Plantar Fasciitis – That annoying heel pain
Among the most common foot injuries is plantar fasciitis, an overuse injury as the result repeatable straining of the plantar fascia. The plantar fascia, located in the arch of the foot, is a thick connective tissue (similar to a ligament) which supports the arch of the foot and assists with the push-off phase of walking.
Almost every person, at some point throughout their life, will experience a form of plantar fascia pain. In simple uncomplicated plantar fascia, the pain is isolated to the fascia, especially the origin point near the heel. However, I often see complicated ones in which thee might Achilles, calf and knee problems all contributing to the pain in the heel. You can also experience discomfort with walking and often those first few steps after prolonged sitting or sleeping can be painful.
What Symptoms Might I have if I have Plantar Fasciitis
One of the first signs you will notice if you have plantar fasciitis pain under your heel or in your foot arch in the morning or after resting.
Your heel pain will be worse with the first steps and improves with activity as it warms up.
Generally, plant fasciitis as an overuse injury will progress along 5 stages:
Stage 1: No-Heel Pain
Stage 2: Heel pain after exercise.
Stage 3: Heel pain before and after exercise.
Stage 4: Heel pain before, during and after exercise.
Stage 5: Heel pain all the time. Including at rest’
Common causes of Plantar Fasciitis
Understanding the cause of your plantar fasciitis is important in the recovery of the pain. Among the common causes are:
- The use of unsupportive footwear, either work shoes or sporting footwear
- An increase in physical activity that can include walking along with running/sport
- Following an acute or chronic injury, like a sprained ankle. This can cause both mechanical and compensatory stress on the fascia.
- Arch position, either high arch (pes cavus) or flat arch (pes planus)
- An increase in pronation of the foot during walking/running
- Obesity is also a significant cause especially when combined with all of the above.
Many people just leave them to try to get better on there own. Whilst this might happen it is often the case that the pain returns. This is because many of the contributing factors might not have been addressed.
It is of utmost importance that the fascia is loaded to help with remodelling of the facia that shows really poor mechanical structure. Science doesn’t agree 100% on how exactly to load the fascia. However, science does agree with the fact that healing will require the right load at the right amount. This is where it gets tricky. Everybody has a different loading profile that will help them. I have found that it is so important to get the loading profile right for each individual patient. I often see conditions that have been loaded to aggressive and causing continual flare up and other cases in which it hasn’t been loaded enough. Your physio should work with you to work out the best loading profile for you (this includes the type of exercise, how hard and how often).
General leg and Body strengthening
Strengthening of the legs, in general, is an important component aspect of the rehabilitation and often lacks consistency by people to make a significant change. A lack of strength, especially with the calf muscle, can contribute greatly to changes to the muscle-tendon junction with the Achilles that ultimately influences the plantar fascia. The strengthening exercise of importance is the eccentric loading of the Achilles tendon. The exercise, which you drop your heel down and raise up, aim to improve the strength of the calf muscle along with lengthening the muscle-tendon junction of the Achilles and plantar fascia. This combination results in less strain with the motion of the foot, especially with running or sporting activity. Other important exercises of note are towel scrunching (essentially on and off gripping of a towel with your feet) for the plantar fascia, single leg balance/stability exercises and gluteal strengthening if needed. A return to activity, especially running, is a slow gradual process that can often start with walk/run intervals then progressed into a full running program. It is recommended to progress the running or activity at only 10% each week to avoid working the fascia.
Stretching is immensely important, especially for the muscles linked to the plantar fascia. This includes the hamstring and calf muscles. I advise regular (every day or a couple of times) stretching throughout the day. Along with stretching the calf and hamstring, stretching of the plantar fascia is important. Using a golf ball or a frozen water bottle are good tools to help self-massage the bottom of your foot. A frozen water bottle can help to ease any pain or inflammation. After periods of inactivity, like sitting or sleeping, actively stretching by pumping your feet up and down can lessen the pain of those first few steps.
Foot and Arch Support
Support for the arch can also be helpful for plantar fascia pain. Initially, the arch will be strapped to unload the plantar fascia while also providing ankle and heel support. I explore various footwear options to help ease the pain.
Cold laser therapy
In all the years I have been treating Plantar Fasciitis (and had it myself) I thought I was getting great results. That was until I started combining my Bioflex Laser system with all the proven treatments that I have previously used. This is in line with my Patient-Centred Participatory Approach (PCPA). The addition of integrated cold laser treatment to my tried and tested treatment approach for heel pain have been a game changer even the complex complicated. I still assess the foot and leg as I used to. Looking for weaknesses, tight structures and correcting biomechanics and changing/modifying footwear. This is not an addon but I include it as an integral part of treatment at no additional cost.
These studies highlight similar results in chronic plantar fasciitis.
1. Ulusoy A, Cerrahoglu L, Orguc S (2017) Magnetic resonance imaging and clinical outcomes of laser therapy, ultrasound therapy, and extracorporeal shock wave therapy for treatment of plantar fasciitis: a randomized controlled trial. J Foot Ankle Surg 56(4):762–767
(Summary available here: https://www.ncbi.nlm.nih.gov/pubmed/28633773)
• Similar results between LLLT (Laser therapy) and Shock wave therapy and in outcomes and MRI changes for plantar fasciitis.
2. Cinar, E., Saxena, S. & Uygur, F. Lasers Med Sci (2018) 33: 949.
(Summary available here: https://www.ncbi.nlm.nih.gov/pubmed/29273892)
There are many other options available to you. I have found with the steps taken above the success rate is very high in getting back to full function. Very rarely in my opinion would more aggressive surgical management be necessary.
Treatment for plantar fasciitis can often be uncomplicated but the recovery period can be prolonged. Simple measures to change the support structures of the foot, and a stretching and strengthening program help immensely. Treatment often fails because of the inability to sustain the rehabilitation program. I work with patients to find a rehab program that is achievable so that we can continue to progress even when feeling frustrated.
Overall what works is an integrated treatment process working with you as part of my Patient-Centred Participatory Approach are a combination to help create a shared vision between patient and practitioner of reducing pain, sustaining wellbeing, optimising life.
For more information on this injury, or to book an appointment to get on top of your foot pain, talk to your friendly Gold Coast Physio today on (07) 55271071.