Plantar Fasciitis Management and Treatment

Anatomy and Role of the Plantar Fascia

The plantar fascia is a thick band of fibrous tissue located on the sole of the foot. The plantar fascia attaches to the plantar medial calcaneal tubercle (heel bone) and extends to the base of the toes, where it divides into five smaller bands that attaches to each toe. The plantar fascia is an important structure that plays several key roles in foot structure, function and support:

Foot support:

One of the primary functions of the plantar fascia is to provide support to the arch of the foot. It acts as a passive tensioner, helping to maintain the arch structure during weight-bearing activities. The arches of the foot help distribute body weight and absorb shock while walking, running, or standing.

Shock absorption:

The plantar fascia acts as a shock absorber, helping to reduce the impact on the foot during activities. It assists in absorbing and dissipating the forces generated during walking or running, protecting the foot and other structures from excessive stress.

Stability and propulsion:

The plantar fascia provides stability to the foot by connecting the heel bone to the toes. It helps in transmitting forces and energy generated by the muscles of the lower leg to the toes, contributing to the propulsive phase of walking and running.

Load distribution:

The plantar fascia plays a role in distributing the load and pressure across the foot during weight-bearing activities. It helps to evenly distribute the body weight across the foot, reducing excessive stress on specific areas.

Windlass mechanism:

The plantar fascia participates in the windlass mechanism, which involves the tightening of the fascia during toe extension. This mechanism assists in the stabilization of the foot’s arch during the push-off phase of walking or running.

When the plantar fascia undergoes excessive tension or repetitive strain, it can become inflamed and develop micro-tears, leading to heel pain from a condition known as plantar fasciitis. This results in heel pain, stiffness, and discomfort in the heel and arch of the foot. Understanding the anatomy and role of the plantar fascia is essential for diagnosing and managing conditions related to this structure effectively.

Causes of Plantar Fasciitis pain

Plantar fasciitis is an extremely common condition, it is estimated that over 900,000 Australians will develop plantar fasciitis, with the age group 45 to 64 most likely to be affected. Plantar fasciitis pain is typically caused by repetitive strain and overuse of the plantar fascia, resulting in irritation and heel pain, inflammation, and micro-tears in the tissue. Plantar fasciitis commonly occurs due to several factors that contribute to the development of plantar fasciitis:

Sudden increase in activity:

A sudden increase in activity is likely to be the main cause for developing plantar fasciitis, as the connective tissues do not have enough time to adapt to the new unaccustomed loads being placed on them suddenly. Abruptly increasing the intensity, duration, or frequency of physical activity without giving the body enough time to adapt, can overload leading to plantar fasciitis and heel pain.

Overuse or excessive activity:

Engaging in activities that put repetitive stress on the feet, such as running, jumping, or prolonged standing are the biggest risk factors, they can strain the plantar fascia and lead to inflammation and plantar heel pain caused by plantar fasciitis.

Foot mechanics:

Abnormal foot mechanics or structural issues can increase the stress on the plantar fascia. Flat feet, high arches, overpronation (excessive inward rolling of the foot), or supination (insufficient inward rolling) can all contribute to plantar fasciitis.

Improper footwear:

Wearing shoes with inadequate support, poor cushioning, or insufficient support can contribute to the development of plantar fasciitis. High heels and shoes with a rigid sole can also increase the risk. Supportive shoes can help to control the forces placed on your foot.

Age and weight:

Plantar fasciitis is more common in middle-aged and older individuals. Excess body weight can put additional stress on the plantar fascia, increasing the risk of developing the condition.

Tight calf muscles:

Tightness or inflexibility in the calf muscles can place increased strain on the plantar fascia leading to plantar fasciitis. This is because tight calf muscles limit ankle dorsiflexion, causing compensatory forces on the plantar fascia during walking or running.

Occupational factors:

Certain occupations that involve prolonged periods of standing, walking on hard surfaces, or wearing non-supportive footwear can increase the risk of developing plantar fasciitis.

Biomechanical issues:

Issues with alignment, such as leg length discrepancies or abnormal walking patterns, can place uneven stress on the plantar fascia and can contribute to the development of plantar fasciitis.

It is important to note that individual cases of plantar fasciitis can have multiple contributing factors, and the exact cause may vary from person to person. A healthcare professional, such as a physiotherapist, can help identify the underlying causes and develop an appropriate treatment plan based on the individuals’ needs.

