For many of us who have experienced pain in the sole of our foot you will know how awkward this is, especially those of us who have suffered from foot pain previously termed plantar fasciitis. Every morning waking up stiff, with a walk to the loo or to breakfast mimicking a prolonged stroll over broken glass. With a sharp pain in the heel and howls of ‘argh’ and muted mutterings of profanities filling the morning air is it any wonder you end up weary and fed up? However not only is it the initial morning steps that are affected by this annoying issue, but participation in your favourite sport, active hobbies and even getting out of your chair and moving at work can all be restricted by this annoying condition. The physiotherapy information held in this piece will hopefully give you an insight into the condition and its physio rehabilitation, as well as highlighting how a physiotherapist can help you recover.
What is the Plantar Fascia?
The plantar fascia itself is a tough band of fibrous tissue that extends from the heel bone to the base of the toes in your foot. It supports the arch on the inner side of the foot and helps you to manage load during walking and running. The condition involves some swelling of the fascia’s attachment to the heel bone and a microscopic breakdown of its collagen based structure.
How common is Plantar Fasciopathy?
In the general population the prevalence of Plantar Fasciopathy is estimated to range from 3.6% to 7% (Dunn, et al 2004) and may account for as many as 8% of all running-related injuries (Taunton et al., 2002). Over the course of our life time the prevalence may grow as high as 10% meaning that a large proportion of us will at some point be affected by this painful issue. Plantar Fasciopathy can affect both genders equally and most age groups, however it does become more prevalent in those between 40 and 60 years of age and those participating in sport.
Plantar Fasciopathy is a condition which has been shown within both clinical practice and the medical literature to improve with treatment. However due to the nature of the problem it’s not a condition which resolves quickly, with most literature sources reporting a period between approximately three months to one year being needed to fully resolve this issue. The positive news coming out of recent scientific studies is that around 80% of people with Plantar Fasciopathy gain a full recovery (Rasenberg, et al, 2016).
What might cause your pain?
- Biomechanics / joint mobility – The way in which you move or hold your posture can have an effect on the risk of you developing Plantar Fasciopathy. Reasons include things like overpronation of your foot (Figure 1), leg length discrepancy, poor ankle, knee or hip control. Typically, the most frequently seen factor is overpronation accompanied by control issues with hip adduction (moving toward the other hip) and poor impact control on stepping and running (van Leeuwen et al, 2015).
- Footwear – Old and new footwear have both been linked to potential increases in pressure and strain levels across the plantar fascia. As mentioned overpronation due to our biomechanics can be an issue which leads to this condition but this can also result from how our footwear supports the foot. Not enough or too much support and our arch can drop (causing overpronation) or become inflexible causing stiffness at the ankle. A supportive shoe tailored to your requirements it best.
- Increases in load in your Job / Sport – Sudden increases in the amount of standing, walking or the sports we do can cause increase pressure to build on the plantar fascia and surrounding tissues. For instance, if you don’t have good shock absorption from a strong calf complex as well as reasonable control at the knee the foot will either over stiffen or develop overpronation though underactivity of the muscles aiding arch stability.
- Weight – Being overweight is another risk factor for developing this issue. Those with an increased BMI (Body mass index) have also been found to have an increased thickness of their heel fat pad, alongside reduced elasticity in their foot which can place tension and pressure on the Plantar fascia.
- Muscle weakness – Current research studies suggest that weak calf and intrinsic foot muscles could both place greater stress on the plantar fascia or initiate a drop into overpronation. Certain muscles in the calf are key in helping to control impact and preventing excessive movement (upwards) of the ankle and foot, whilst the intrinsic muscles of the foot help to support the arch.
What can a physiotherapist do? / What are the key factors and treatment options to address?
- Rest – If you have an acute onset of pain in the foot rest generally should be your first step to recovery. The first step is to cut down on things like barefoot walking, running, sport or prolonged periods on your feet which will reduce the irritation to your foot. The next step is to use things like heel raises, gel cups, physiotherapist applied taping and some icing of your foot to help offload, reduce inflammation and decrease pressure on your foot.
- Loading Exercise – High load strength training in particular has been found in the literature (Rathleff, et al, 2014) to be very beneficial in the treatment of Plantar fasciopathy. These exercises should form the cornerstone of your rehabilitation for this problem with results in clinical studies and in my own practice being very favourable for those completing the programme regularly. The aim is to strengthen the calf complex and utilize natural mechanisms in the foot to improve load tolerance across the plantar fascia.
- Education – Knowing what the problem is, what caused it and how you are going to combat this are the key things. Education regarding these areas are the foundations of your recovery.
- Soft tissue release – Done by a therapist or by yourself soft tissue massage into the foot can be an effective way to relax tight foot musculature and to increase the pliability of the plantar fascia. When done at home this is generally best done with a small firm ball or a frozen bottle of water, that way you can settle any inflammatory response at the same time.
- Stretching – Specific stretching of the Plantar Fascia has been found to be highly helpful (Digiovanni,2003), it can be completed by both you or a physiotherapist and will be taught to you by the physio in one of your treatment sessions.
Plantar fasciopathy can be a challenging condition to treat with the importance of identifying the cause and rectifying it being very individual to each person. Treatment should be based on your needs rather than any generic advice gained from friends or the internet. The key principle being if in doubt get it checked out!
We here at Activate Physiotherapy are very happy to help.
Thanks for reading
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