Plantar Fasciitis – Symptoms, stretches and exercises
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What is Plantar Fasciitis?
Plantar Fasciitis is a common overuse injury which results in pain on the bottom of the heel. This condition (also known as Plantar Fasciopathy) is estimated to affect at least one in ten people of the course of a lifetime.
The Plantar Fascia is a band of connective tissue that spans the arch of your foot and helps to provide stability. As excess stress is placed on this tendon, there can be irritation leading to pain where it attaches into the heel.
In Plantar Fasciitis, thickening and degenerative tissue is much more likely to be found than inflammation. This is why the term Plantar Fasciopathy may be more accurate.
Plantar Fasciitis symptoms
-Pain at the base of the heel, usually pain is worse on the first couple of steps
-This pain will usually decrease with some movement, but worsens with too much activity
-Symptoms can also be felt under the arch of your foot, or into the calf
-Burning pain is not as common but can also occur if nerves around the heel are irritated
Plantar Fasciitis causes
Plantar Fasciitis is an overuse injury caused from too much load over time on the Plantar Fascia. The loading exceeds the bodies ability to heal, causing micro-damage. This cycle continues, forcing the body into an unhealthy repair response.
Causes of Plantar Fasciitis can include:
-Walking or running that is increased greatly over a short period of time
-Increased walking on uneven ground like the beach
-Poor footwear and not changing shoes
There are many different risk factors for Plantar Fasciitis. Having these doesn’t make you certain of having the injury, but it will increase the likelyhood.
This will depend on how much running is normal for you. People that suddenly increase their running load will be more at risk of Plantar Fasciitis.
-Increased Body Mass Index (BMI)
As BMI increases, the likelihood of getting Plantar Fasciitis also increases. This is due to the extra mechanical load placed on the plantar fascia. Obesity also causes the body to be in a pro-inflammatory state which can increase risk of inflammation and injury.
-Limited Ankle Bend (tight calf muscles)
Tight calf muscles will limit the amount your ankle can bend and place more stress on the Plantar Fascia. This will add cumulative stress which increases the risk of injury.
As with BMI, less ankle movement is associated with higher risk of injuring the ankle.
-Prolonged weight bearing at work
Increased time spent on your feet increases the load on the plantar fascia. This places you more at risk due to the increased demands placed on the Plantar Fascia. This is only a problem if your body is unable to adapt appropriately to the demands placed on the Fascia.
-Excessive pronation of the foot
Pronation is where your foot caves inwards during walking. This places more stress on the Plantar Fascia. Watch the below video for more of an understanding on what pronation is:
Treatment for Plantar Fasciitis
Treatment for Plantar Fasciitis is multi-faceted. Most people will respond excellently with non-surgical management and their symptoms will resolve within a year.
Non-surgical management can involve numerous interventions, although some have more evidence than others.
Weight-loss is important to think about with any tendon disease. Weight loss can reduce the over-all inflammation in the blood-stream and help reduce the load on your Plantar Fascia.
The most effective treatment for Plantar Fasciitis is load management.
Because the issue was too much load in the first place, load needs to be managed appropriately. This doesn’t mean complete rest. Complete rest can have the opposite effect if performed for excessive periods.
The best treatment is finding a load that doesn’t flare up the fascia, and slowly increasing the load from there. Some examples of exercises that can increase load on the fascia are given below, along with other treatment options.
As mentioned above, exercises should be the treatment of choice for Plantar Fasciitis. This is hard as it does involve effort, but this will be rewarded in the long term.
The difficulty is finding an exercise that doesn’t flare-up the pain. Below are some exercise suggestions starting at the most basic and increasing in difficulty.
Toe curls for Plantar Fasciitis
Sit in a chair with a towel under your feet. From here curl your toes inwards, keeping your heel on the ground. The aim is to scrunch the towel under your feet.
This will help the intrinsic foot muscles to activate and support the arch of your foot.
Seated Calf Raise
Sit in a chair leaning forward with elbows resting on your knees. From this position slowly lift your heels off the ground, pushing up with your toes. You can adjust the amount you are leaning on your knees depending on how hard you need the exercise to be.
