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Plantar Fasciitis

What is plantar fasciitis?

 

Plantar fasciitis is one of the most common causes of heel pain in both sedentary and athletic populations.1,2 It affects more than 1 million people each year.2  It involves degeneration of the plantar fascia, a thick fibrous band that originates in your heel and extends all the way up to your toes.1,2 The plantar fascia functions to support the arch of the foot, protect muscles, tendons, nerves and blood vessels from injury (ie. when you step on something) and functions in shock absorption. It can, however, become problematic when it is chronically stretched and overloaded. Fortunately, 90% of patients get better with conservative management like physiotherapy.2

 

Do I have plantar fasciitis?

 

Plantar fasciitis often manifests itself as severe pain across the bottom of the foot when taking the first few steps after prolonged rest (ie. when you get out of bed in the morning).1,2,3,4 Although walking can improve symptoms initially, the plantar fascia often becomes aggravated again when you are on your feet for a long period of time.1,2,3 It can be especially tender when direct pressure is applied to the center of the heel or if both your ankle and big toe are flexed up towards your nose putting the plantar fascia on stretch.1,2

 

How does plantar fasciitis develop?

 

Plantar fasciitis is not often caused by a single traumatic event but rather develops gradually over time as a result of excessive loading.1 Every time you take a step your foot must change shape to adapt to the ground. This stresses the plantar fascia and causes microtears to develop; especially in individuals with pre-existing alignment issues. Fortunately these microtears heal with scar tissue. However, with excessive standing, walking and running the plantar fascia goes through a cycle of microtearing and healing through the formation of scar tissue and eventually causes thickening of the structure.1 As this thickened scar tissue is stretched, it often becomes symptomatic.1

 

Am I at risk of developing plantar fasciitis?  

 

Individuals with an increased risk of developing plantar fasciitis include those with:

Pes planus (flat feet)1,2,4 or pes cavus (high-arched feet)1,4

Overpronation (feet roll in with walking)1,2

Poor ankle, knee and/or hip alignment1

Prolonged standing, especially on a hard surface1,2,3

Walking barefoot1

Poor footwear1

Obesity1,2,3,4

Deconditioning1

Inadequate stretching1

Long distance running2,3

Decreased ankle range of motion3,4

Tight calf muscles4

 

What can physiotherapy do for plantar fasciitis?

 

Initially physiotherapy will focus on pain management and breaking up scar tissue that has developed.1 Your physiotherapist will also work with you to improve any existing postural alignment and biomechanical issues in order to prevent the reoccurrence of plantar fasciitis. They will help you figure out ways to modify your normal daily activities in order to reduce symptoms of plantar fasciitis and suggest the most appropriate footwear for prolonged weight bearing based on your individualized foot type. Techniques used to achieve these goals include but are not limited to:

       Stretching1,2,3,4

       Strengthening3

       Soft tissue massage1

       Deep myofascial release1

       Joint mobilization3

       Athletic taping1,3

       Orthotic prescription1,2,3,4

       Intramuscular stimulation (IMS)1,3

       Ice massage2

       Night splints2,3

       Modalities1,2,3

Plantar fasciitis usually resolves within 6 to 8 weeks with physiotherapy, however, the coexistence of other medical issues may lead to an increased healing time.1

 

 

By Melissa Richardson (UWO PT Student)

References

[1] Schwartz EN, Su J. 2014. Plantar fasciitis: A concise review. Perm J. 18(1): 105-107.

[2] Goff JD, Crawford R. 2011. Diagnosis and treatment of plantar fasciitis. Am Fam.

84(6):676-82.

[3] Martin RL, Davenport TE, Reischl SF, et al. 2014. Heel pain - plantar fasciitis:

revision 2014. J Orthop Sports Phys Ther. 44(11):A1-33.

[4] Cutts S, Obi N, Pasapula C, Chan W. 2012. Plantar fasciitis. Ann R Coll Surg Engl.

94:539-42.

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