Plantar Fasciitis Treatment in Los Angeles
Increased pain with the first few steps in the morning is the classic symptom of plantar fasciitis. Dr. Alexis Dixon, MD, FAAOS, a board-certified orthopaedic foot & ankle surgeon in Marina Del Rey, treats the calf tightness at the root of the problem.
Foot & Ankle Conditions
What Is Plantar Fasciitis?
Plantar fasciitis is often a very painful and persistent condition rooting from inflammation of the soft tissues around the heel. The plantar fascia is a thin ligament that spans from the heel bone, or calcaneus, and fans to the forefoot.
The plantar fascia acts like the tight string of a bowstring on the arch of the foot and helps support the arch. It can become aggravated due to an increase in activity or stress on the foot, such as in obesity or very high-arched feet. Some people have a propensity to inflammation in this area and find that the issue is recurrent despite prior treatment.
Get an Accurate Diagnosis
Diagnosis
Dr. Dixon evaluates the symptoms in the office with a thorough physical examination and weight-bearing (standing) x-rays.
Other sources of heel pain can include stress fractures, and these should be ruled out. Because a heel spur is not the cause of the pain, removal of the heel spur will not help plantar fasciitis.
Symptoms
The classic symptom is increased pain with the first few steps in the morning, or after standing from a seated position. Pain also worsens after activity and is usually less so during activity.
What Causes It?
The root of the problem is calf tightness. Medial head tightness of the gastrocnemius muscle within the calf can put excessive stress on the arch of the foot when walking. The calf is tightest after a period of rest, and especially after a night of sleep.
For this reason, some providers recommend night splinting. The knee must be kept straight to effectively stretch the calf, so many people find the splints to be uncomfortable and ineffective.
There is sometimes a heel spur on x-ray. It is a very common finding, and it is not the source of the pain. Approximately 1 out of 10 people have a heel spur on x-ray, but only 5% of those people have plantar fasciitis.
Conservative First, Surgical When Needed
Treatment Options
Because the calf tightness is the root of the problem of plantar fasciitis, the mainstay of treatment is stretching of the calf. This is the only treatment that will yield lasting results. However, there are measures that you can take to make daily activities more comfortable in the meantime.
Nonsurgical
Calf stretch
Stand about three feet from a wall or counter. Turn the symptomatic foot inward slightly, then step forward with the opposite foot towards the wall and lean against the wall. Keep the back knee straight and the heel against the ground, while the front knee bends, and keep your torso in line with the back leg. You should feel the stretch high on the calf. Do not bounce, and hold this stretch for several minutes. Aim for about twenty minutes of stretching a day, which you can divide into small increments at your convenience. Stretch both sides to prevent plantar fasciitis and other injuries on the other side.
Plantar fascia stretch
In a seated position, cross one ankle over the other knee. Pull your big toe upwards with one hand while you firmly massage the arch with your other thumb. The fascia should feel tight. This should be done for several minutes at a time and can be done multiple times throughout the day, including before and after activity.
Ice
Apply an ice pack to the area for twenty minutes each night. Only use ice if you have no numbness in your feet. If you have any neuropathy, ice application may not be safe. Set the ice pack on the floor and place a dry washcloth on top, then set your foot on the ice pack. Ice for up to twenty minutes at a time, and be sure to wait an hour if you are going to repeat the ice application.
Anti-inflammatories
Over-the-counter anti-inflammatory medication helps in the meantime. NSAIDs should be taken around the clock for two to three weeks for anti-inflammatory dosing. Speak to your physician if you have concerns about whether anti-inflammatories are safe for you.
Heel cup or lift
You may have already found that boots or shoes with a slight heel are more comfortable. This is because it takes a little tension off the tight calf muscle, and therefore off the plantar fascia. Adding a silicone heel cup with a slight lift in your dress shoes and tennis shoes can make activity more comfortable until your calf becomes less tight.
Avoid bare feet
Feet flat on a hard surface is the least comfortable state for a person with plantar fasciitis. Wear cushioned house shoes at home and protect the bottoms of your feet.
If overuse is aggravating the plantar fascia, you should rest from the offending activity until the pain subsides.
What to Avoid
Do not immediately get injections or surgery for plantar fasciitis. Injections should be done sparingly to prevent rupture of the plantar fascia, which cannot be repaired once ruptured. Likewise, a surgical release of the plantar fascia, when not indicated, can lead to collapse of the arch. Because a heel spur is not the cause of the pain, removal of the heel spur will not help plantar fasciitis. Oral steroids are not recommended as first-line treatment of plantar fasciitis because of the systemic risks. There are more specific treatment options in most cases.
Why Choose a Physician
Why See a Board-Certified Orthopaedic Surgeon (MD)?
For best results, see a board-certified orthopaedic surgeon with accredited fellowship training in foot and ankle surgery about your heel pain. Foot and ankle orthopaedic surgeons complete medical school, five years of residency training in orthopaedic surgery, and a yearlong advanced fellowship focused on foot and ankle care.
Dr. Dixon is a board-certified orthopaedic foot & ankle surgeon, not a podiatrist. She is a Fellow of the American Academy of Orthopaedic Surgeons (FAAOS), which requires six years of post-graduate training. With plantar fasciitis, the treatments that carry real risk are the ones to be careful about: injections should be done sparingly, and a surgical release that is not indicated can lead to collapse of the arch.
After Treatment
What Recovery Looks Like
Stretching the calf is the only treatment that will yield lasting results, and the heel cup, the ice, the anti-inflammatories, and the house shoes are the measures that make daily activities more comfortable in the meantime. Adding a silicone heel cup can make activity more comfortable until your calf becomes less tight.
Seek attention from a specialist if you are concerned that the pain is worsening, or if it is not responsive to these treatments. Other sources of heel pain can include stress fractures, and these should be ruled out.
What Patients Say
Patient Reviews
Patient Questions
Plantar Fasciitis FAQs
About Your Surgeon
Alexis E. Dixon, MD, FAAOS
Dr. Dixon is a board-certified orthopaedic foot & ankle surgeon practicing in Marina Del Rey, California. USC-trained and named an LA Magazine Top Doctor since 2017, she combines surgical expertise with a conservative-first philosophy, treating the underlying joint and tendon, not just the symptom. She treats ganglion cysts, bunions, Achilles injuries, plantar fasciitis, fractures, and the full range of foot and ankle conditions.
Meet Dr. Dixon →Heel Pain With Your First Steps? Get a Real Diagnosis.
Get an accurate diagnosis and a clear plan from a board-certified orthopaedic foot & ankle surgeon in Marina Del Rey.
Sources
References
The patient handout for this condition draws on the following sources.