Standing Calf Raise
Standing with back against a wall, slowly lift onto your toes. Keep your bottom against the wall to ensure you don’t lean forwards, making the exercise easier.
See our Calf Raise article for all the tips and progressions of calf raises.
Stretches are important to help gain ankle range of motion. Remember limited ankle bend is a risk factor in developing Plantar Fasciitis.
The best form of stretching is called eccentric stretches. This is where your muscle is working, but still lengthening. An example is standing on the edge of a step and slowly lowering down. Your calf muscles are working to slow the movement, but still getting stretched.
This is a great exercise to help lengthen the calf muscle. Be careful though, as this will also increase the strain on your Plantar Fascia. This exercise may be performed a little later in the rehabilitation.
Massage can provide short term relief, but is not going to address the underlying problem. Muscles will adapt to the injury and become tight and sometimes painful. It can help to relieve these muscles with some massage.
It is always advisable to avoid massaging directly over the Plantar Fascia. This can aggravate the already unsettle fascia.
Rather pick muscles around the fascia that often react to the injury. This would generally be the calf muscles, and the muscles under the arch of your foot (but stay away from the heel).
Taping for Plantar Fasciitis
Taping can also provide temporary relief for Plantar Fasciitis. The use of tape can help to take pressure off the Plantar Fascia by helping to prevent caving of the foot arch’s.
The video below is helpful in the the first technique can be used for both Achilles Tendinopathy and Plantar Fasciitis.
Many home remedies have been suggested, however there are only a couple that will actually work.
One home remedy that does work effectively involves rubbing the arch of your foot. Get a water bottle filled nearly to the top and freeze it overnight. Sit in a chair with the frozen water bottle under the arch of your foot. Slowly rub the bottle up and down the arch, taking care to avoid direct pressure over the heel.
This can be performed for 5-10 minutes and will help reduce tension in the plantar arch.
Insoles otherwise called orthotics/orthoses have some evidence to support their use in Plantar Fasciitis. Both custom orthoses and regular orthoses have been shown to reduce first step pain for the condition. The effects of orthotics may not last in the long term (over a year), with studies suggesting they are effective usually in the short to mid-term.
Due to the expense of custom orthoses it is worthwhile looking at trialling an off-the-shelf orthotic to see if this helps with your heel pain. Evidence for off-the-shelf versus custom orthotics are equivocal, and they are not too expensive, so it is worth a trial.
If insoles make your heel pain worse, it is recommended to take them out again. Change should be felt in a couple of days, but if they aren’t making the pain worse a trial of orthotics can be undertaken for 3-4 weeks.
Shoes for Plantar Fasciitis
There are many different shoes on the market for Plantar Fasciitis. It is important to find a shoe that is comfortable for you, and a snug fit.
There is evidence to support regular changing of shoes to prevent heel pain for conditions such as stress fractures. Shoes should be changed roughly every year at the latest.
When looking for a shoe, make sure there is flexibility in the mid-foot, a firm heel cup, and padding around the heel of your foot.
We have an article on shoes for Achilles Tendinopathy that can give some examples of brands to look out for!
Surgery for Plantar Fasciitis
Surgical intervention should only be considered as a last resort for Plantar Fasciitis. It is recommended to trial conservative treatment for at least 6-months before considering surgery.
Most people with Plantar Fasciitis will improve without the need for surgery.
It is important to point out that surgery does not always definitively solve heel pain. Approximately one quarter of patients will still have pain after surgery.
There are many associated risks including; infection, nerve injury or collapse of the foot arch.
If surgery is required, surgeons will usually opt for the least invasive techniques. Although there are different approaches, most surgeries involve cutting back part of the plantar fascia. This helps to relieve tension on the Plantar Fascia.
Plantar Fasciitis is a disease that effects the Plant Fascia where it attaches into the heel. Load management is essential in the treatment of this condition. Surgery is only a last resort option, and not needed in the majority of cases.
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