Plantar fasciitis is one of the most common conditions causing heel pain. It involves inflammation of the plantar fascia — a tough, fibrous band of tissue that runs along the sole of the foot. The plantar fascia attaches to the heel bone (calcaneus) and to the base of the toes. It helps support the arch of the foot and has an important role in normal foot mechanics during walking.
Tension or stress in the plantar fascia increases when you place weight on the foot, such as with standing. The tension also increases when you push off on the ball of the foot and toes. Both of these motions occur during normal walking or running. With overuse or in time, the fascia loses some of its elasticity or resilience and can become irritated with routine daily activities.
What causes plantar fasciitis?
In most cases, plantar fasciitis develops without a specific, identifiable reason or injury. The plantar fascia is cleverly designed to absorb the stresses and strains that we place on our feet when walking, running, and doing other, normal daily and sporting activities. However, with overuse and/or as we get older, the fascia loses some of its elasticity and resilience, and the high force from activity can irritate or tear the plantar fascia. The body will always attempt to heal itself by initiating a natural inflammatory (healing) response. This inflammation is often what causes the heel pain and stiffness of plantar fasciitis. At first, the damage may only be minor and not cause any major problem, but if the injury progresses, it may become more painful and debilitating. Without the appropriate and timely rest and optimal treatment, inflammation of the plantar fascia will continue to be exacerbated, and the tissue may not be able to repair itself. This leads to a cycle of significant pain and dysfunction.
What are the risk factors for plantar fasciitis?
While there is often no identifiable cause, there are, however, many factors that can make you more prone to developing this condition. This can be set out into 3 categories:
- Overloading or overuse of the fascia
- Spending many hours standing each day (postmen, teachers, policemen, nurses)
- Repetitive high impact activity (running, dancing, high impact sports)
- Starting an unaccustomed/new or a sudden increase of activity
- Wearing shoes with thin soles, or hard soled shoes, ballet pumps, or flip-flops
- Obesity
- Problems with the health of the Fascia
- Age – as we get older, tendons and ligaments tend to shorten and lose some flexibility, making the tissues stiffer and less able to tolerate stress (plantar fasciitis is most common among people aged 40 to 60)
- Diabetes – is a known risk factor of plantar fasciitis
- Biomechanical Factors
- Flat feet or high arches
- Tight calf muscles, or Achilles tendon
- Weak calf muscles and foot musculature
- An unusual walking or running gait
- Excessive weight/obesity
What are the symptoms of plantar fasciitis?
The main symptom of plantar fasciitis is heel pain, particularly when you first put your foot down in the morning or getting up after sitting for a period (known as ‘start up’ pain). The pain is often described as stabbing pain, throbbing, or a burning ache, that is typically exacerbated when the plantar fascia is used after a period of prolonged rest. Most people experience plantar fasciitis in one foot at a time, but it’s possible for it to affect both your feet at once. It can be a very painful, debilitating condition that causes significant distress and suffering.
The most common symptoms of plantar fasciitis include:
- Pain on the bottom of the foot near the heel
- Pain along the arch of the foot, sometimes accompanied by a ‘lump’ or thickening on the sole of the foot.
- Often exquisite, pinpoint pain on palpation.
- Pain when first getting out of bed, or after a long car ride. The pain often reduces or subsides after a few minutes of walking
- Increased pain with prolonged walking.
- Increased pain with exercise, especially higher impact activities. – Greater pain with the first 10 mins of activity, reduced pain during activity and then increased pain after exercise or activity.
How can Physiotherapy help with plantar fasciitis?
- Relative Rest and modification of activity – considering the location of the injury, this can often be quite challenging. However, your physio will advise you on appropriate rest and activity modification to ensure that the pain settles, and the plantar fascia is able to heal.
- Pain Management – taping the foot to offload and reduce the pressure on the plantar fascia can help to reduce your pain. Ice can also be applied to the affected area.
- Stretching Exercises – your physiotherapist may teach you self-stretching methods to improve muscle flexibility and help restore normal movement – especially for your calf muscles and Achilles tendon.
- Manual therapy – to help improve movement and reduce muscle stiffness, your physiotherapist may use manual therapy such as massage or soft tissue release techniques to the foot and calf.
- You can also carry out self-massage directly to the plantar fascia at home using a massage ball (a massage ball, golf ball or even a frozen water bottle will do the job!)
- Muscle strength – muscle imbalances and weakness in the muscles of your foot and lower limb can contribute to problems with plantar fasciitis. Your physiotherapist will design a resistance program to strengthen all your muscle groups, and ensure they are working together in synergy.
- Advise on footwear and orthotics – your physiotherapist will be able to offer you advice on the best type of footwear for you
- Biomechanical and movement re-education – this may involve teaching you how to correctly squat, lunge, run or jump.
- Functional and sports specific training – once your pain, strength, and range of movement improve, functional training can help you safely resume more demanding activities and get you back to the exercise/sport that you enjoy.
If you are concerned that you might have plantar fasciitis, book in for an assessment with one of our Physios at Bend + Mend in Sydney CBD.
