What is the Plantar Fascia?
Plantar fasciitis is the most common cause of heel pain and accounts for up to 15% of all foot symptoms among adults (Buchbinder, 2004). The plantar fascia is a thick connective tissue that runs from the heel to the heads of the metatarsal bones supporting the under surface of the foot. Histological studies in chronic cases of plantar fasciitis demonstrate degenerative changes to the plantar fascia and may include fibroblastic proliferation and chronic inflammatory changes (Lemont, Ammirati, & Usen, 2003).
What is the anatomy of the Plantar Fascia
The plantar fascia is a broad flat fibrous connective tissue that spans from the medial calcaneal tubercle to the heads of the metatarsals. The tissue is largely comprised of longitudinally orientated type I collagen fibres (Neufield & Cerrato, 2008). They are orientated as such to support the arch of the foot as the tissue undergoes tension when the foot is weight bearing (Wearing, Smeathers, Urry, Hennig, & Hills, 2006).
The plantar fascia also serves as a unit to conserve energy; in the phase of gait where the toes are dorsiflexed the plantar fascia becomes taught via the windlass mechanism and aids in propulsion (Lemont et al., 2003). It also serves as another attachment point for muscle tissue.
Imaging is limited in its ability to diagnose plantar fasciitis though it may be utilised in order to rule out other possible conditions. Calcaneal stress fractures and other bony lesions can mimic the clinical symptoms of plantar fasciitis and may require MR imaging or a bone scan to be ruled out (Weber, Vidt, Gehl, & Montgomery, 2005).
A rupture of the plantar fascia can present with similar symptoms however the onset of pain is resultant of a mechanism or sudden onset and may cause an inability to weight-bear after the initial injury and other physical activity (Rolf, Guntner, Ericsater, & Turan, 1997).
Tarsal tunnel syndrome or compression of the medial calcaneal branch of the posterior tibial nerve can cause symptoms of heel and plantar foot pain, though the type of pain is usually of a burning nature. Symptoms involving nervous tissue may also present with pain that radiates up the leg. There will also be notable tenderness over the medial aspect of the heel or inferior to the medial malleolus. A positive Tinel’s test could also suggest nerve involvement (Alshami, Souvlis, & Coppieters, 2008).
5 Hot Tips for fixing youyr plantar fasciitis
5 tips for self-management:
· Avoid wearing flat shoes or walking in bear feet
· Regular stretching of the plantar surface of the foot, particularly when getting out of bed and after inactivity
· Reduce painful weight-bearing tasks for a period of 2 weeks
· Adopt other exercises such as swimming or bike riding as a replacement for running
· Utilising a frozen water bottle as a roller for the under surface of your foot at the end of the day
Do I have Plantar Fasciitis?
I have pain in the heel and or arch area
Difficulty with walking
Pain with putting foot to ground first thing in the morning. Eases in less than 1 hour.
Different footwear or bare feet influence my pain
I find that I need to avoid certain shoes to be more cmofortable.
Better with medications or applying ice
i find that I am using ice or medications (analgesics/anti inflammatories)
If you suffer from 2 or more of the above you likely have Plantar fasciitis
What causes plantar fasciitis?
Plantar fasciitis is defined as an overuse injury (Lemont et al., 2003). Prior to the onset of symptoms increased amount of weight-bearing activity, such as walking and running, can cause an overuse response within the plantar fascia that progresses to generate degenerative changes causing the symptoms of plantar fasciitis. Overuse can come in many forms, not just increased load-bearing activity, and in the case of plantar fasciitis changes in footwear or exercise surface can alter the dynamics of plantar foot tissue, enough to generate an overuse response (Cole, Seto, & Gazewood, 2005).
What are the symptoms of a Plantar Fasciitis?
In most cases plantar fasciitis presents as a gradual onset of heel or plantar foot pain that is generally worse during the first steps in the morning or after periods of inactivity (Buchbinder, 2004). The pain tends to improve with activity throughout the day and then worsens towards the end of the day with increased weight-bearing tasks (Young, Rutherford, & Niedfeldt, 2001). In some cases the heel and plantar foot pain can cause a limp.
In many cases identifying the cause of overuse and altering physical load will have a strong influence on pain reduction. Patients should be advised to avoid walking in flat shoes or barefoot, and in some cases they may also benefit from taping or orthotics to support the medial arch of the foot (Buchbinder, 2004).
Research has also demonstrated some evidence in treatments involving stretching, heel cushions, nonsteroidal antiinflammatory medication and massage (Neufield & Cerrato, 2008).
Early treatment within the first 6 weeks of onset is also likely to hasten recovery of plantar fasciitis (Young et al., 2001).
More costly treatment options such as corticosteroid injections, night splints and immobilisation with a cast or CAM boot should be reserved in cases where initial conservative treatment fails. In extreme cases plantar fascia release surgery and nerve decompression may be considered.
When can I return to activity
Your Physiotherapist will advise you as to when you are safe to return to sport/activity.
You can speed things up by an accurate rehabilitation program. Your Physiotherapist will provide you with exercsies and a management plan.
If you do not have a Physiotherapist download a program below and contact uswith any questions you may have?
How do I make an appointment?
Select from the page menu your closet Physica Clinic. We look forward to you attendin.
Footwear and Plantar Fasciitis
Self guided foot assessment
Pain relief for Plantar Fasciits
Splints that can help!
Sitting postions- can sitting really affect my foot
Self management strategies
Sign up for 6 week exercise program to be pain free
If you have already signed up to our program you will be receiving your six week program to reducing your pain. Weekly you will receiv video advice and as always we are hereon our Facebook page to answer any questions. .
Return to activity
- If you are have pain for less than 10 minutes in the morning you are ready to start a graduated return to walking program.
- Pain must be no grater than 4/10 in the morning and not worsen each day after commencement
- If you are have completed the waling program check list then you are ready to start a return to running.
- Note you will not be painfree yet.
So now your feeling a bit better
I still have issues- what next?
Alshami, A. M., Souvlis, T., & Coppieters, M. W. (2008). A review of plantar heel pain of neural origin: differential diagnosis and management. Manual Therapy, 13(2), 103-111. doi:10.1016/j.math.2007.01.014
Buchbinder, R. (2004). Plantar Fasciitis. The New England Journal of Medicine, 350(21), 2159-2166. doi:10.1056/NEJMcp032745
Cole, C., Seto, C., & Gazewood, J. (2005). Plantar fasciitis: evidence-based review of diagnosis and therapy. Am Fam Physician, 72(11), 2237-42.
Lemont, H., Ammirati, K. M., & Usen, N. (2003). Plantar Fasciitis: A Degenerative Process (Fasciosis) Without Inflammation. Journal of the American Podiatric Medical Association, 93(3), 234-237. doi:10.1.1.624.9029
Neufeld, S. K., & Cerrato, R. (2008). Plantar fasciitis: evaluation and treatment. Journal of the American Academy of Orthopaedic Surgeons, 16(6), 338-346.
Rolf, C., Guntner, P., Ericsäter, J., & Turan, I. (1997). Plantar fascia rupture: diagnosis and treatment. The Journal of foot and ankle surgery, 36(2), 112-114.