Plantar Fasciitis – How can physio help?
Your plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes.
Your plantar fascia acts as a passive limitation to the over flattening of you arch. As the plantar fascia develops micro tears or becomes inflamed it is known as plantar fasciitis.
What Causes Plantar Fasciitis?
There are two valid mechanisms which contribute to its occurrence.
Compression plantar fasciitis is most often associated with a specific occurrence of impact or with running sports, especially those that involve toe running rather than heel running styles.
Traction plantar fasciitis is commonly diagnosed in individuals with poor foot biomechanics, the plantar fascia is repeatedly stressed and overloaded. Flat feet or weak arches are two common factors which contribute to over stretching of the region.
What are the Symptoms of Plantar Fasciitis?
The first indication you may be suffering from plantar fasciitis is pain felt under the heel or arch of your foot when you first begin to mobilise.
Plantar fasciitis is consistent with the four stages of a typical stress response injury.
Phase 1—Normal (no pain)
Phase 2—Heel pain post exercise
Phase 3—Heel pain before and after exercise
Phase 4—Heel pain all the time, even at rest
Plantar Fasciitis Diagnosis
After taking your history of onset, details of symptoms and performing a comprehensive clinical examination, your physiotherapist or sports doctor can usually give a fairly accurate diagnosis of plantar fasciitis.
X-rays show calcification within the plantar fascia or at its insertion into the calcaneus. This is known as a calcaneal spur. Although spurs occur regularly in individuals with plantar fascia pain, X ray alone is not a reliable source to diagnose a spurs involvement, as they occur regularly in individuals without pain.
Ultrasound scans and MRI are used to identify any tears, inflammation or calcification of the plantar fascia, thus giving insight into the severity of an individual’s injury and expected time for recovery.
Pathology tests (including screening for HLA B27 antigen) may identify spondylo arthritis, which can often cause symptoms similar to Plantar Fasciitis.
Who is more at risk?
- Those who are active
- Those who are overweight
- Those who are pregnant
- Those who are on their feet
- Those who have Flat Feet or High Foot Arches
- Those of us who are ageing
- Those of us with other co-morbidities
Plantar Fasciitis Treatment
Plantar Fasciitis has quite a favourable prognosis and its effects are reversible, in fact about 90% of people improve significantly within two months of initial treatment.
Due to poor foot biomechanics being the primary cause of plantar fasciitis it is vital to thoroughly assess and correct your foot and leg biomechanics to prevent future plantar fasciitis episodes.
As physiotherapists we are well placed to be able to assess foot mechanics through video gait analysis and aide in dynamic biomechanical correction of lower limbs.
We may also recommend wearing some sort of passive device such as orthotics, or recommend footwear suitable for your foot type.
Our physios at Physio Professionals are trained in prescribing and fitting such devices.
If plantar fasciitis continues after a few months of conservative treatment, your doctor may give you a corticosteroid injection. Although short-term benefits have been shown, they actually retard your progress in the medium to long-term, which usually means that you will suffer recurrent bouts for longer.
There are essentially 8 stages that need to be covered to effectively rehabilitate plantar fasciitis and prevent recurrence.
Phase 1 – Early Injury Protection: Pain Relief & Anti-inflammatory Tips. Rest, Ice, and Protection.
Our first aim is to provide active rest from pain-provoking foot postures. This means that you should stop any movement or activity that provoked your foot pain and apply ice. After the first 48 hrs anti-inflammatory medication and creams may help to relieve pain and swelling. Supportive foot wear, tape, braces or heel cups can help to reduce pain in this early phase. Your physiotherapist will guide you using a range of pain relieving techniques including joint mobilisations, massage, electrotherapy and dry needling to assist you.
Phase 2: Regain Full Range of Motion
With the right care Inflamed structures will settle when protected. It may take several weeks. During this time It is important to lengthen and orientate your healing scar tissue via massage, gentle stretches, and light active exercises thus avoiding lumpy non effective healing of the involved tissue.
Phase 3: Restore Foot Arch Muscle Control
Your foot is controlled via muscles. These muscles have a vital role as the main stabilisers of the foot preventing excessive loading as we stand walk and run every day of our lives. Your physiotherapist is an expert in the assessment and correction of your dynamic foot control and will help you to correct your normal foot biomechanics and provide you with tailored exercises to address weakness and lack of endurance.
Phase 4: Restore Normal Calf & Leg Muscle Control
Although difficult to comprehend, all of your leg muscles play an important role in controlling your foot arch and its normal function. It is very important to address any neuromuscular dysfunction or weakness.
Phase 5: Restore Normal Foot Biomechanics
Your foot biomechanics are the main predisposing factor to plantar fasciitis.
After a biomechanical assessment your physiotherapist may prescribe and fit you with orthotics.
Phase 6: Improve Your Running and Landing Technique
Adverse ground forces can be minimised and sporting performance improved through correction of technique and application of exercises. Depending on what your sport or lifestyle entails your physiotherapist will develop a speed, agility, proprioception and power program to prepare you for light sport-specific training.
Phase 7: Return to Sport or Work
As physiotherapists we will discuss your goals, time frames and training schedules with you to tailor your rehabilitation facilitating a complete return to sport or work.
Phase 8: Footwear Analysis
Often it is poorly designed footwear that can lead to the injury seek the professional advice of your healthcare practitioner for suitable footwear.