Plantar fasciitis is a very common form of foot and heel pain. It is when the plantar fascia (the flat band of connective tissue at the bottom of your foot which connects your toes to your heels) becomes strained and irritated. The function of the plantar fascia is to support the arch of your foot It is a condition common to people that are on their feet a lot with work or through exercise.
Irritation over an extended period of time can lead to calcification of the tendons which can be seen as heel spurs on an X-ray. Although an indication of the amount of pressure placed on the tissues over time, heel spurs are not always directly related to the amount of heel pain that you might experience.
Heel pain is the most common symptom. It is usually most painful at the bottom of the foot at the point of the heel where your arch begins. You might find that the pain is noticeable when you are on your feet or running and also first thing in the morning as it stiffens up overnight.
Plantar fasciitis will not be painful when you are sitting or lying down so foot pain at night time may be a sign of other conditions and you should have it assessed.
Plantar fasciiitis usually occurs as a result of repeated strain or "over-stretching" of the plantar fascia tissues. It can also occur due to compression or direct trauma to the tissues.
In most cases plantar fasciitis can be linked to either an increase or change in activity or to underlying factors that may have predisposed you to developing it. Frequently it is a combination of both. Some of these causes and factors include:
Foot pronation (excessive rolling in of the foot).
High arches.
Footwear that is ill fitting or not suitably supportive.
Frequent or an increase in frequency of running. Particularly on hard surfaces.
Tightness through the achilles tendon and calf muscles.
Being overweight.
Abnormal walking patterns and running patterns (this is sometimes difficult to realise yourself!
Previous ankle or foot injuries.
Weak muscles in the foot.
Other groups of people where there is a greater frequency of plantar fascia pain include: pregnant women, people with diabetes and middle aged men and women
When treating plantar fasciitis it is important to understand why your are developing it rather than seeking treatment that will only reduce the symptoms. A physiotherapist or chiropractor can diagnose the pain through a physical examination of the foot and an assessment of risk factors.
The good news is though, that plantar fasciitis is very treatable in most cases. As with most over-use tissue injuries, the first step is to take relative rest from aggravating activities and manage any inflammatory process that may be occurring. the use of ice therapy and in some cases anti-inflammatory medication can assist in reducing the pain and irritation.
The next phase is to restore normal pain free movement around your ankle and. Your physiotherapist or chiropractor will also use other techniques to reduce your symptoms including:
Dry needling.
Kinesiotaping.
Rigid sports taping.
Soft tissue releases of the plantar fascia.
Stretches for the muscles around the ankle and the bottom of the foot.
Once normal movement is achieved and pain is reduced the most important step is to address the issues that are contributing to your heel pain.
The third phase of treatment is restore the correct activation and strength of the muscles in your foot and also those of your ankle. This will allow you to load through your foot with a better distribution of weight and improve your ability to absorb shock. At this stage if you have abnormal foot mechanics such as excessive rolling inwards of your arches then a suitable orthotic insert will be important to correct your foot and ankle position. It is also important that you wear the correct foot wear in the first place.
Once the internal and physical issues regarding your muscle strength and body mechanics have been addressed, a gradual return to activity is recommended. During this stage your therapist can correct issues with your running and walking patterns as well as the way that you land when performing jumping, running or hopping movements during sport.
With the right care a complete return to pain free activity is possible in more than 90% of cases however a correction of all the underlying contributing factors is needed to ensure that you avoid the problem reoccurring.
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