Plantar Fasciitis

What is Plantar Fasciitis?

Plantar Fasciitis is a common condition affecting the planar fascia. This is a strong band of connective tissue that runs from the ball of the foot to the heel bone (calcaneus).  Pain commonly occurs at the point where the fascia inserts on to the base of the heel bone. It starts off as an inflammatory reaction, however if the condition lasts longer than three months it is deemed a chronic injury. The building blocks of the tissue are likely to have been disturbed and recovery can be more prolonged. We should be calling the condition Plantar Fasciopathy at this chronic stage.

What is it’s Role?

The plantar fascia contributes to supporting the arch of the foot by acting like the ‘string’ where the foot bones are the bow.

During walking the plantar fascia acts like a spring which may assist with storing and releasing kinetic energy. One study found it carries up to 14% of total body weight during the contact phase when walking.

Causes of Planta Fasciitis

Plantar Fasciitis is often associated with overload such as a sudden increase in weight-bearing activity like running and jumping.  Alternatively, overload can occur if a previously sedentary person embarks on a long walk (a bushwalk with a backpack and new shoes is a classic example).  Tight calf muscles, over-pronation (flat feet) of the foot and gains in bodyweight are other common causes.

Less common causes are stiffness of the ankle joint or trauma such as stepping on a pebble. Occasionally a heel spur can be seen on X-ray, this is the result of a prolonged period of overload but can be asymptomatic.

Symptoms

Patients generally complain of sharp pain underneath the heel bone when standing.  This pain often subsides when “warmed up”.  You may experience pain during the first few steps in the morning or when rising from a seated position.  We call this “start-up” pain.  Symptoms can become very severe and debilitating.

Diagnosis

The earlier your physiotherapist or GP diagnoses you the better.  Diagnosis is fairly easily made in the clinic after taking a careful history and performing a few select tests.  Occasionally we may request an ultrasound or x-ray if improvement are slow or very severe.

Treatment

Plantar Fasciitis is often multi-factorial so it is important to see your local physiotherapist for a full assessment and treatment plan.

Firstly, your physiotherapist must address your pain.  Physiotherapists commonly use taping techniques, soft tissue massage, exercises,  footwear education and activity modification to achieve this.   Very occasionally we may suggest you wear a walking boot if symptoms are severe.  Once your physiotherapist begins treatment you will often experience a reduction of pain within days which is great.

Next comes the essential rehabilitation phase though.  This consists of progressive loading of the fascia via specific, measured strengthening exercises.  This period encourages the body to heal itself and may also involve a stretching component as well as appropriate sports specific drills.  Commonly rehabilitation takes 3-4 months minimum and the good news is that you can do the bulk of it yourself with just a little guidance from your physiotherapist.

If rehabilitation does not go to plan, your physiotherapist may need to suggest medical intervention in the form of a steroid injection. This should not be your first level of management though.

In Summary

The ultimate goal is to be symptom-free with all activities you want to pursue.  Causes are many and varied.  Treatments are also variable so it is important to be assessed professionally in order to identify the options that will work for you.

 

 

For more information on the conditions we treat and services we offer, or to book an appointment please call 9939 0157 or email us at info@focusphysiotherapy.com.au

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