Hi my name is Andrea Furlan. I am a physiatrist and pain specialist in toronto canada foot pain
is very common in the pain clinic where i work and one of the most common causes of foot pain is
plantar fasciitis. This condition causes my patients to feel sharp pain in the bottom of
their foot. It stings or burns when they walk, especially those first few steps
after getting out of bed in the morning. So
let's talk about plantar fasciitis and how to treat it before it becomes chronic.
To understand plantar fasciitis, we need to learn something about the feet. Our feet has arches.
The arches are important because they act like a spring absorbing the shock
during locomotion. Let me explain the plantar part of the foot. Plantar is
the location of the problem because plant is another word for the bottom of the foot.
The plantar fascia is a tight band of tissue that spans from under the heel bone to the toes.
This tight bands are responsible for maintaining the arch. Some people have a high arch which means
the band is too short. Other people have a flat foot. In this case the fascia is very stretched.
Usually the shape of the arch is determined genetically, and they may not cause any symptom,
but in some cases there will be an inflammation or swelling of the plantar fascia. And that's
when the person will start noticing pain in this area of the foot. In medicine, anything ending
with "itis" means swelling or inflammation. Appendicitis is swelling of the appendix.
Tonsillitis is swelling of the tonsils. Bursitis the swelling of the bursa. So you get the idea.
So when we put it together plantar fasciitis is inflammation of the fascia in the plant of the
foot. Well plantar fascia's job is to pull on the bones in the foot so that the arch is maintained
while walking. All this pulling combined with a high arch, excessive weight, aging tissues,
or overuse, can injure the fascia, the plantar fascia by causing micro tears in the tissue. And
as part of the normal healing process the body will send more blood to the area and floods it
with inflammatory cells. An exaggerated healing response causes pain and swelling which is why
the plantar fasciitis is commonly treated with ice and anti-inflammatories: pills or topical creams.
So, it's better to prevent micro tears from happening in the first place than to rely on ways
to treat the pain afterwards. Plantar fasciitis is usually most painful first thing in the morning,
because our feet naturally flop over into a relaxed position while we sleep.
This isn't usually a problem, but the longer the foot stays in this position trying to heal the
fascia, the more allows the tissues to become shorter and even tighter. When we eventually
do get up and suddenly put weight on our foot, and force it to stretch out beyond what it can handle,
the tearing starts all over again. This happens day after day, over and over,
so it isn't hard to see why the pain can quickly get worse and become chronic. If you'd like to
know more about chronic pain i have another video about it. Diagnosing plantar fasciitis is usually
done through a combination of physical exam and medical history. X-rays aren't really useful,
in fact, used to lead to some unnecessary surgeries. Heel spurs are extra bone growths
that were often surgically removed when they were found on x-rays of people who had heel pain.
But removing heel spurs isn't usually helpful since there is no relationship between the
amount of bone spurring and the amount of pain. Many people with heel spurs have no pain and
many people with heel pain have no bone spurs. It turns out that plantar fasciitis and heel
spurs just share many of the same risk factors. So, what is the treatment for plantar fasciitis?
We've already talked about anti-inflammatory medications and ice. A great tip is to freeze a
plastic bottle of water so you can roll it under your feet. You can do this several times a day,
wearing a sock to prevent frost bite, or you can get a roller like this and leave it under your
desk and massage it many times during the day. But to really get a leg up on the problem the repeated
micro tears must be stopped. It isn't really realistic to stay off your feet long enough for
the plantar fascia to fully repair, and besides that much bed rest would set off a domino effect
of other problems, I give my patients a treatment plan that starts with stretching
their fascia before standing, if they have been off their feet for a while like during sleep.
So, this exercise is what I recommend people to do before you get out of bed in the morning.
So you're going to get a bed sheet like this
and so you're going to raise your leg pulling down like this. So,
then you're stretching the calf muscles and the plantar fascia and you can do this ten times.
It's important to do this before you get out of bed and you can use a
bed sheet like this, or you can put a yoga strap and do with both legs
in the morning, or after any period of prolonged rest. Massaging can also
help to loosen the tight tissues and reduce the swelling. Taking
your time to gently stretch the tissues allow them to expand without tearing.
When this isn't enough, I add a brace that keeps the foot in a neutral position during sleep.
When you keep your foot like this, instead of letting it naturally flop over, you stop the
tissue from becoming shorter and tighter as it heals. Arch support is also important, especially
for people who walk a lot, are overweight, are starting a new sport, or engage in high impact
activities. Typical plantar fasciitis doesn't need expensive orthotics, just a simple arch support or
footwear that is hard and solid like this would do the trick. But remember that shoes lose their
support over time with use. Foot strengthening exercises can also help support the arch.
Scrunching up a towel with your toes like this is a great way to start. Walking on your tiptoes
help to strengthen the muscles of the calf which are very important to maintain the medial arch.
A physiotherapist or a similar healthcare provider can design a custom routine that can be practiced
at home every day. They can also apply other treatments such as laser, acupuncture, deep heat
ultrasound, heat, or electrotherapy. But these passive treatments, like most passive treatments
can become costly and the pain relief usually only lasts a short while. Stretching and strengthening
are key to long-term relief. I usually do not recommend injections in the plantar fascia.
First the procedure is extremely painful, and second injection of steroids into the fascia
has not been proven in scientific studies to prevent progression from acute to chronic pain.
So, in summary plantar fasciitis is very common. In the majority of people the pain resolves with
ice, anti-inflammatories, self-massage, exercises ,weight loss, and footwear changes. A few
patients will need to see a specialist for a more individualized treatment plan. And please remember
that this video is not intended to provide medical advice. It's only for educational purposes.
If you think you have foot pain and it's due to plantar fasciitis please consult a physician or
a professional specialist in foot for a treatment plan specialized for you. It's important that you
get medical advice and individualized treatment. If you like this video don't forget to like it,
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