The plantar fascia is a thick (and strong) tissue situated under our foot and connects the heel to the toes to help create our foot arch. It is very commonly injured (10-15% of population) and can occur on one side but also on both feet. There are multiple causes to developing pain in the plantar fascia and we will focus mostly on the overuse related condition. The plantar fascia can be overloaded through excessive stretching, excessive loading from walking and running and also from poor footwear such as wearing thongs too much. When the plantar fascia is subject to overuse strain it initially becomes inflamed similar to all other tendons and this resulting inflammation can give sharp pain, dull pain or burning or the feeling of tightness. It is important to seek assistance from a physiotherapist in the early stages rather than the ‘see how it goes’ approach as there are important treatment and management strategies that can help settle this condition in a matter of weeks.
There are unfortunately a fair amount of cases that extend beyond the simple inflamed plantar fasciitis that lasts weeks to cases that last months to up to 2 years in the worst case scenario. For the longer term cases what is clear is that the tissue is no longer acutely inflamed but painful because of micro-damage that has not healed like in tendinopathy. The good news is that It is a condition that can be managed conservatively and >90% cases who have Physiotherapy fully recover.
A physiotherapy subjective and physical examination should be considered for an accurate diagnosis with special foot and ankle testing. The following signs and symptoms do indicate plantar fasciitis:
- Heel pain with first steps in the morning or after long periods of rest
- Tenderness at the base of heel
- Increased foot tenderness when walking barefoot
- Sudden increase in activity
As the diagnosis is usually clinically based, Imaging is not usually required. In some cases an Xray or ultrasound may be performed. A common finding on Xray is the presence of a heel spur however this is not always associated with plantar fasciitis and is just a coincidence. Most heel spurs do not cause any pain.
All Physiotherapy treatment needs to be specifically prescribed so it is tailored to the individual to get the best and quickest results. An example of Physiotherapy treatment modalities includes:
- Strengthening of our lower limb muscles and specifically the ankle/foot stabilising and intrinsic muscles, a graded approach is highly recommended
- Mobilisations and manipulations of the ankle joint
- Foot orthoses/orthotics
- Manual therapy
- Address biomechanics of foot and ankle
- Dry needling/acupuncture
- Ice and heat
- Relative rest from aggravating activities
- Anti-inflammatory medications
For those with persisting cases there are a range of alternative treatment solutions which your Physio can discuss with you and these include being in a moon boot/walker for a period of time, cortisone or PRP injections or shockwave treatment. There is no conclusive evidence that these treatments work but can be trialled in cases that have failed usual conservative management. In some cases surgery may even be considered but this is often a last resort.
The key to getting a good result and returning to full function is early management. Activate Physiotherapy offer same day appointments to attend their clinic to ensure your plantar fasciitis is managed with the best management from the start. Following your assessment our Physiotherapists will develop a tailored program based on your deficits. Our approach is unique and our physiotherapists understand the importance of settling your pain and helping you get back to what you love.
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