WHAT IS IT? PLANTAR FASCIITIS
The “plantar fascia” is an aponeurosis (strong band of connective tissue) that runs from the calcaneus to the base of the toes. The function of the plantar fascia is to provide support for the arch of the foot, whilst acting as a shock-absorber during movement.
Plantar fasciitis is an overuse condition which is similar to a tendinopathy. Inflammation is not typically present.
Signs & Symptoms
Symptoms usually develop gradually over a few days or even a few weeks, but it can come on suddenly.
Gradual onset of pain
Pain is felt on the medial aspect of the heel or arch
Pain is worse in the morning, after prolonged sitting or standing, and after exercise. In more chronic cases pain is felt on walking and during exercise.
Pain may be reproduced by stretching the aponeurosis
Mild swelling may be present at the arch or heel
What Causes It?
Many factors may contribute to the development of plantar fasciitis.
Poor quality shoes with poor cushioning, loose, high heeled or lack arch support can contribute to causing strain on the plantar fascia.
Sudden increase in running intensity or distance, or changed running surfaces.
Tight lower limb muscles (achilles, calf, hamstrings, glutes)
Stiffness of the ankle and subtalar joints
Being flat-footed, having a high arch or an abnormal pattern of walking can affect the way your foot works, putting stress on the plantar fascia.
How to Self Manage
Follow the R.I.C.E principles
Avoid walking and exercising barefoot and on hard surfaces – choose laced shoes with cushioned heels and a good arch support. Change these regularly (every 6-12 months dependant on distance and frequency of use)
Your doctor, physiotherapist or podiatrist may prescribe off-the-shelf or make custom-fitted orthoses to correct your foot biomechanics
Pain relief or anti-inflammatories will often ease symptoms, as well as ice applied for 20mins sessions.
As being overweight adds extra pressure to the plantar fascia losing weight may help.
Prognosis
The fascia tissue heals quite slowly, commonly taking up to several months.
Following conservative management, the wearing of a splint fitted to your calf and foot while you sleep may be recommended. This effectively stretches the fascia, tendons and surrounding tissue. By holding them in a lengthened position overnight they are stretched more effectively resulting in less morning pain.
As a last resort, when other treatments haven’t worked, your doctor or physiotherapist may suggest injections of corticosteroid into the plantar fascia attachment at the heel to provide temporary relief.
When all else fails, surgery to detach the plantar fascia from the heel bone called a plantar fasciotomy. It's generally an option only when the pain is severe and debilitating and every other treatment method has been exhausted.
How Physio Helps
Your physiotherapist will be able to:
Palpate and assess your foot to determine if your problem is plantar fasciitis.
Assess your biomechanics by observing you in standing, walking, and if necessary, running.
Test your mobility and determine if you have excessively tight muscles or stiff joints contributing to your foot pain.
Provide manual treatment aimed at speeding up your recovery, which may include joint mobilisation, massage, taping, acupuncture, and if necessary, recommendation of orthoses or possibly a splint.
Prescribe an exercise rehabilitation program involving stretches and strengthening to correct any imbalance or overuse issues.