We have all heard of plantar fasciitis – either through a friend or family member who has had it or through Dr Google when searching our symptoms. But what is plantar fascia and what causes plantar fasciitis?
What Is Plantar Fasciitis?
The Plantar Fascia is a long ligament-like structure that starts at the heel bone (Calcaneus) and runs to all 5 balls of the feet (Metatarsal heads) at the bottom of your foot. The plantar fascia can become inflamed and small micro tears may occur, this is generally due to overuse of the Plantar fascia, resulting in Plantar Fasciitis.
Plantar fasciitis symptoms
The Podiatrists at Foot Centre Group sees many cases of heel pain everyday. Typically Plantar Fasciitis is reported as a dull ache through to a sharp stabbing based pain that is most common at the bottom of your heel, just before the arch. Pain is usually most typical first few steps in the morning, after sitting for a prolonged period, worse after walking/ exercise or after standing for long periods of time.
Causes of plantar fasciitis
You have pain on the bottom of the foot and you think you have Plantar Fasciitis but what actually causes it to happen?
Imagine your plantar fascia is like a fan, one starting point (Origin) where the tendon-like structure then spans out to all 5 metatarsal heads (Insertion). The plantar fascia helps to support the arch of your foot and is a main shock absorption during all activities (walking, running, jumping and playing sports). The Plantar fascia can easily become overused due to repeated stress caused by the surrounding muscles not playing their role in shock absorption during activity as well as other factors such as increasing activity too fast, change of activity surface or footwear. These are just a few reasons why plantar fascia may become inflamed. Repeated overuse of the plantar fascia can irritate the fascia and cause small little tears through the plantar fascia.
Treatment for Plantar Fasciitis:
Home treatment Options:
The most common mistake we see here at Foot Centre Group is thinking that complete rest from all activity will help with your heel pain. While this may be the case initially, as soon as you start back at your normal activity and back into your routine you plantar fascial pain will routine.
We recommend if trying to treat your plantar fasciitis at home that you start doing the following as soon as it becomes tender rather than waiting and hoping it just gets better on its own. It is important when treating any fascial injury that the first 6 weeks are most important to ensure it doesn’t become chronic.
- Activity modification- keep moving but reduce your load by roughly 50%. If you normally walk 5km per day, either look at alternating to every second day or reducing the distance of your daily walks)
- Medication: to help with pain if needed this can be either anti-inflammatory(nurofen) or panadol)
- Foot exercises: grab a firm ball (lacrosse ball, golf ball) and begin by rolling the ball slowly from your heel all the way up your arch and then slowly across and back down repeat this for at least 5 minutes.
Have you tried all of these and your plantar fascia still seems to be painful?
This is when one of our amazing podiatrists can help!
Podiatry based treatment for Plantar Fasciitis and Heel Pain
When seeking podiatric help for your plantar fasciitis your podiatrist will ask numerous questions about your injury to understand what may have caused it and to ensure that the cause of your heel pain is plantar fasciitis and not any other heel pathologies.
At Foot Centre Group our podiatrist will then go through an in depth assessment of your foot’s mobility, strength and have a look at your gait (the way you walk).
From collecting information about your injuries and the assessments they will then let you know the cause of your heel pain and how they can help treat you plantar fasciitis.
Treatment option may include:
- Shockwave therapy: Extracorporeal shock wave therapy (ESWT) is a noninvasive treatment that involves delivery of shock waves to the plantar fascia to reduce pain and promote healing of the tissue.This therapy usually requires around 4-5 treatments roughly 1 week apart. We use this as part of our treatment plan for your plantar fasciitis in conjunction with other treatments
- Dry needling Dry needling treats muscle tissue, and its goal is to reduce pain, by targeting trigger points with the muscle. When performing dry needling our podiatrist performs this around the area into the foot muscle and calf muscles.
- Strength and conditioning: Your podiatrist will create a personalised strength and conditioning program specific to your injury, your goals and based around your level of strength. Our strength and conditioning programs are designed in conjunction with all the other other treatments to get you healed and perform at your best.
- Foot Mobilisation and Manipulations:Foot mobilisation techniques (FMT) is a manual hands on therapy developed to improve your foot and ankle function by targeting stiff, mal-aligned or dysfunctional joints to improve the function of your lower limb that our podiatrist would have noted from your initial assessment. By reducing stiffness of the joints and foot it allows for your soft tissue structures (Plantar fascia) to not be overloaded.
- Strapping/ taping: Our podiatrist have found that this one of the treatments that most clients find reduces their heel pain/ plantar fascial pain significantly and quickest. This is due to the strapping deloading the plantar fascia and allowing for better 1st toe facilitation allowing for a better biomechanical loading pattern. However due to tape losing its strength quiet fast, we use it as an adjacent treatment and never as a stand alone treatment option
- Orthotics: Our podiatrist are all trained in prescribing orthotics. Orthotics can be a great tool to help with your plantar fascial pain and can be a quick easy way to reduce your pain and get you back to what you love doing. This is due to orthotics allowing your foot to be offloaded through changing of your biomechanics. All of us have different biomechanics and feet speak to one of our podiatrist to discuss if orthotics may be a suitable option for you and your injury.
- Footwear: Our podiatrist can assess your footwear to see if they may be a contributing factor to your plantar fasciitis. We recommend bringing your footwear along to your initial appointment so they are able to discuss what options will be most suitable for you and your injury.
If our podiatrist/ you have tried the options above and still find that your heel pain is persisting it may be worth discussing with your podiatrist what other options are available. This can include:
- Further imaging: X-ray/ Ultrasound and perhaps an MRI- to ensure that there is nothing else occurring around the site of pain.
- Cortisone injection: This is generally done through a podiatric surgeon or Radiographer and is done under Ultrasound guidance. Injecting steroid medication into the tender area can provide temporary pain relief. Speak to your podiatrist before undergoing this treatment option.
- Surgical intervention: if all of the above treatment options surgery could be discussed- but should only be done if nothing has helped. Your podiatrist will recommend you to be the best surgeon for this if it is needed.