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Plantar fasciitis

is a term you may have heard of before when people are talking about or have experienced heel or foot pain. Prevalence within the general population it is estimated to range from 4-7% and account for up to 8% of all running-related injuries; as many as 10% of people in the total population will experience plantar fasciitis at some point in their life [1,2]. So needless to say if you haven’t heard of or experienced it you’re one of the few, because it is something seen quite often in the clinic.


So what is the plantar fascia? The plantar fascia is a band of connective tissue that originates at the heel and inserts on the tendons of the forefoot and toes with the purpose of supporting the arch of the foot and acting as a shock absorber for pressure placed on the foot [3].

[3]


Plantar fasciitis is believed to be degeneration of the fascia resulting from repeated microtears of the fascia that lead to an inflammatory response. This condition is caused by abnormal and repeated biomechanical forces on the plantar fascia [2,3]. Patients suffering from plantar fasciitis experience pain along the ‘heel end’ of the plantar fascia and around its attachment to the heel bone. Pain aggravates with load, patients likely experience there pain walking and running and when first standing after a period of inactivity, such as getting out of bed in the morning [2]. An example being if you have recently increased your running distances or had to stand all day in dress shoes over the weekend and have woken with heel pain, there’s a good chance it’s plantar fasciitis.


Risk factors for Plantar fasciitis [2,3]:

  • Poor foot mechanics (ie. flat feet, high arches)

  • Altered or incorrect gait patterns

  • Tight calf muscles or Achilles tendon

  • Leg length discrepancy

  • Decreased ankle range of motion

  • Increased running, walking or prolonged standing

  • Increased BMI (body max index) and obesity

  • Incorrect footwear or poor-fitting shoes

Important to note that 45% to 85% of patients suffering from plantar fasciitis, a heel spur is also present [4].


Plantar fasciitis sometimes now referred to as plantar fasciopathy, has historically been treated similar to a tendinopathy for pain relief and rehabilitation. So what can Our Physio do to help you get rid of your plantar fasciitis?

  • Comprehensive whole body assessment identifying any issues with alignment and leg length, joint range of motion restrictions or reduced muscle length and tightness from other parts of the body that may contribute to increased load on the plantar fascia bilaterally or one sided.

  • Hands on treatment to address impairments like poor foot or gait mechanics, alignment, reduced muscle or joint range of motion to accelerate your recovery.

  • Structured and progressed exercise therapy to target pain relief, appropriate training loading and volume as well as any weakness or impairments that contribute to excessive loads on the plantar fascia.

  • Education and advice surrounding other social and environmental factors that may be contributing to your symptoms.


Strength vs stretching?


Rathleff et al. [1] shows in a randomised comparative study strength training involving calf raise style exercises (see exercise 1.) had improved outcome measures for foot function opposed to plantar specific stretching in a 3 month timeframe; 6 and 12 month follow ups for this same study showed no difference or preferable modality for long term effect. But if you ask anyone choosing between what’s going to lead faster improvements in pain and function strength training would be the easy choice.

The theory behind these findings are that high-load strength training may normalise tendon structure, increase load tolerability of the plantar fascia and thereby improve patient outcomes. Another explanation may be that the exercise help improve ankle dorsiflexion (flexing foot up) range of motion as well as improving intrinsic foot strength and ankle dorsiflexion strength. This research provides more recent evidence strength training may be the solution towards more effective treatments for plantar fasciitis.


Other aids to complement your management that are shown to be effective are taping techniques, orthotic insoles, heel cups, or night splints; to help offload the plantar fascia further [2,3]. If you’re looking for additional adjunct therapy options corticosteroid or platelet-rich plasma injections could also be an option for individuals to consider further into a treatment plan if symptoms are ongoing and debilitating [3,5,6]. Plantar fasciitis is an inflammatory process from increased loading, thus an non-steroidal anti-inflammatory medication can also be effective in reducing symptoms [7]; speak with your doctor if this is something you are able take to assist with your recovery.


So what are some key take aways and tips for managing your plantar fasciitis?

  • It is important that you decrease or avoid activities that aggravate your symptoms.

  • Perform the exercises as your physiotherapist has instructed (otherwise they are unlikely to work) and they need to be performed slowly to decrease risk of symptom flaring and with enough load. A slight amount of pain is ok, but it is important to notify your physio if your pain gets worse after your exercises or within 24 hours.

  • Heel inserts and appropriate footwear can help.

  • Icing the plantar fascia can help with pain relief and decrease inflammation.

  • Self releases are a way to maintain range of motion and decrease pain at home (see exercise 2.)


Assessment and diagnosis for each individuals injury should always be conducted prior to developing a treatment plan with exercise prescription and appropriate progressions. Should you have any further questions or would like to discuss your heel or foot pain with a physiotherapist, please contact Our Physio Central Coast (02) 4339 4475.

Acknowledgement and references

Michael Rathleff

[1] Rathleff, M. S., Mølgaard, C. M., Fredberg, U., Kaalund, S., Andersen, K. B., Jensen, T. T., ... & Olesen, J. L. (2014). High‐load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12‐month follow‐up. Scandinavian journal of medicine & science in sports, 25(3), e292-e300.

[2] Schuitema, D., Greve, C., Postema, K., Dekker, R., & Hijmans, J. M. (2019). Effectiveness of mechanical treatment for plantar fasciitis: a systematic review. Journal of sport rehabilitation, 29(5), 657-674.

[3] Luffy, L., Grosel, J., Thomas, R., & So, E. (2018). Plantar fasciitis: a review of treatments. JAAPA, 31(1), 20-24.

[4] Kirkpatrick, J., Yassaie, O., & Mirjalili, S. A. (2017). The plantar calcaneal spur: a review of anatomy, histology, etiology and key associations. Journal of anatomy, 230(6), 743-751.

[5] Rhim, H. C., Kwon, J., Park, J., Borg-Stein, J., & Tenforde, A. S. (2021). A Systematic Review of Systematic Reviews on the Epidemiology, Evaluation, and Treatment of Plantar Fasciitis. Life, 11(12), 1287.

[6]Hurley, E. T., Shimozono, Y., Hannon, C. P., Smyth, N. A., Murawski, C. D., & Kennedy, J. G. (2020). Platelet-rich plasma versus corticosteroids for plantar fasciitis: a systematic review of randomized controlled trials. Orthopaedic Journal of Sports Medicine, 8(4), 2325967120915704.

[7] Donley, B. G., Moore, T., Sferra, J., Gozdanovic, J., & Smith, R. (2007). The efficacy of oral nonsteroidal anti-inflammatory medication (NSAID) in the treatment of plantar fasciitis: a randomized, prospective, placebo-controlled study. Foot & ankle international, 28(1), 20-23.




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