What is Plantar fasciitis?
The plantar fascia is a thick fibrous band that attaches from the heel bone underneath the foot to the toes. It supports the arch of the foot.
Plantar fasciitis is a common foot problem which causes heel pain under the heel or pain along instep of foot. The more updated term for this condition is plantar fasciopathy- this is to reflect that the problem is often more degeneratative than inflammatory. It is estimated to affect 1 in 10 people between the ages of 40 and 60. It usually starts as a dull intermittent pain that is worse in the mornings then progresses to a stronger pain which may last all day. It is rarely painful at rest sitting or lying.
Predisposing factors to plantar fascitis;
- Flat feet [overpronated]
- High arched feet[ over supinated]
- Inappropriate footwear
- Running on toes/ uphill running
- Increasing age
- Obesity [high BMI] especially in those with standing jobs.
- Stiff ankles
- Leg length differences
- Sudden increases in weight bearing activities such as running and increasing amount of running too quickly.
- Poor foot intrinsic muscle strength
- Occupations which involve prolonged standing
- Tight calf muscles
You can see from the above that a middle aged overweight person that takes up running in inappropriate footwear would be at risk of developing the condition.
TREATMENT of plantar fasciitis at Swords Physiotherapy
Home care
Rest- minimize weight bearing activities such as running-try swimming instead. Standing should be decreased by 50% at work for patients with standing jobs.
Ice-use a frozen bottle of water to roll under arch of foot.
Avoid bare foot walking particularly on hard surfaces. Keep shoes beside the bed to put on first thing in the morning when pain is worse.
Physiotherapy
Physiotherapy, for plantar fascitis, may involve Taping, electrotherapy [ultrasound/ interferential therapy ]and ice ,to reduce pain and swelling. It may take as long as 4 weeks to settle pain initially.
Biomechanical analysis will be undertaken as part of the assessment to determine cause of the problem. Often, tight hamstrings and calves can be a contributing factor, as can structural foot abnormalities.
Prescription orthoses/ heel wedges and or raises will help take pressure off the painful fascia and help minimize the chance of recurrence.
Exercises to strengthen the intrinsic foot muscles and stretch any muscles that are tight will be prescribed as appropriate. Patients may need to be prescribed appropriate aerobic exercised to assist with weight loss if this is relevant to the problem.
As the calf muscle is the muscle that affects the heel and loading of the plantar fascia it will need to be strengthened. For plantar fasciopathy the calf exercise is performed with the plantar fascia loaded- ie. the big toe rests on a rolled up towel and then the heel is raised from the ground slowly – 3 seconds up 2 seconds pause and 3 seconds lowering. 3 sets of 12 repetitions would be the usual aim. The exercise is preformed every second day.
Your physiotherapist will be monitoring patients pain level during work/sport, after work/sports and the morning after work/sports. This will guide patients exercise progression. Usually we ask patients to use a pain scale from 0 [no pain ] to 10 [ unbearable pain] to help quantify the pain intensity. When pain levels are reported to be 3/10 or less, at above 3 points in time, it is usually appropriate to progress exercises.
With patients keen to return to running they will first need to be able to walk 10km symptom free. From that point running will be phased in gradually with 1 mins run followed by 2 mins walking to start with. It would be expected to take about 8 weeks to rehab from walking to running as progressions need to be slow.
Other treatment
Anti – inflammatory medication may be prescribed in the initial stages. This can help ease the symptoms . It will not cure the problem.
Cortisone injections. In the past injections were often given for plantar fasciitis. Repeated injections can weaken the plantar fascia and predispose it to rupture. Today injections are reserved for the small percentage of patients that do not respond to conservative care.
Surgery is very rarely preformed on plantar fasciitis. In patients that have the condition over a year with severe disability it may be considered.
Vitamins /food supplements thought to possibly help are vitamin c, zinc and glucosamine.
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