How is Plantar Fasciitis diagnosed?

Plantar fasciitis is typically diagnosed through a combination of a thorough medical history, physical examination, and, in some cases, imaging studies. Here is an overview of how we diagnose plantar fasciitis:

Medical history:

The healthcare professional will begin by asking you about your symptoms of plantar fasciitis, including the location, duration, and intensity of the pain. They may inquire about any activities or events that may have triggered or worsened the pain, such as sudden increase in running.

Physical Examination:

The healthcare professional will perform a physical examination of your foot and ankle to assess the range of motion, strength, and flexibility. They will look for signs of inflammation, tenderness, or swelling along the plantar fascia. The healthcare professional may gently press on specific areas of your foot, including the heel and the base of the toes, to determine the location and severity of the pain. Tenderness at the attachment of the plantar fascia is a common finding in plantar fasciitis.

Gait analysis:

The healthcare professional may observe your walking pattern or ask you to walk to assess your foot mechanics and any abnormal movement patterns that may contribute to plantar fasciitis.

Imaging studies:

In most cases, imaging studies are not required to diagnose plantar fasciitis. However, in situations where the diagnosis is uncertain or to rule out other foot conditions, imaging tests such as X-rays or ultrasound may be ordered. Plantar fasciitis is an irritation of the plantar fascia insertion in most cases, X ray may not highlight this pathology.

X-rays can help rule out other causes of heel pain, such as stress fractures or heel spurs, while ultrasound can provide detailed images of the plantar fascia to assess its thickness and integrity. Heel spurs are often a common finding, but heel spurs are really symptomatic. Heel spurs occur due to a calcium deposit that causes a bony protrusion. Bone spurs do occur, and good assessment will identify if they are a cause of concern. Occasional Magnetic Resonance Imaging (MRI) may be indicated to assess complex pathology.

It is important to note that the diagnosis of plantar fasciitis is primarily based on clinical assessment and history. Imaging studies are typically used to confirm the diagnosis if there is uncertainty or to rule out other potential causes of heel pain.

If you are experiencing foot pain, it is recommended to consult with a healthcare professional, such as a physiotherapist, who can perform a comprehensive evaluation and provide an accurate diagnosis based on your specific symptoms and medical history.

Management and Treatment

Plantar fasciitis is a common condition characterised by pain and inflammation at the plantar fascial insertion or along the plantar fascia, a thick band of tissue that runs along the bottom of the foot, connecting the heel bone to the toes. It is typically caused by repetitive strain and overuse of the foot, leading to micro-tears and degeneration of the fascia. The management and treating of plantar fasciitis usually involves a combination of conservative measures aimed at reducing pain heel, promoting healing, and preventing recurrence. Here are some common approaches:

Rest and activity modification:

Avoid activities that worsen the heel pain, such as excessive walking, running, or standing for long periods. Resting the foot and moderating your activity allows the inflamed tissues to heal.

Ice therapy:

Apply ice to the affected area for about 15-20 minutes a few times a day. Ice helps to reduce heel pain, inflammation, and swelling.

Pain relief medications:

Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help alleviate heel pain and reduce inflammation. Always consult with a healthcare professional before taking any medication.

Stretching and strengthening exercises:

Perform gentle stretching exercises for the calf muscles, achilles tendon and plantar fascia to release tissue to improve flexibility and relieve tension. Strengthening exercises for the foot and lower leg muscles can also help support the arch and reduce strain on the plantar fascia.

Orthotic devices:

Wearing supportive shoe inserts or orthotic devices can help distribute pressure more evenly on the foot, provide arch support, and reduce strain on the plantar fascia. These can be custom made or in most cases purchased over the counter as a temporary solution to rest your foot.

Footwear modifications:

Choose supportive shoes with good arch support, cushioning, and shock absorption. Avoid high heels and shoes with minimal support.

Night splints:

Using a splint or brace at night can help stretch the calf and the arch of the foot, reducing morning pain and stiffness.

Physiotherapy:

A physiotherapist can provide specialised treatments to treat plantar fasciitis such as Extracorporeal ShockWave Therapy (ESWT) or soft tissue manual techniques to help plantar fascia release, both will help relieve heel pain and promote healing.

