Robert Rosenstein, DPM
Jennifer Zienkowski, DPM
Michael Coppers, DPM
CONDITIONS AND TREATMENTS
STRETCHING
Plantar fasciitis is the term commonly used to refer to heel and arch pain traced to an inflammation on the bottom of the foot. More specifically, plantar fasciitis is an inflammation of the connective tissue, called plantar fascia, that stretches from the base of the toes, across the arch of the foot, to the point at which it inserts into the heel bone. Overpronation is the most common cause of plantar fasciitis. As the foot rolls inward excessively when walking, it flattens the foot, lengthens the arch, and puts added tension on the plantar fascia. Over time, this causes inflammation.
Also known as heel spur syndrome, the condition is often successfully treated with conservative measures, such as the use of anti-inflammatory medications, ice packs, stretching exercises, orthotic devices, and physical therapy. Note: Please consult your physician before taking any medications. In persistent cases, Extracorporeal Shock Wave Treatment (ESWT) may be used to treat the heel pain.
Extracorporeal Shock Wave Therapy (ESWT) is used to treat chronic heel pain (plantar fasciitis). "Extracorporeal" means "outside of the body." During this noninvasive procedure, sonic waves are directed at the area of pain using a device similar to that currently used in nonsurgical treatment of kidney stones.
Extracorporeal Shock Wave Therapy is prescribed for patients who have experienced plantar fasciitis for an extended period of time -- six months or more -- and have not benefited from other conservative treatments. The brief procedure lasts about 30 minutes and is performed under local anesthesia and/or "twilight" anesthesia. Strong sound waves are directed at and penetrate the heel area to stimulate a healing response by the body. ESWT is performed on an outpatient basis. Although there are no bandages, someone will need to drive the patient home.
People who are not candidates for ESWT include pregnant women and individuals with neurological foot disease, vascular foot disease, pacemakers, or people taking medications that interfere with blood clotting (such as Coumadin).
This therapy is a safe and effective alternative treatment for heel pain and only requires a short recovery time. Clinical studies show a 70 percent success rate for treatment of plantar fasciitis using Extracorporeal Shock Wave Therapy.
Before beginning any exercise regimen, proper stretching is essential. If muscles are properly warmed up, the strain on muscles, tendons, and joints is reduced.
Stretching exercises should take 5 to 10 minutes and ought to be conducted in a stretch/hold/relax pattern without any bouncing or pulling. It is important to stretch the propulsion muscles in the back of the leg and thigh (posterior) as well as the anterior muscles.
Some effective stretching exercises to prepare the foot and ankle for exercise include:
- The wall push-up. Face a wall from three feet away, with feet flat on the floor, and knees locked. Lean into the wall, keeping feet on the floor and hold for 10 seconds as the calf muscle stretches, then relax. Do not bounce. Repeat five times.
- The hamstring stretch. Put your foot, with knee straight and locked, on a chair or table. Keep the other leg straight with knee locked. Lower your head toward the raised knee until the muscles tighten. Hold to a count of 10 then relax. Repeat five times, then switch to the other leg.
- Lower back stretch. In a standing position, keep both legs straight, feet spread slightly. Bend over at the waist and attempt to touch the palms of your hands to the floor. Hold the stretch for 10 seconds and repeat 10 times. Do not bounce.
Excessive tightness of the calf muscles can contribute to many foot and some knee problems. A key point of injury is the Achilles tendon, which attaches the calf muscle to the back of the heel. When the calf muscle tightens up, it limits the movement of the ankle joint.
Calf muscle stretching is very useful in the prevention and treatment of many foot problems. Two typical methods for stretching your calf muscles include the wall push-up (described above) and this technique: Standing approximately two feet from a wall. While facing the wall, turn your feet inward ("pigeon toed") and lean forward into the wall, keeping your heels on the floor and the knees extended. Keep your back straight and don't bend at the hips. Hold the stretch for 10 seconds and do the stretch 10 times in a row.




