The Plantar Fascia is a thick, flat band of connective tissue that supports the arch of the foot. It acts like a spring to give power when pushing off the ground during walking and running.

Plantar fasciitis occurs when this structure becomes overloaded and inflamed or irritated. While it is a very common condition in adults, a slightly different form is also seen in children and teenagers, who often have Achilles tendonitis at the same time.

What are the symptoms?

Pain is usually felt in the arch and/or heel of the foot. It is often worse with the first few steps taken in the morning or after sitting down for a period of time. Other children find that the pain gradually builds up during the day.

Symptoms are often aggravated by spending a long time on their feet and by activities such as PE, running and sport.

What are the causes?

1. Growing quickly, or growing continuously over a period of time, can lead to muscle tightness. This may alter the mechanics of the hip, knee and ankle and increase stress on the Plantar Fascia.
2. Altered foot mechanics and posture, such as excessive pronation (rolling in too much or flattening of the foot).
3. Wearing shoes that lack adequate support.
4. A sudden increase in activities that involve spending a lot of time on the feet, such as running, football, rugby or dance.
5. Weight gain, which places additional pressure on the feet. This can also happen if plantar fasciitis makes exercise painful and activity levels reduce.

Treatment

Home exercise programme

This is usually the part of treatment that corrects the problem and is the cornerstone of treatment.

The programme consists of stretching and strengthening exercises. Results can often be seen within four to six weeks if the exercises are completed as advised.

More severe cases may take longer and may also require foot orthotics.

Strapping

Strapping may help to relieve symptoms.

Foot orthotics

If symptoms remain after the muscle imbalance has been corrected by the home exercise programme, foot orthotics may be needed to help reduce stress on the Plantar Fascia.

Things to do at home

Ice

After your main activity of the day has finished, for example school or sport, ice can be applied to help reduce symptoms.

A useful way to do this is to partially fill a 600ml drinks bottle with water and place it in the freezer. Once frozen, roll your foot over the bottle to provide an ice massage.

Anti-inflammatory medication

Anti-inflammatory medication, such as Ibuprofen, may help reduce pain and inflammation.

If taken, it should be used according to the instructions provided with the medication. If you are taking any other medication, check with your GP or pharmacist first.

Rest

Do not take part in activities that aggravate your symptoms.

Remain as active as comfort allows.

Footwear

Firm, supportive footwear is important to provide support for your feet and body.

Please see the footwear information sheet for further advice.

Home exercise programme

Part one – stretches

You are doing the stretches correctly when you feel a strong pull in the muscle. There may be some discomfort initially, but no tears in the eyes.

If possible, try to complete some stretches before school as a good start to the day. The stretching programme should only take five to 10 minutes each day.

• hold the position for 30 to 60 seconds
• relax
• keep breathing
• complete five stretches per leg per day, five days per week as a minimum.

Calf stretch

• stand with only the ball of your foot on the edge of a bottom step
• keep your feet pointing straight ahead and your body upright
• gently lower your heel until you feel a strong pull in the back of your leg
• hold on to a banister for balance, but do not bend.

Hold for 30 to 60 seconds. Complete five stretches per day, five days per week.

Hamstring stretch

• stand facing a bed, chair or sofa and use your hands to steady yourself
• place your heel on the bed or chair with your knee bent and your chin on your knee
• gently straighten your knee until you feel a strong pull at the back of your thigh.

Hold for 30 to 60 seconds on each side. Complete five stretches per leg per day, five days per week.

Part two – strengthening

It is normal for a muscle to ache when it is being worked hard. This usually means the muscle is working.

Stop when you feel you cannot do any more, but try to complete one more repetition than the day before.

• complete as many repetitions as you can each day, gradually building up to 30 on each leg
• only count good-quality repetitions
• it does not matter how few you start with; gradually doing more each day is the key
• use slow and controlled movements throughout
• quality is more important than quantity – it is better to do five good repetitions than 10 poor repetitions.

Calf strengthening

Stand close to a wall and place your hands against it for support.

• stand on one leg, keeping the knee straight, and rise up onto your tiptoes
• it is important to go as high as possible
• slowly lower yourself back down in one controlled movement
• do not allow the other foot to touch the ground
• do not bend your knees.

Goal: gradually build up to 30 repetitions. If this is too difficult, begin by rising onto tiptoes using both feet. Once you can comfortably complete 20 repetitions, begin practising on one leg.