Extracorporeal shock wave therapy (ESWT):

This non-invasive procedure involves delivering shock waves to the affected area, promoting tissue healing and reducing heel pain. Shock wave therapy is typically used for chronic cases that do not respond to conservative treatments.

Corticosteroid injections:

In some cases, a healthcare professional may recommend a corticosteroid injection to reduce heel pain and inflammation. However, these injections are usually reserved for severe cases and their long-term effectiveness is debated.

Surgery:

Surgery is generally considered a last resort if all conservative treatments have failed. It involves releasing the plantar fascia or removing any bone spurs that may be contributing to your symptoms.

It is important to note that plantar fasciitis can take time to heal, and treatment outcomes vary from person to person. Symptoms can last anywhere from a few weeks to several months, or longer in severe and chronic cases.

Prevention of Plantar Fasciitis

It is much better to prevent plantar fasciitis as opposed to treat plantar fasciitis, due to the chronic nature of this type of heel pain. Preventing heel pain and chronic plantar fasciitis involves adopting certain lifestyle habits and making modifications to reduce the risk of developing the condition. Here are some preventive measures that can help:

Maintain a healthy weight:

Excess body weight can put additional stress on the plantar fascia. Maintaining a healthy weight reduces the strain on the feet and lowers the risk of developing plantar fasciitis.

Gradual increase in activity:

If you are starting a new exercise routine or increasing the intensity of your activities for example running, do so gradually. Sudden changes in activity levels can strain the plantar fascia. Allow your body time to adapt to the new demands.

Wear proper footwear:

Choose shoes that provide adequate support, cushioning, and arch support. Look for shoes with a supportive arch, a cushioned sole, and a wide toe box. Avoid wearing high heels and shoes with minimal support, as they can contribute to foot strain.

Replace worn-out shoes:

Regularly check your shoes for signs of wear and replace them when necessary. Worn-out old athletic shoes may not provide adequate support or cushioning, increasing the risk of plantar fasciitis.

Warm-up and stretch:

Prior to exercise or physical activity, perform a warm-up routine that includes gentle stretches for the calf muscles, achilles tendon and plantar fascia. Calf stretching helps improve flexibility and reduces the risk of injury.

Strengthen foot and leg muscles:

Incorporate exercises that strengthen the muscles of the foot and lower leg into your fitness routine. Strong muscles provide better support and stability for the plantar fascia helping to reduce pain.

Avoid prolonged standing or walking:

If your occupation requires prolonged periods of standing or walking on hard surfaces, take regular breaks to rest your feet and relieve pressure on the plantar fascia. Consider using supportive insoles or cushioned mats to reduce the impact on your feet.

Maintain proper foot mechanics:

Pay attention to your foot mechanics and seek professional guidance if you have flat feet, high arches, or any other foot abnormalities. and start to develop foot pain. Orthotic devices or supportive inserts can help improve biomechanical issues and reduce the risk of plantar fasciitis. Gait and biomechanical factors should be assessed in stubborn cases of plantar fasciitis to help with chronic pain.

Reduce or modify your activities:

Pay attention to any pain or discomfort in your feet. If you experience foot pain, especially in the heel or arch, reduce or modify your activities to prevent further strain on the plantar fascia.

Incorporate cross-training and alternate between different activities to avoid overuse injuries, exercise physiologists are well trained to assist with this. Variety helps distribute the stress on your feet more evenly and reduces the risk of developing plantar fasciitis. Plantar fasciitis is often as a result of repetitive overload breaking down the fascial structures as they fail to cope with load.

By adopting these preventive measures, you can reduce the likelihood of developing plantar fasciitis or experiencing a recurrence of the condition. However, if you do experience chronic heel pain, it is important to consult with a healthcare professional for an accurate diagnosis and appropriate treatment.

At Lilyfield Physiotherapy

We are very experienced at helping resolve chronic plantar fasciitis by helping guide you on how to manage this chronic condition. We will also provide evidence-based treatments and exercises to get you on the path to recovery.

Plantar fasciitis is a traction injury due to pull of the plantar fascia at its insertion. This leads to failure at this point due to overload and failure of this attachment. Treatment of plantar fasciitis can be complex and patients with plantar fasciitis often get frustrated and despondent. Plantar fasciitis improves with time and good management, patience and time is the key to recovery.

Stop limping and get on the path to recovery!