Plantar Fasciitis: The never-ending pain under my heel
Figure 1: Foot Pain - Plantfasciitis - Physio Frenchs Forest, Physio Macquarie Park
How Common is Plantar Fascia Pain:
Plantar fasciitis effects 3.6-7% of the population (Rathleff et al, 2014).
Despite using shoe inserts and stretching, 40% of patients still have symptoms after 2 years (Rathleff et al, 2014).
What is the plantar fascia?
The plantar fascia is a fibrous band of connective tissue that originates from the heel bone and connects to the toes. It’s role is to act as a passive limitation to the over flattening of the foot.
Why me?
This is termed a chronic injury in many individuals and has an no apparent reason why it started. However, we do know it’s more common in those who have flat feet or poor arch control, are involved in a sport that requires the use of the toes more than the heels, those who stand a lot for work or individuals with a lack of arch support in their footwear.
What are the signs and symptoms of plantar fasciitis?
Pain under your heel
Heel pain after long periods of resting or your first steps in the morning.
Heel pain after exercise
How can Physiotherapy help plantar fasciitis
1) Rest, Ice and protection:
Rest the foot from foot provoking postures such as long periods of standing or activities that may be aggravating the pain
Ice: gentle massage with a frozen bottle can help in the initial stages
Anti-inflammatories in the early stages may be beneficial
2) Restore normal foot biomechanics:
Your physiotherapist may tape the foot in the early stages to improve both your pain and address any biomechanical problems.
3) Stretching and strengthening of the plantar fascia.
Figure 2: Foot Pain - Plantfasciitis - Physio Frenchs Forest, Physio Macquarie Park
We know from studies that when the CORRECT load is placed across the plantar fascia, it will yield positive results.
To generate a load through the plantar fascia the toes must be extended on a towel or foam as the above picture illustrates(Stecco et al, 2013). The individual should then perform as calf raise by pushing through the toes and lifting the heels in the air. The individual should perform 3 sets of 12 repetitions unless a pain level of 3/10 is reached prior.
Stretch the plantar fascia for 10 X 10 seconds, 3X/day by placing your hand over the toes and pulling them upwards.
Figure 3: Foot Pain - Plantfasciitis - Physio Frenchs Forest, Physio Macquarie Park
Can a injection help plantar fasciitis
A corticosteroid injection combined with strength training is superior to the when these treatments are prescribed on their own.
Results are often observed at the 3 month mark post injection (Johannsen et al, 2018)
In Summary:
Plantar fasciitis affects a large amount of the population
There are many factors that may be causing your pain and unless these are identified you may continue to have the pain for 2 + years.
Performing the exercises as illustrated above correctly with the right dosage, along with shoe support should improve your symptoms within 3 months (Rathleff et al, 2014).
Addition of a corticosteroid injection may aid recovery.
See our expert Physiotherapy team at Frenchs Forest and Macquarie Park!
Reece Jones
Principal Physiotherapi
Set In Motion Physioterapy
References:
Rathleff, M., Molgaard, C., Fredberg, U., Kaalund, S., Anderson, K., Jensen, T., Aaskov, S., Olesen, J. (2014). High-load strength training improves outcome in patients with plantar fasciitis: a randomized controlled trial with 12-month follow up. Scandinavian Journal of Medicine and Science in Sports.
Johannsen f., Herzog R., Malmgaard-Clausen N et al. (2018). Knee Surg Sports Traumatol Arthrosc, https://doi.org/10.1007/s00167-018-5234-6