Firstly what is the plantar fascia? It’s a thick fibrous band of connective tissue that spans across the sole of the foot from base of the heel bone (calcaneus) to the under surface of each of your toes.
The plantar fascia has a few important roles;
- serving to support the bones and joints in the foot,
- works as a passive limitation to collapsing of the arch on the inside of the foot
- enables us to push off from the ground
When your plantar fascia develops microtears or gets inflamed this is known as PLANTAR FASCIITIS.
Plantar facsciitis can be one of those problems that seems to come from no-where, however there are several risk factors that can play a role in the development of this painful and often debilitating condition All of the following increase the amount of stress placed through the plantar fascia;
- Pronated (flat) feet
- High arches – tend to have a tighter plantar fascia
- Higher impact sports such as running, jumping sports
- Overweight – carrying excessive weight
- Pregnancy – weight gain, hormones and fluid retention
- Poor footwear – unsupportive shoes with no arch support or stiff shoes
Plantar fasciitis usually begins as a result of repetitive over stretching or traction forces coupled with poor foot biomechanics and / or weakness of the intrinsic foot muscles.
Trauma can also result in plantar fasciitis, for example landing hard on an object which can bruise your plantar fascia, however often this actually leads to another condition called fat pad contusion or ‘stone bruise’ which can mimic plantar fasciitis.
Some of the typical features of planatr fasciitis include:
- Pain upon waking – when you first put your foot down you elicit a stretch through the plantar fascia which is painful. Generally the pain will improve as you warm up.
- Pain aggravated by long periods of standing or high intensity activity.
- Swelling may be present around the under surface of the heel
- Tenderness on the attachment of the plantar fascia into the calcaneus.
What can you do?
Firstly you need a diagnosis which can, in most cases, be made by a skilled physiotherapist based on your history and a thorough clinical examination.
Unfortunately Plantar Fasciitis can be a stubborn and tricky problem to treat so patience is paramount. There are a few key ‘phases of rehabilitation’.
PHASE 1: Reduce pain and inflammation
Ideally you should immediately implement rest from pain provoking foot positions. In short don’t do anything that hurts.
For very acute episodes with severe pain & swelling icing can be helpful.
Anti-inflammatory medication is also an option.
PHASE 2: Regain movement, modify loading and restore foot control
As pain allows your physiotherapist will guide you with gentle stretches, massage and movement. Exercise is an important and encouraged part of the rehabilitation process BUT it needs to be largely pain free and controlled. Treatment in physio sessions usually involves;
- Soft tissue massage both to the muscles of the foot but also to surrounding muscles in the lower leg including your calf, peroneals and tibialis posterior.
- Mobilising stiff joints in the ankle and foot
- Advice regarding supportive footwear, training loads and return to exercise
- Use of taping techniques to unload the plantar fascia.
PHASE 3: Address biomechanics, calf & leg control
The biomechanics of the foot and also the entire leg can play a role in the underlying cause of plantar fasciitis, thus it’s important to address the whole picture if you want ensure that it doesn’t return in the future. Some exercises that are often used;
- Intrinsic foot strengthening
- Calf strengthening
- Ankle mobility
- Hip and knee stability
This will usually be coupled with appropriate stretching and trigger ball releases to surrounding muscles to ensure that full range of movement and strength are both restored.
PHASE 4: Return to sport & specific training
Depending on your goals regarding exercise and work you will need a graded return to higher impact activity. For example a basketballer may need to complete a rehab running program which encompasses straight line running, change of direction and shuttle sprints. Once this can be completed with no aggravation jumping, pivoting and ball drills can be added and eventually return to full play.
A few common questions we get thanks to Dr Google….
What about night splints? I have heard of people who used these with benefit, however the clinical research is poor and I personally don’t suggest my clients use them.
Do I need orthotics? This is case by case, there are some people who I refer to a podiatrist for an opinion however I like to believe that developing dynamic foot control via foot stabilisation and a thorough rehab program can eliminate the need for this!
If you have any questions about any of the above or are suffering from plantar fasciitis and would like to make an appointment to see us send us an email at firstname.lastname@example.org or you can find our other details on the contact us page.