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What is Plantar Fasciitis?

Plantar Fasciitis is a common cause of foot pain. Like the tendon's in the elbow that we looked at last week, Plantar Fasciitis is an overload injury to the plantar fascia.

The Plantar Fascia runs from the heel to the toes on the sole of the foot and is vitally important at maintaining stability and arch support in the correct function of the foot. The overload comes into it with excessive walking and weightbearing - or more correctly - too much of an increase in walking. This commonly occurs around summer time, when people spend more time in thongs or no footwear and are at the beach or on holiday. It can also occur with training for any number of running events that are coming up in winter and spring.

So - what does the evidence say when it comes to treatment?

At a basic level, we need to reduce the load or increase the capacity/strength of the tissue. If we reduce the load too much, the tissue gets weaker and takes a lot longer to get strong again. So the best way forward it is modify the load and to increase the capacity and strength of the tendon! Check out these studies below:

Study 1: High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up (Rathcleff et al. 2014)

• Interventions: Strength group: high load + progressive strength training VS  Stretch group: shoe inserts + daily plantar fascia stretching
  • Results
    • At 3 and 12 months, the Strength training group improved their function and reduced their foot pain significantly compared to the stretching and shoe insert group.
    • 81% of individuals who undergo strength training will have a positive changes to pain, disability and activity limitations 

  • Interpretation
    

    • Strength training reduces pain and disability, and improves participation in activities of daily living at 3 months and improvements are maintained at 12 months

Study 2: Ultrasound guided corticosteroid injection for plantar fasciitis: randomised controlled trial (McMillan et al., 2012)

• Interventions: Dexamethasone injection (Steroid injection) VS Saline injection (Placebo injection)
  • Results
    • Significant pain reduction only up to 4 weeks with dexamethasone
    • At 8 and 12 weeks there were no difference in pain level between the saline and dexamethasone injection

  • Interpretation
    

    • Dexamethasone  injections provide limited short term pain relief lasting only up to 4 week

Study  3: Strength training for plantar fasciitis and the intrinsic foot musculature: A systematic review (Duffer et al. 2017)

• Interventions - strength training: a review of all the current research
  • Intrinsic foot muscle exercises improves function, balance, strength in the foot and in performance of dynamic exercises
  • Strength and loading exercises for the plantar fascia improves function in the foot on pain, disability and activity limitations

Take home message

• Strengthening and loading of the foot, ankle and plantar fascia reduces pain and disability, increases participation to activities, improves balance and foot strength
• Strengthening is superior to dexamethasone (steroid injection) for pain relief at 3 months and 12 months following treatment
• Individuals with plantar fasciitis/ plantar heel pain should be strengthening