The plantar fascia is a thick layer of connective tissue on the bottom (plantar) aspect of your foot. It is made up of three bands (lateral, medial, and central) and stretches from the base of you heel bone to the beginning of each toe. The plantar fascia helps create and support the natural arch of your foot and, when stretched by extension of your big toe, becomes taut and actually increases the arch of the foot. This process is called the ‘Windlass Effect’ which increases the rigidity of the foot so you have a solid base of which to push off with in the late-stance phase of walking.

What is plantar fasciitis and why/how does it occur?

-Itis is the suffix which means inflammation. Therefore, plantar fasciitis literally translates to ‘inflammation of the plantar fascia’. Most commonly, we see this condition arise as a result of repetitive overuse, especially when a sudden increase in weight-bearing activity is noted. For example, runner’s can often experience plantar fasciitis when attempting to increase weekly mileage too quickly. Risk factors include limited ankle range of motion and obesity. Footwear, calve tightness, and both flat-feet or high-arches have also been observed as predictors for having a higher risk of developing this condition. Women have a higher incidence than men pain typically occurs during between the ages of 40-70 years.

Plantar fasciitis is mostly commonly felt as an intense, sharp and/or dull pain on the bottom surface of the heel where the central band inserts on the calcaneous, or in the middle of the arch. Pain is most often experienced when in weight-bearing after a period of non-weight bearing (i.e after a night of sleeping). Pain is typically at its worse during the first few steps out of bed in the morning and gradually lessens as the tissue “warms-up”. However, people affected by plantarfasciitis often experience an increase in pain near the end of the day also.

This condition has been observed to affect approximately two million Americans each year and 10% of the population within the course of a lifetime. Symptoms are almost always resolved with conservative management, but can last several months to 2 years depending on the severity of symptoms.

 

What is the treatment for plantar fasciitis?

Before treatment commences, care must be taken to screen for other causes of foot and heel pain. More specifically, an evaluation by a therapist at Life’s Work Physical Therapy will help to screen for:

  • calcaneal (heel bone) stress fracture or bone bruise
  • fat pad atrophy/inflammation
  • tarsal tunnel syndrome: irritation of the nerves that enter the foot from the ankle
  • Paget bone disease
  • Sever’s disease: seperation and/or inflammation of the growth plate of the calcaneous
  • referred pain from the lumbar spine
  • other areas influencing foot mechanics, such as the knee and hip
  • sacroiliac dysfunction

Once plantar fasciitis is identified, treatment usually consists of first reducing the inflammation through appropriate modalities. Anti-inflammatory modalities, such as iontophorisis with dexamethasome, have been shown to provide short-term relief. Frequent icing 2-3 times per day, using a frozen water bottle and rolling it up/down the arch of the foot, has been proven beneficial in some cases. You can also discuss with your physician about the appropriateness for over-the-counter anti-inflammatories, such as ibuprofen.

The most important factor for reducing plantar fascial symptoms and decreasing the risk of reinjury is identifying and removing the actual cause of the patient’s symptoms. Therapists at Life’s Work Physical Therapy are experts in identifying joint dysfunction, muscle tightness, and various activities & positioning that can be contributing to the foot symptoms. For example, manual therapy to the foot and ankle, in order to increase dorsiflexion at the ankle and in conjunction with therapeutic exercise, has been shown to be effective at reducing plantar fascial symptoms.

Your physical therapist can identify specific muscle tightnesses which can be lengthened with an appropriate stretching protocol. For example, fibers of the achilles tendon have been shown to be continuous with the plantarfascia, and thusly, tightness within the tendon can produce undue stress on the bottom of the foot. Similarly, muscle weakness, such as the posterior tibialis muscle, can contribute to dysfunctional foot positions (i.e. excessive pronation). Specific loading of these muscles can improve the strength so that the ankle-foot complex functions more optimally to reduce stress in the plantar fascia.

Other treatments include taping, foot orthoses, footwear modifications, and night splints to reduce excessive shortening of the plantar fascia may also be considered, for short-term relief of pain.

If you are experiencing pain in the foot, or heel, consistent with possible plantar fasciitis, contact Life’s Work Physical Therapy today so that you can be set up with an hour-long, one-on-one evaluation with one of our expert clinicians, and begin heading down the path to recovery.