Heel pain is one of the more common complaints physiotherapists see in the foot and ankle region. In many cases a thick band of tissue known as the plantar fascia is implicated, giving rise to a condition known as plantar fasciopathy. This condition is more common with increasing age and has a peak incidence between 40 and 60 years old, affecting men and women in sedentary and active populations. Typically, people with plantar fasciopathy complain of intense heel pain worse on the first steps in the morning or after periods of rest. This article will outline why this may occur and what will help manage pain and return to function.
Essential anatomy
The plantar fascia is a thick band of connective tissue that extends from the heel towards the toes. One of the primary benefits of the plantar fascia, due to its anatomy and high tensile strength, is that it helps prevent the collapse of the foot's longitudinal arch when we stand on our feet. Increasing tension through this thick band of tissue creates extra stability for the foot through a mechanism known as the “windlass mechanism”. This mechanism becomes an essential consideration during rehabilitation.
What causes plantar fasciopathy?
The exact reason some people develop plantar fasciopathy is still under examination. However, an overuse injury contributed to by the confluence of several risk factors. Risk factors for plantar fasciopathy include;
- Increase in physical activity (too much, too soon)
- Increasing age
- Increased body weight
- Biomechanical dysfunction
- Flattening of the feet (collapsed arch)
- Reduced ankle and toe range of motion
- Reduced strength around the ankle joint
- Inappropriate footwear
- Genetics
Having one or more of these risk factors can make it more likely to develop plantar fasciopathy. Importantly, when the demands placed on a tissue in the body increase too quickly or exceed the current capacity of that tissue, the body may not be able to keep up, and tissue degradation and repetitive strain injury is possible. High-risk activities for the plantar fascia include repetitive high impact loads on the feet, e.g. walking, running and jumping. These activities are not inherently risky; however, in combination with one or more risk factors above. Suppose too much of these activities are completed too soon for the body to adapt and get used to them. In that case, there is the possibility of injury developing to the plantar fascia.
Physiotherapy treatment of plantar fasciopathy
Mobility
Biomechanical risk factors for plantar fasciopathy include reduced range of motion at the ankle joint and in the great (big) toe. As a consequence, treatments designed to improve range of motion at these joints can be beneficial. Techniques include;
- Soft tissue massage
- Joint mobilisation
- Stretching and mobility exercises
Control
Control refers to the precise timing of muscle activation and inhibition by the body and nervous system, allowing movement to occur. In plantar fasciopathy control exercises, several lower limb joints may help individuals better co-ordinate actions and absorb the load. This principle is explicitly applied on a case-by-case basis by physiotherapists depending on the individual in question. In general, control exercises may also be useful to reintroduce movement and range of motion in previously sensitised tissues and have a pain-relieving effect.
Strength
Restoring and improving strength is often very important in those with plantar fasciopathy. Your physiotherapist may prescribe specific strengthening exercises for the foot, calf and other lower limb muscles to help support their function and improve capacity.
Summary
In summary, remember these critical points on plantar fasciopathy;
- Plantar fasciopathy is a common condition treated by physiotherapists that causes pain in the heel of the foot.
- The most common cause is a rapid increase in repetitive impact loading of the foot, likely contributed to by the presence of several risk factors.
- Successful rehabilitation depends on restoring tissue capacity through strengthening while addressing any modifiable risk factors (e.g. orthoses for collapsed arches)
If you are suffering from heel pain, book in with your Physio for a thorough assessment by clicking [HERE]. Once the cause has been identified, a plan can be designed specifically for you and get you back to doing what you love.
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