Plantar Fasciitis and how physiotherapy can help
Are your first steps in the morning extremely painful? Do you notice an ache or sharp pain in your heel when walking, standing, or running? Do you have trouble walking barefoot?
Plantar fasciitis is one of the most common causes of heel pain in adults, and can be debilitating. Your physiotherapist can help treat your heel pain in many ways, using exercise and strength training, massage and dry needling, shockwave therapy and education around footwear and load management.
What is plantar fasciitis?
The plantar fascia is a thick, fibrous ligament that runs underneath your foot, from the base of your heel (calcaneus) to your toes. It forms the arch of your foot and plays an important role in spring function (propulsion and running) and shock absorption.
Plantar fasciitis describes the inflammation, irritation and micro-tears of the plantar fascia that occur when it is injured or overloaded. Injury to the fascia can be acute (sudden) or chronic (long term) in nature. Acute tears of the fascia often occur in runners, however, most cases are caused by progressive and long-term overload.
Plantar fasciitis is the third most common injury to affect distance runners, after tibial stress syndrome (shin splints), and Achilles tendinopathy.
Causes
Plantar fasciitis can occur for a variety of reasons, and there are several factors that can increase your risk of developing the condition;
- Age: plantar fasciitis is most common between the ages of 40-60.
- Activities that place a lot of stress on the heel and foot muscles, including running, jumping activities, ballet, and aerobic dance.
- Foot mechanics: Flat-feet (pes planus) or an abnormal gait pattern can affect the way weight is distributed through the foot and arch and put added stress on the plantar fascia.
- A high BMI: increased weight means more stress is placed through the fascia
- Standing based work, especially on hard surfaces
- A history of repetitive overload, or previous trauma to the foot
- Diabetes or other metabolic conditions
Does this sound like you?
Repetitive overload of the fascia usually happens for two reasons;
Traction: Unlike muscle, the plantar fascia is not very stretchy or elastic. When too much traction or stretch is forced on the fascia, this micro-trauma can occur.
- An increase in training load
- An increase in your daily walking, or a new exercise regime
- A change in your work
- Walking further than usual on a holiday
- Going back to your regular activities too quickly after a different injury
Compression: These injuries usually occur with trauma, like landing on an object that bruises your plantar fascia. Sometimes these symptoms are similar those of a heel fat pad injury – this is more likely if a single hard landing has brought on your symptoms. It is important to seek a proper diagnosis from your physiotherapist.
- Standing on hard surfaces for prolonged periods
- Hitting your heel on a sharp corner
- Landing heavily on a rock or hard surface
- Walking or running on a firm/ hard surface
Symptoms
The main symptom of plantar fasciitis is pain under the heel, which can be dull or sharp. You may experience an ache or burn in the heel and sole of the foot, usually right in the middle or slightly towards the inside arch, and the heel may be slightly swollen.
The pain is often worse:
- In the morning, as you take your first steps
- Moving after prolonged standing or sitting
- After intense activity
- Pain often improves with activity, and returns after a period of rest
In later stages the pain often becomes constant, or is aggravated part way through activity, and is commonly described as an intense or dull ache in the base of the heel, like stepping on a rock.
Treatment – how can your physiotherapist help?
- Exercises: A home or gym-based program of progressive strengthening of your calf, foot and leg muscles, stretching, and eventually spring loading and return to sport exercises.
- Massage and dry needling
- ESWT: Shockwave therapy
- Taping
- Advice and education on load management strategies specific to you.
- Orthotics – for some patients, supporting the arch and de-loading the fascia can be very effective.
- Cortisone injections performed by your GP (often a last resort, after other options have failed).
What can you do at home?
There are several things you can do at home to help relieve your symptoms and help give your fascia the best chance of healing.
- Your home exercise program as prescribed by your physiotherapist.
These exercises will be specifically designed for you, to help to reduce pain, improve your function, and let you get back to doing the things you love!
- Rolling a ball under your foot.
After sleeping or resting your plantar fascia tightens and shortens, hence the sharp pain with your first steps. Try rolling a golf ball/ tennis ball/ rolling pin under your foot for a few minutes in the morning before you start the day to stretch the fascia and give the muscles a gentle massage.
- Stretching your calf muscles.
Overactive calf muscles contribute to heel pain, and keeping them flexible helps to reduce the tension placed on the plantar fascia during walking. Extend one leg about a step behind the other, so that one leg is straight and the other one bent. Keep the heel of the straight leg on the floor, toes pointing forward and lean forward with the hips.You should feel a strong pull in the calves. Hold this position for about 30-60 seconds and repeat twice every day.
- See your physiotherapist for further information, exercise and treatment.
We want to help get you back to doing what you love!
There can be many causes of heel pain, and it is important to be assessed by your physiotherapist or healthcare professional to find out which treatment options are best for you.
Other potential causes of heel pain can include;
- Fat pad irritation
- Achilles tendinopathy
- Calcaneal stress fracture
- Nerve entrapment (lateral plantar nerve)
- Other tendinopathies – posterior tibial tendon or peroneal tendons
- Tarsal Tunnel Syndrome
- Referred pain from your lower back