The plantar fascia is a band of connective tissue running under the foot, which supports the arch and acts like a spring to help us push off. Plantar fasciitis is a common overuse injury, which may develop over a period of time but can occur suddenly with increased load and is characterised by pain in the heel or arch and decreased weight bearing tolerance.
Plantar fasciitis occurs on a continuum and may be short lived or if poorly managed, become chronic and last for years. It can be present in both active and sedentary populations and is more common between 40 – 60 years old.
- Sudden increase in training load or intensity.
- Poor footwear or a change of footwear may cause overload.
- High BMI.
- Poor lower limb strength or biomechanics.
- Work requiring increased loadbearing or standing.
Plantar fasciitis is largely diagnosed by your physiotherapist based on factors in your history and physical exam including;
- Morning pain that warms up to a degree is common.
- Palpation of the plantar fascia reproduces pain.
- Test such as calf raises, designed to load the fascia will reproduce pain.
- Patient will often describe it as feeling like a bruise underneath the heel.
- Imaging may be used to help confirm the diagnosis or rule out other pathology, but the predominant diagnosis is made clinically.
Management of plantar fasciitis is a multimodal approach based on the assessment, often including;
- Education surrounding the causes and management of plantar fasciitis.
- Activity modification to reduce load such as decreased walking or running.
- Graduated loading of the fascia with strength training and a slow progression back to explosive movements such as running.
- Stretching of the plantar fascia
- Taping of the arch.
- Correction of abnormal biomechanics.
- Changes in footwear with good support and cushioning (or possibly orthotic support).
- Other adjuncts may include manual therapy, shockwave therapy, ice, pain medication or injections in some cases.
While a common and often disabling condition, with a concerted effort on rehabilitation and a shared decision making process between the client and physiotherapist, a significant improvement in symptoms and function should be possible.
If you are putting up with Plantar fascia pain, book now with one of our experienced physiotherapists to create a plan to get you back In Balance and doing the things you love!