Plantar Fasciitis is a leading cause of foot pain. So what is it? And what can be done for it?
Plantar fasciitis is pain on the inside aspect of the heel. The plantar fascia is a thick fibrous band of connective tissue originating on the calcaneus (heel bone) and stretches out to the toes. It acts to help maintain the arch of the foot. Plantar fasciitis is an inflammation at this insertion into the heel bone (in more long standing cases it can start to cause degeneration in the plantar fascia).
Many people with plantar fasciitis also have a heel spur, this is a hook of bone that forms on the calcaneus (heel bone), this can be found on X-ray. The heel spur itself is not thought to be the primary cause of pain, rather the inflammation and irritation of the plantar fascia seems to be the primary problem. It is considered that plantar fasciitis may even cause heel spurs by irritating the bone, where the fascia connects.
How does it happen?
Plantar fasciitis occurs as a result of stretching or ‘pulling’ of the plantar fascia from its attachment on the heel bone. Running and walking is commonly associated with the development of plantar fasciitis. This injury is called an overuse injury; it may happen over a long period of time before the patient decides to seek treatment. There are many factors which can contribute to overuse of the plantar fascia, including:
- Long periods of standing, especially if wearing poor footwear (e.g. shoes that do not provide enough support for the arch of the foot, or enough cushioning)
- High body mass index – carrying excess weight increases the load on the plantar fascia
- Increased training program – e.g. running/walking further especially if wearing old or inappropriate footwear
- Bio-mechanics – e.g. having flat feet increases the load on the plantar fascia and can lead to overuse
- Standing or walking on a lot of hard surfaces
How does it feel?
The pain is typically worse in the morning, with the first steps being very tender until the area warms up. Pain is worse with high impact weight-bearing activities. The site of tenderness is localised to the inside aspect of the heel, and is usually described as a dull ache. Over time, combined with the repetitive nature of running or walking, the inflammation can get worse and the intensity of the pain increases.
What should you do?
If you have or suspect you have plantar fasciitis then you should seek treatment as soon as possible. The earlier this injury is treated, the more successful the outcomes.
You can start some self treatment including:
- ice – apply crushed ice wrapped in a wet cloth to the affected area for 10 minutes 1-3 times per day
- massage – you can gently massage the plantar fascia (on the bottom of your foot) for 2-5 minutes daily, take care not to massage so hard that it is painful, alternately you can use a tennis ball or golf ball to roll over the plantar fascia, this may be particularly useful in the morning before getting up out of bed.
- ice massage – use a drink bottle filled with water, that you have frozen, roll your foot over the frozen bottle for 3-5 minutes, this combines the ice and massage components if you prefer.
- stretching – you can do stretches for the calf (lean forward in a lunge position, keeping the back heel down and knee straight to stretch the calf). To stretch the plantar fascia put one foot against the wall and lean forward to stretch out the bottom of the foot. Each of these stretches should be held for 30 seconds.
- footwear modifications – you should try to wear supportive footwear (like walking shoes or joggers) rather than sandles or flip flops which do not offer any arch support for the foot.
- heel cushioning and foot orthoses – your physiotherapist or podiatrist can recommend appropriate heel cushions or orthoses depending on your foot type.
What shouldn’t you do?
You shouldn’t ignore the problem. This injury is deceptive in that it warms up and you are able to walk and run on the area. Unfortunately each time you run on it you are causing more problems. With time, the pain will not warm up and your injury is far harder to treat, and may take longer to respond to conservative treatment.
Could there be any long-term effects?
There could be long-term problems with chronic pain in the area if symptoms are not adressed quickly.
Physiotherapy is important in the diagnosis and management of plantar fasciitis. An accurate diagnosis is necessary to ensure successful management outcomes. Once the extent of the injury is established, a treatment plan can be prescribed.
The treatment involves a combination of ice, massage, taping, stretching, and strengthening of the intrinsic muscles of the foot (to help unload the plantar fascia) as well as assessment and correction of bio-mechanical anomalies which may have caused the injury. Footwear assessment is also important in the successful treatment of plantar fasciitis. The physiotherapist will also be able to provide assistance in the return to activity program to prevent re-occurrence of the injury.