PLANTAR FASCIITIS

What is plantar fasciitis?

The plantar fascia is a piece of strong connective tissue that runs along the bottom of the foot. It creates the foot’s arch, by connecting the heel bone to the toes, and is very important in assisting with walking.

Plantar fasciitis (or fasciopathy) is inflammation of the plantar fascia, either through overstretching, overuse, or a medical condition. It is also often associated with a heel spur, which is a bony prominence poking out from the heel bone. Many people can have heel spurs without any pain.

Who is at risk of getting plantar fasciitis?

Plantar fasciitis is most often associated with impact and running sports, especially those that involve toe running rather than heel running styles. It is common in people who have just increased their intensity of walking or running, putting additional strain on the plantar fascia.

It is also common in individuals with poor foot biomechanics that stress the plantar fascia, such as flat feet or weak foot arch control muscles. This causes repeated overstretching of the plantar fascia. Ageing and weight gain also places increased stress and tension on the plantar fascia.

Common signs and symptoms

• Pain under the heel (often in the inside part)

• Pain is worse in the morning when taking the first few steps

• Pain after prolonged sitting or standing

• Symptoms will improve with activity as the foot warms up

• Pain after, but usually not during, exercise

• Pain is worse when barefoot on hard surfaces and with stair climbing

Tips to help prevent the onset of plantar fasciitis

• Maintaining a healthy weight to minimise stress on the plantar fascia

• Wearing supportive shoes which have good arch support and absorption

• Avoid going barefoot, especially on hard surfaces

• Replacing running shoes every 6 months to 1 year before they stop supporting and cushioning the feet

• Warm up before sport and allow adequate recovery time after training

• When starting a new activity or exercise program, make sure to gradually ease into it

• Avoid activities that cause pain

Management

Management of plantar fasciitis initially focuses on reducing pain. This can be done by:

• Modifying load by adjusting training volume, intensity, frequency etc

• Modifying footwear. Avoid open-back shoes, sandals, thongs, any shoes without raised heels

• Avoid going barefoot

• Wearing orthotics to help distribute the pressure to the feet more evenly, and to stimulate the small foot muscles. Orthotics will provide good arch support, and may also include a heel lift.

• Taking anti-inflammatories such as ibuprofen to help reduce pain and swelling

• Taping to offload the plantar fascia and provide extra arch support while allowing the foot to heal

• Regular icing to help reduce pain and swelling. Apply for 20minutes every couple of hours

• Stretching of the plantar fascia and calf muscles to relieve pain

Once the pain begins to settle, treatment aims to improve strength and load capacity. Exercises focused on strengthening the calf and small foot muscles are prescribed and gradually progressed as the plantar fascia is able to tolerate more load. Once adequate strength is restored, we aim to work on power by adding speed elements to the strength work.

A physiotherapist will conduct a thorough assessment to determine what factors have contributed to the onset of plantar fasciitis. They will be able to provide expert advice on how to manage the condition, as well as use manual techniques to help release the plantar fascia. They will also provide a detailed exercise program that is tailored to the individual incorporating stretching and strengthening exercises.

For those who are runners, a running assessment would be undertaken to examine your running technique to look for any factors that may be contributing. Corrective strategies would then be taught to address the poor running techniques.

Examples of exercises

Plantar fascia stretch

Start by placing your toes up on the wall with the ball of the foot and heel on the ground. Lean into the wall slowly until you can feel a stretch in the bottom of your foot. Hold for one minute and repeat up to three times.

Calf stretch

Begin by standing in front of a wall with one foot back behind you keeping your knee straight and heel on the floor. Bend your front knee and gently lean forward until the stretch is felt in the calf of the back leg. Hold for one minute.

Calf raise with rolled towel under toes

Fold a towel in half and roll from one end. Stand with the ball of your foot flat on the ground and your toes up on the roll. Slowly raise up onto your toes for 3 seconds, hold at the top for 3 seconds, and then slowly come down for three seconds.

If you are suffering from plantar fasciitis, and would like more information or help please call us on 9875 3760 or email us on info@wphphysio.com.au. We would be more than happy to assist you in your recovery.