The clinical presentation is consistent with plantar fasciitis. Initial treatment includes stretching of the plantar fascia and achilles tendon. Shoe inserts and heel cups may be beneficial in relieving symptoms as well. Symptoms often take up to 6 months or a year to resolve and surgical release of the plantar fascia should be reserved for the exceptionally recalcitrant cases. Pfeffer et al conducted a level 1 study of 236 patients with plantar fasciitis. All patients were treated with achilles tendon and plantar fascia stretching. The patients were then randomized to a custom orthotic or prefabricated insert. The patients who received a prefabricated insert demonstrated significantly greater improvement in clinical symptoms at 8 weeks. Harty et al conducted a biomechanical study of foot loading on live subjects. Lack of knee extension was associated with prolonged loading of the forefoot. The authors concluded that through the windlass mechanism of the plantar fascia, hamstring tightness may predispose the foot to development of plantar fasciitis. Illustration A demonstrates the proper technique of plantar fascia stretching through stabilization of the hindfoot and hyperextension of the toes. Illustration B demonstrates an achilles tendon stretch that also incorporates eccentric loading of the gastroc-soleus.
Pfeffer G, Bacchetti P, Deland J, Lewis A, Anderson R, Davis W, Alvarez R,Brodsky J, Cooper P, Frey C, Herrick R, Myerson M, Sammarco J, Janecki C, Ross S,Bowman M, Smith R. Comparison of custom and prefabricated orthoses in the initialtreatment of proximal plantar fasciitis. Foot Ankle Int. 1999 Apr;20(4):214-21.
PMID:10229276 (Link to Abstract)
Richardson EG: Heel pain, in Coughlin MJ< Mann RA (eds): Surgery of the Foot and Ankle, ed 7. St. Louis, MO, Mosby, 1999, pp 1090-1209.
Harty J, Soffe K, O'Toole G, Stephens MM. The role of hamstring tightness inplantar fasciitis. Foot Ankle Int. 2005 Dec;26(12):1089-92.
PMID:16390645 (Link to Abstract)