Plantar Fascitis

The most common cause of heel pain is plantar fascitis. Its common symptom is pain when a person takes initial steps after a period of inactivity or after prolonged weight bearing. It is also precipited by increase in recent weight bearing activity. The pain can be reproduced when pressing/provocating the proximal insertion of the plantar fascia. There is positive windlass test ( specificity of almost 100%). The tarsal tunnel test as well as other tests of peripheral nerve entrapment should be negative to establish the diagnosis. 

Once you have established that your patient has plantar fascitis, you should first tell him to avoid flat shoes and barefoot walking. You should also advise them on performing various stretching exercises for plantar fascia and calf muscles which can be done at home. Also one needs to avoid whatever activities like excessive running, dancing or jumping that causes the pain. Soft silicone heel shoe inserts will be of great help. 

Regarding the pharmacological therapies, NSAIDS for 2-3 weeks is beneficial. Similarly, injecting the tender areas of the plantar region with glucocorticoids and local anesthetic ( 1ml each) has proved to be beneficial for the patients.

Some home exercises for Plantar Fascitis

 Figure B shows feeling for the tension on the plantar fascia. This stretch to be done till the count of 10, repeated 10 times, 2 to 3 times a day.

 Pull the top part of your foot with a towel. Maintain the stretch for 10-30 seconds, 5 times each session, twice a day.

Point and flex the foot. Make circles rotating your ankle