in the instep

Pain worst on the first step in the morning and after
getting up following a period of inactivity

Pain aggravated by long periods of standing or time
on your feet
What is the treatment?
The mainstay of treatment is a rigorous plantar fascia and calf
stretching programme (see page 5) to lengthen the tight
tissues, decreasing the tension and allowing healing. This is best
coupled with silicone heel cushions (Viscospot) to protect the
painful area.
The stretching may cause an initial increase in your symptoms but
this will usually settle over the first week if you keep to the
programme.
The majority of patients’ symptoms begin to improve within
1 to 2 weeks of starting the treatment and the vast majority
will have improved significantly within 8 weeks.
Other treatments you may also find helpful in combination with the
stretching programme and heel cushions are:

Non-steroidal anti-inflammatory tablets or locally applied gel

Ice packs (a plastic bottle of water frozen and then rolled
under the foot)

Night stretching splints
The stretching programme
To achieve the greatest benefit and prevent making your
condition worse, you should perform the stretching programme
gently and consistently.
You will need to spend about half an hour a day performing the four
stretches. This is broken down into three sessions of three stretches,
with an additional stretch performed before getting out of bed in
the morning.
Before your first step
in the morning
Morning session
Midday session
Night session
Seated plantar fascia stretch
Hold for 10 seconds, repeat 10 times
10 minutes per session
Wall plantar stretch + Wall calf stretch
+ Step calf stretch
Hold each stretch for 1 minute
Repeat each stretch 3 times
Seated plantar fascia stretch
Sit with your bare foot crossed over the opposite knee. With the
hand of the affected side pull the toes and foot back towards the
shin until you feel the stretch in the arch of the foot. To check that
the stretch is correct, feel the taut plantar fascia with the opposite
hand. Hold this stretch for 10 seconds and repeat 10 times.
Wall plantar stretch
With your shoes on, stand facing a wall. Dig the heel of the
affected foot against the floor close to the wall, such that the
undersides of your toes are against the wall with your toes bent
backwards. Push the knee of the affected foot towards the wall.
You should feel the stretch both in the arch of the foot and in the
calf. Your knee should not be able to touch the wall.
Rela
x leg
To increase the stretch, move your heel closer to the wall and your
toes further up the wall, again pushing your knee towards the wall.
Hold this stretch for one minute and repeat three times.
Stretch
Stretch
Wall calf stretch
Stand facing the wall, with your hands resting on the wall in front
of you at shoulder height. Reach the affected foot out behind you,
with the toes pointing forwards towards the heel of the opposite
foot, such that, with your knee completely straight, your heel can
still just sit flat on the floor. Then bend the opposite knee, pushing
forwards such that you feel a stretch in the affected calf. Hold this
stretch for one minute and repeat three times.
Hips in
Stretch
leg
Straight knee
lax
Re
Rotate foot
towards midline
Step calf stretch
Stand with the balls of your feet resting on the edge of a step,
holding on to something for balance. With your knees straight,
allow your heels to sink below the step such that you feel a stretch
in the calf. Hold this stretch for one minute and repeat three
times.
Initially you may find this is uncomfortable and you may only be
able to do this by sharing the weight through each foot. With time,
as you are better able to tolerate the stretch, you may find it better
to perform the stretch on only the affected side, lifting the other
foot into the air.
Stretch
Direction of
movement
Frequently asked questions
I’ve tried physiotherapy and insoles before and it didn’t work,
why should this?
Not all stretching programmes and insoles are as effective. Until
this treatment has been tried in full it is not possible to rule it out.
Should I continue to exercise?
Rest tends to allow the plantar fascia to tighten and has not been
shown to resolve your symptoms faster. Running causes sudden
impact and stress to the painful area with each step and is
probably best avoided until your symptoms resolve. If you do
choose to continue running, select soft running surfaces, wear your
heel cushions and decrease the intensity of your training. Other
non-impact exercise, such as swimming, cycling and cross-training
are preferable as they cause less stress on the plantar fascia.
How long should I continue with the stretching programme and
heel cushions?
Continue until your symptoms have fully resolved. If after stopping
the treatment your symptoms begin to return, simply restart the
programme until the symptoms resolve again.
What if my treatment fails?
If after 3 months of performing the stretches correctly and wearing
the heel cushions consistently you have not improved, you will
need further assessment and consideration of alternative therapy.
This may include injections or heel shockwave therapy. Only very
rarely is surgery required.
Evidence base behind treatment strategy
DiGiovanni, BF; Nawoczenski, DA; Malay, DP et al.: Plantar
fascia-specific stretching exercise improves outcomes in patients
with chronic plantar fasciitis. A prospective clinical trial with twoyear follow-up. J Bone Joint Surg Am. 88:1775-1781, 2006.
Pfeffer, G; Bachetti, P; Deland, J et al.: Comparison of custom and
prefabricated orthoses in the initial treatment of proximal plantar
fasciitis. Foot Ankle Int. 20:214-221, 1999.
With thanks to the Physiotherapy Department, Yeovil District
Hospital NHS Foundation Trust, for their help in producing this
leaflet.
If you require further information or advice,
please contact:
Orthopaedic Secretary: 01935 384818
If you need this leaflet in another format, e.g. large
print or another language, please telephone
01935 384233.
Leaflet No: 09-15-101 Author: JRB Grundy
01/15 Review date: 01/17