What is Plantar Fasciitis?
Plantar fasciitis is a condition affecting the arch and heel of the foot. The plantar fascia is a band of fibrous tissue that originates at the heel and fans up to attach to the base of the toe bones. The plantar fascia is responsible for the medial longitudinal arch. Plantar fasciitis is the most common cause of heel pain. Although it was previously thought to be an inflammatory condition, research has recently declared it a degenerative condition, due to repetitive microtears in the plantar fascia. The condition is usually caused by multiple factors, however often biomechanical imbalances are involved. These biomechanical imbalances result in repetitive strain and high levels of loading of the structure and thus microtearing. Often plantar fasciitis and heel spurs are associated with one another. A heel spur may develop on the heel bone as a direct result of constant pulling at the attachment site of the plantar fascia. A heel spur can be either on the bottom of the heel or at the back of the heel. Bone spurs develop over time and are often asymptomatic, however, they have also been known to cause pain in many cases.
Symptoms of plantar fasciitis tend to vary among people, but typically, you may experience the following;
- Pain in the heel or arch of your foot, usually on the inside or central heel
- Pain in the first few steps of a morning
- Pain following periods of rest
- Heel pain which gradually worsens
- Pain during or after exercise
Who is the most at risk of Plantar fasciitis?
Although plantar fasciitis can affect anyone, there are people who are considered a higher level of risk, these groups include;
- Middle aged people
- Long distance runners
- Obese people
- People in the military
What are the causes of Plantar fasciitis?
Plantar fasciitis is usually considered to have multiple contributing factors which tend to vary from person to person. These factors may include the following;
- Biomechanical causes, these relate to the way the body moves
- Calf tightness and muscle weakness can alter your biomechanics and place further strain on the feet
- Sudden weight gain – This places a greater load on the feet and specifically the plantar fascia
- Poor or ill fitting footwear
- Long periods of standing on hard surfaces
- Sudden increase in activity (exercise intensity, duration or frequency)
What other conditions could I have?
Although there are many causes of heel pain, plantar fasciitis is the most common. Some differential diagnosis’ that your podiatrist may explore include the following;
- Sever’s disease (in children)
- Achilles tendinopathy
- Heel spurs
- Fat pad atrophy
- Stress fracture
Usually your Podiatrist will have a good understanding of your symptoms and be able to diagnose you based on their clinical assessment.
Is Plantar Fasciitis Permanent?
Although plantar fasciitis is often challenging to treat, it is not permanent. If there are underlying biomechanical causes (which is usually the case), they need to be addressed and resolved to ensure that the condition is not recurring. For example, if you have a highly pronated foot posture (your feet roll in) this can place a greater load on the plantar fascia (than a neutral foot posture) and thus lead to degeneration of the plantar fascia (or plantar fasciitis). If the pronated foot is not corrected, the condition will be both difficult to resolve and will likely return. In this case, an orthotic device may be used to correct the foot posture and therefore offload the plantar fascia, giving it relief from load and allowing the plantar fascia to rest and recover. Plantar fasciitis is notorious for being a long lasting condition, so it is always best to have it treated as soon as possible. Remember that your plantar fasciitis experience may be completely different from someone else’s.
Treatment for plantar fasciitis will vary from patient to patient. As previously discussed, there are usually many factors contributing to plantar fasciitis, this means that many treatment modalities will likely be explored in order to address all contributing factors. Your Podiatrist will conduct a detailed physical examination, a gait analysis and a history of your pain to determine what the likely cause(s) are. In some cases ultrasound and X-ray may be done to determine diagnosis.
The treatment path may include;
- Specific plantar fascia strapping – Your podiatrist may strap you to assist in altering the plantar pressures and supporting the plantar fascia.
- Orthotics to redistribute plantar pressures and correct foot posture – As previously mentioned your foot posture or your gait may be a contributing factor to plantar fasciitis. Your Podiatrist is highly skilled when it comes to identifying and addressing biomechanical imbalances. Your orthotics will be specific to your foot and your biomechanical needs.
- Stretching and strengthening of the calf muscles – Your Podiatrist will provide a program specific to your strength and stretching needs. Usually these exercises will be specific to the calves. Research has shown that strength deficits and tightness in the calves can play a role in soft tissue pathologies such as plantar fasciitis. It is recommended that you do your exercises daily to get the best results.
- Shockwave therapy – Shockwave therapy is used to stimulate the healing response and has been recognised as a successful treatment method for heel pain and other lower limb pathologies.
- Footwear modifications – Your Podiatrist may modify your inner sole to assist with your pain or they may advise you as to what footwear is best suited to you and your foot type.
- Anti inflammatory medication can be used to decrease the inflammation and thus make the condition more manageable.
- Activity modification – In some cases your Podiatrist may advise that you reduce your physical activity levels to allow the plantar fascia to heal. Usually your podiatrist will encourage you to stay active, but may suggest exercise that places less demand on the plantar fascia, such as swimming or cycling.
- Dry needling – Dry needling is a treatment modality used to target tight muscle spindles that may impact the function and mobility of the foot and ankle.
- Cortisone injection – In some cases, your podiatrist may refer you for a cortisone injection. Usually this is only indicacted once all other conservative treatment options have been exhausted.
- Surgery – It is rare, but in some cases surgery may be considered, Again, this is usually only explored after a long period of time exploring conservative treatments.
Is there anything I can do at home to assist in treatment? While we recommend that you seek professional advice as soon as possible, there are some steps you can take to encourage healing.
- Rolling the bottom of the foot with a frozen water bottle – This is great way to release tension and inflammation in the plantar fascia.
- Self massage specific to the plantar fascia – You can do this with your fingertips or with a lacrosse or spikey ball. This will help to increase blood flow and release tension.
- Stretching – Stretching of the plantar fascia and the calves is easy to do at home and can be very beneficial.
- RICE – usually rest, ice, compression and elevation is used for acute injuries (plantar fasciitis is a chronic condition), but it has been known to be beneficial for reduction of inflammation levels.
- Pain medication or specifically non-steroidal anti-inflammatory drugs – As mentioned before anti inflammatory drugs can be used to decrease levels of inflammation and therefore assist in management of the condition.
Regardless of the severity of your condition, we always recommend you seek professional advice as soon as possible. There are many other conditions that cause heel pain, so best to have a consultation with your Podiatrist to confirm your diagnosis. Once you have been correctly diagnosed your podiatrist will design a treatment plan specific to your needs and goals. At Foot Centre Group we respect that each and every patient is different and therefore responds differently to treatment, your podiatrist will work with you to find the treatment path that is right for you.