What is plantar fasciitis?
Plantar fasciiitis is commonly known as jogger’s heel or heel pain. In order to understand this condition, you first need to know what is the plantar fascia. The plantar fascia ligament is a thick band of dense connective tissue that provides support for the longitudinal arch of the foot during weight bearing and runs along the sole from the heel bone to the ball of the foot.
Illustration of the plantar fascia of the foot.This band may become inflamed through overuse (e.g. an unusual amount of walking, running, or jumping), or occasionally through trauma (e.g. having your foot on the brake in a car accident). Where it inserts into the heel bone then becomes microscopically red, hot and swollen and causes pain in the heel, especially on the instep and can extend further along the medial longitudinal arch of the foot. The pain is generally worst in the mornings when taking those first few steps and may ease up throughout the day, but will worsen with prolonged weight bearing.
How do we treat it?
Physiotherapists will assess the stage of the condition, where they diagnose whether it is acutely inflamed (initial stage), sub-acutely inflamed, or if the condition has progressed to what is termed chronic plantar fasciopathy. This is a painful degenerative condition whereby the ligament has attempted to heal but with abnormal scar tissue.
Depending upon the stage of the condition, physiotherapists will then use any of the following treatment modalities or techniques:
- Ultrasound, muscle stimulation, interferential therapy to break down scar tissue, increase circulation to the affected area, strengthen the intrinsic foot muscles, decrease swelling and inflammation
- Acupuncture to decrease pain and inflammation and increase circulation
- Taping to de-load and support the arches of the foot, decrease swelling and inflammation, to provide proprioceptive or “joint sense” information to the foot)
- Contrast baths to increase circulation and decrease inflammation
- Massaging the sole of the foot with a cold pop can or roller to increase circulation, decrease inflammation and break down scar tissue as well as stretch the foot muscles and fascia
- Stretching of the calf muscles and plantar fascia (the calf muscles have an anatomical attachment to the plantar fascia and tight calf muscles may predispose you to the condition)
- Balance and joint sense exercises to de-load the plantar fascia
- Exercises to work the intrinsic and extrinsic muscles of the foot to de-load the plantar fascia
The physiotherapist will have a look at all of your daily footwear to ascertain whether you have the necessary arch support. If not, he/she may prescribe custom orthotics, particularly if the condition is prolonged, or if your primary forms of cardiovascular exercise are weight bearing, spending most of your day standing at work, or if you love to do activities of daily living such as gardening or golfing. Some clients may be able to get away with better footwear, or over -the-counter orthotics. One common mistake is that clients with this condition forget to wear shoes in the house, and if they have hardwood, tile or vinyl floors, this puts a lot of unnecessary stress on the plantar fascia. Over-pronators tend to put more strain on the plantar fascia, as do people with flat feet. If the client has developed associated heel spurs, it is better to get custom orthotics which will lessen the impact of walking on ‘a bony spike’.
Things to avoid if you are symptomatic:
- Unnecessary weight-bearing since this is an over-use injury in general
- Stairs, uphill and downhill walking and crouching
- Walking barefeet
In certain circumstances, if the condition is not improving with physiotherapy and the above interventions, the client may be referred back to their family physician for a course of over-the-counter or presciption anti-inflammatories.
Chronic plantar fasciopathy was commonly treated with dexamethasone or corticosteroid injections. However, a recent research article published in the Clinical Journal of Sports Medicine by Canadian researchers (Vancouver, BC, May 2014) has determined that workers with plantar fasciopathy who stood for prolonged periods experienced the same short-term therapeutic effectiveness with a physiotherapy-led exercise program compared with an injection of corticosteroid with stretching.
Surgery would be the last option. Consulting with your doctor to assess the best option for your condition.
It is important to please seek treatment in the early stages since the condition becomes more difficult to treat the longer you are symptomatic.
For more information on plantar fasciitis, please visit the Canadian Physiotherapy Association website.