In this Q & A, Meghan Kelly, MD, Assistant Professor of Orthopedics at the Icahn School of Medicine at Mount Sinai, provides at-home stretching tips that treat heel pain in more than 90 percent of plantar fasciitis patients and advises on how to prevent developing the painful condition.
How do I make my heel stop hurting?
To immediately deal with the pain associated with plantar fasciitis, you can use ibuprofen (ex. Advil) or naproxen (Aleve). In addition, rolling a frozen water bottle under the arch of your foot can also relieve the pain.
What can I do to treat plantar fasciitis?
The way to treat about 95 percent of plantar fasciitis cases is by stretching. There are two main stretches which, if done well every day, should make the condition go away in about a month. This method worked for me and every one of my patients.
On the left, Dr. Kelly shows how patients can stretch their plantar fascia and, on the right, she demonstrates an Achilles tendon stretch.
Attend to your plantar fascia.
Plantar fasciitis is an inflammation of the plantar fascia—a thick band of tissue at the bottom of the foot. You can address this inflammation by stretching that tissue. Do this by putting your leg in a “figure four” position with the ankle over the opposite knee. Then, grab your toes and pull them toward your shin and massage the plantar fascia for 5 minutes. You should do this stretch two or three times a day.
Your Achilles tendon is tight. Loosen it.
Almost everyone has a tight Achilles—it’s just the way we’re built—and a tight Achilles tendon can affect the plantar fascia. There are a couple of stretches that can help. The one I like, and that I show my patients, involves standing on a stair or curb with both heels facing out. Hold onto the railing, then move the heel that is painful off the edge of the stair or curb and let it drop. Allow your other foot to relax. Hold this position for five minutes. I know that’s a really long time, but the Achilles tendon is a very large tendon and it takes time to stretch it. Do this twice a day. It doesn’t always feel great at the time, but it really does help.
The hardest part about treating this condition is being diligent about doing these stretches twice a day, every single day. I often recommend taping a reminder on your refrigerator, or some place you can’t avoid seeing. If your heel hurts after you stretch, that’s normal. That’s when you can ice it and/or take a painkiller.
Should I try to stay off my feet? Do I need to wear special shoes in the house or outside?
You can walk as much as you want with plantar fasciitis. If it starts to hurt, you can stop—but you aren’t damaging anything if you keep walking.
In terms of footwear, the best shoes for plantar fasciitis are ones that fit correctly—both in length and width—and provide arch support. You can also use removable inserts (called orthotics) to “fix” a pair of shoes that does not have the support you need. I recommend trying over-the-counter orthotics first, to see if they help as custom-made ones can be very expensive. If you have really flat feet or very high arches, you can get over-the-counter orthotics that are designed to help with that.
I don’t routinely recommend wearing shoes inside—I’m a big fan of bare feet—but, if you’re having pain from plantar fasciitis, wearing supportive shoes in the house can sometimes help. Try it and see if it works for you.
Should I use a foot brace or splint, or a boot?
There are splints available at your local pharmacy that hold your foot at a right angle while you sleep. This will keep your plantar fascia stretched out overnight, and then, when you get up in the morning, you won’t have heel pain as you step out of bed. Some people swear by this method. The majority, however, tell me that they tried an overnight splint but woke up in the middle of the night to take it off because it was uncomfortable. If you want to try using a splint, that’s fine; it won’t do any damage. But, there are no research studies that prove its effectiveness.
Occasionally, I prescribe a walking boot for plantar fasciitis patients as it can take some pressure off the heel. But that can backfire. If you’re wearing the boot all the time and not doing the stretching exercises, your calf muscles may weaken. That won’t help with the pain. Sometimes, I give patients a walking boot for about a week, just to get them walking until the pain becomes bearable. During that time, I urge them to continue doing their stretches and, as soon as they can, I encourage them to stop using the boot altogether.
All in all, the best—and most effective—treatment for plantar fasciitis is stretching.
What if I’ve tried all this and am still having pain?
If none of this works, you might try formal physical therapy. A physical therapist may be able to help you do your stretches more effectively. Sometimes they have equipment in the physical therapy suite that you don’t have at home and can be beneficial.
If none of that works, there are also some procedures available. Extracorporeal shock wave therapy is a noninvasive method of stretching the plantar fascia that involves applying waves of electricity to the tissue. Another option is the Tenex FAST procedure. With this approach, we poke tiny holes in the plantar fascia with a needle. perform these procedures and those who do will likely only try them if everything else has failed.
How can I prevent plantar fasciitis?
The best way to prevent the condition is to avoid unsupportive shoes and to stretch before and after you exercise. But sometimes you do everything right and still end up with plantar fasciitis. That’s why it’s good to know what stretches can treat it.