Try doing these stretches before walking or doing any other morning tasks. Use the following steps:. Picking up a marble with the toes will flex and stretch the foot muscles. When the pain first appears, keeping off the injured foot can help. First aid for a foot injury can include the RICE method:. Non-steroidal anti-inflammatory drugs NSAID , such as ibuprofen, help to reduce both pain and inflammation.
People may wish to take this medication as directed on the package or recommended by a doctor. Shoe inserts offer additional support to the arch of the foot. Inserts will limit stress on the plantar fascia and may be especially helpful to people who spend much of the day on their feet.
Soft, supportive arch inserts may work as well. Always speak to a doctor who specializes in foot health, called a podiatrist, for more information. Some people find that massage helps with symptoms. Focus on massaging the arch of the foot around the injured area. If surrounding muscles have become tense because of the pain, massage those too.
Some people find relief from massaging the arch of the foot with an ice bottle. If stretches, exercises, and home remedies do not help, a doctor may recommend medical treatment. However, surgery is rarely needed.
A thick mass of tissue called the plantar fascia connects the toes to the heel bone. Inflammation in this tissue, called plantar fasciitis, can cause intense pain in the heel.
Doctors do not fully understand why some people get this injury and others do not. Plantar fasciitis is caused by straining the part of your foot that connects your heel bone to your toes plantar fascia. Page last reviewed: 01 April Next review due: 01 April Plantar fasciitis. Check if you have plantar fasciitis The main symptom of plantar fasciitis is pain on the bottom of your foot, around your heel and arch.
Plantar fasciitis and bone spurs. American Academy of Orthopaedic Surgeons. Ferri FF. In: Ferri's Clinical Advisor Elsevier; Mayo Clinic; Schneider HP, et al. Tenotomy-fasciotomy with Tenex technology adults. Most individuals naturally sleep with the feet plantar-flexed, a position that causes the plantar fascia to be in a foreshortened position.
A night dorsiflexion splint allows passive stretching of the calf and the plantar fascia during sleep. Theoretically, it also allows any healing to take place while the plantar fascia is in an elongated position, thus creating less tension with the first step in the morning.
A night splint can be molded from plaster or fiberglass casting material or may be a prefabricated, commercially produced plastic brace Figure 8. Several studies 13 , 14 have shown that use of night splints has resulted in improvement in approximately 80 percent of patients using night splints.
Other studies 15 , 16 found that night splints were especially useful in individuals who had symptoms of plantar fasciitis that had been present for more than 12 months. Night splints were cited as the best treatment by approximately one third of the patients with plantar fasciitis who tried them.
Anti-inflammatory agents used in the treatment of plantar fasciitis include ice, NSAIDs, iontophoresis and cortisone injections. Ice is applied in the treatment of plantar fasciitis by ice massage, ice bath or in an ice pack. For ice massage, the patient freezes water in a small paper or foam cup, then rubs the ice over the painful heel using a circular motion and moderate pressure for five to 10 minutes.
To use an ice bath, a shallow pan is filled with water and ice, and the heel is allowed to soak for 10 to 15 minutes. Patients should use neoprene toe covers or keep the toes out of the ice water to prevent injuries associated with exposure to the cold. Crushed ice in a plastic bag wrapped in a towel makes the best ice pack, because it can be molded to the foot and increase the contact area. A good alternative is the use of a bag of prepackaged frozen corn wrapped in a towel. Ice packs are usually used for 15 to 20 minutes.
Icing is usually done after completing exercise, stretching, strengthening and after a day's work. The use of anti-inflammatory drugs in chronic inflammatory diseases is somewhat controversial. Disadvantages of NSAIDs are many, including the risk of gastrointestinal bleeding, gastric pain and renal damage. Iontophoresis is the use of electric impulses from a low-voltage galvanic current stimulation unit to drive topical corticosteroids into soft tissue structures. One study 19 found that the use of iontophoresis resulted in significant improvement after two weeks but no long-term differences at six weeks.
The major disadvantages of iontophoresis are cost and time because, to be effective, it must be administered by an athletic trainer or physical therapist at least two to three times per week. Thus, iontophoresis use is probably best reserved for the treatment of elite athletes and of laborers with acute plantar fasciitis whose symptoms are preventing them from working. Corticosteroid injections, like iontophoresis, have the greatest benefit if administered early in the course of the disease but, because of the associated risks, they are usually reserved for recalcitrant cases.
A plain radiograph of the foot or calcaneus should always be obtained before injecting steroids to ensure that the cause of pain is not a tumor. Steroids can be injected via plantar or medial approaches with or without ultrasound guidance.
Studies 20 , 21 have found steroid treatments to have a success rate of 70 percent or better. Potential risks include rupture of the plantar fascia and fat pad atrophy. In cases that do not respond to any conservative treatment, surgical release of the plantar fascia may be considered. Plantar fasciotomy may be performed using open, endoscopic or radiofrequency lesioning techniques.
Overall, the success rate of surgical release is 70 to 90 percent in patients with plantar fasciitis. In general, we start by correcting training errors. This usually requires relative rest, the use of ice after activities, and an evaluation of the patient's shoes and activities.
Next, we try correction of biomechanical factors with a stretching and strengthening program. If the patient still has no improvement, we consider night splints and orthotics. Finally, all other treatment options are considered.
Non-steroidal anti-inflammatory medications are considered throughout the treatment course, although we explain to the patient that this medicine is being used primarily for pain control and not to treat the underlying problem. Already a member or subscriber? Log in. Interested in AAFP membership?
Learn more. Mary's program and a primary care sports medicine fellowship at the Medical College of Wisconsin.
He received his medical degree from the Medical College of Wisconsin and completed his family medicine residency at the Medical College of Wisconsin St.
Address correspondence to Craig C. Young, M. Wisconsin Ave. Reprints are not available from the authors. Overuse tendinosis, not tendinitis: a new paradigm for a difficult clinical problem part 1.
Phys Sportsmed. Conservative treatment of plantar heel pain: long-term follow-up. Foot Ankle Int. The process of athletic injury and rehabilitation. Athletic injuries and rehabilitation. Philadelphia: Saunders, —8. Reid DC. Sports injury assessment and rehabilitation.
0コメント