Plantarfasciitis is a common foot condition and the most common cause of heel pain. The plantar fascia is a thick band of connective tissue that connects your heel to the ball of your foot. Pain occurs when the area breaks down, becoming weak, swollen, or irritated. This is a common condition in both athletes and the sedentary population alike and without the correct physiotherapy treatment plantarfasciopathy can turn into a long-term niggly injury. The reason that the name has changed is that we’ve recently figured out that there isn’t any inflammation, hence dropping the -itis!
The most common signs and symptoms of plantarfaciopathy are:
- Pain on the bottom of your foot but usually towards the underside part of the heel.
- Tenderness to touch over your heel.
- Pain on weight bearing activities tends to be worse after periods of rest e.g. taking your first few steps in the morning after getting out of bed or getting out of the car after sitting down for a while.
- In more severe cases any weight bearing can be painful and the pain can increase with activity
- Stiffness in the bottom of your foot arch.
- Stretching of the plantarfascia by pulling your toes and ankle up towards your shin bone often increases the pain.
What is your plantar fascia?
The plantar fascia is a flat band of ligaments that connects the ball of your feet to your heel bone. The plantar fascia is vital to maintaining normal foot arch biomechanics and provides dynamic shock absorption for your foot.
The exact cause of planatarfasciopathy is a degenerative overuse condition. Repetitive microtrauma causes the plantarfascia to breakdown and it can become weak, swollen, and irritated. Generally, plantarfaciopathy is a self-limiting condition that most commonly lasts for around 3-9 months, though can last for 2 years if treated with only rest (don’t do this!). It is important to remember that in the majority of cases the plantarfascia is not damaged but rather just overworked or overloaded.
What are the main risk factors for developing plantarfasciopathy?
The main risk factors for plantarfasciopathy for the average population are:
- Having a high body mass index (BMI), meaning more weight and load is going through your foot and plantarfascia
- Decreased range of motion in your ankle joint e.g. You can’t pull your foot up far towards your knee
- If you have reduced extension in your big toe
- Reduced strength in your calf causes the load to go onto your plantarfascio
Common risk factors in the athletic population are:
- Increased training volume e.g. if you have recently increased the amount of km’s of running per week
- Recent changes in running style
- Recent change in footwear
How does physiotherapy help with plantarfasciopathy?
The way to successfully treat this condition is to first offload the plantar fascia for a period of time to help reduce the irritation and sensitivity and then carefully begin to increase the load it can tolerate.
It’s a fine line between flaring up your condition and following a successful rehab path. Here at Fixio our physiotherapists understand the devil is in the detail and we make sure your recovery stays on the right path.
Stage one can be thought of as the pain-dominant phase. During this phase, the plantarfascia can be swollen and is most often very sensitive to activities that involve being on your feet. Generally, this stage will last one to eight weeks. This is where we use every trick in our physio playbook to help reduce your symptoms such as:
- Reducing aggravating activities as much as possible.
- Ankle and foot joint mobilisations to improve range of movement.
- Stretching and soft tissue massage of the plantar fascia calf muscle and the intrinsic foot muscles.
- Trailing a heel pad or heel wedge, or taping your arch and heel to help offload the plantarfascia.
- Using painkillers (in conjunction with your G.P).
- Self-massage using a golf ball or tennis ball.
- Trialling more supportive footwear under close supervision from your physio.
The second part of treatment is the load dominant phase. During this stage, your pain is under control and we now need to gradually begin to build tolerance in the plantarfascia and foot arch muscles. This will mainly be done by incrementally strengthening the muscles with exercises like heel raises that you can do at home or in a gym.
Although plantarfasciopathy can be an extremely annoying injury with the correct advice and individualised training program we can get you back to your regular activities.