Plantar Fasciitis

Plantar fasciitis is one of the most common causes of heel pain. It can resolve with time but if symptoms do not resolve, it can become difficult to treat and has a risk of rupturing.

If you have heel pain, we recommend a physiotherapy assessment to diagnose if your heel pain is in fact plantar fasciitis.

Signs and symptoms of plantar fasciitis

If you’ve ever had plantar fasciitis you’ll know very well that pain is its main feature.

Pain is felt in the heel and bottom of the foot. It's usually on one side and most severe with the first steps of the day or after a period of rest. Pain is frequently brought on by bending the foot and toes upwards.  Sometimes people also experience numbness, tingling , swelling or radiating pain.

Good news is that the pain seems to reduce with continued walking. Bad news is that if left untreated or treated incorrectly the plantar fascia can rupture. Some signs of plantar fascia rupture include a clicking or snapping sound, significant local swelling, and acute pain in the sole of the foot.

This is why we recommend a physiotherapy assessment as early as possible to correctly diagnose and prescribe appropriate treatment.

Top 3 treatment strategies to do immediately

1.      Rest and Move – limit activity to give the plantar tissue a chance to heal. Rest doesn’t mean stop all activity. It means stop over exertion, extreme exercise, standing for extended periods of time and/or high loaded activity. In other words, continue to walk and use your foot in a normal way. 

2.      Ice – can help but then some people also find heat beneficial.

3.      Support - the arches of your foot at ALL times. This means no bare feet, high heels, flat sandals or thongs (flip flops). Do wear shoes with a supportive arch like trainers or orthotic flip flops.

What causes Plantar Fasciitis?

Plantar fasciitis is a disorder of connective tissue in the arch of the foot. 

The causes of plantar fasciitis are not entirely clear. Some common risk factors include long periods of standing, a sudden increase in exercise and obesity. It is also associated with inward rolling of the foot, a tight Achilles tendon and a lifestyle that involves little exercise. 

What can a physiotherapist do for Plantar Fasciitis?

A main focus of physiotherapy is to reduce the pain by strengthening the calf muscles and plantar fascia. This helps the soft tissue (muscles and fascia) to withstand the amount of work it needs to do on a daily basis for you to stand, walk and move.

ASSESSMENT

A physiotherapist will firstly conduct a comprehensive assessment. This involves assessing the symptoms but also screening for other related conditions. The differential diagnosis for heel pain is extensive. It includes but is not limited to calcaneal stress fracture or bursitis, osteoarthritis, spinal stenosis involving lumbar or sacral spinal nerves, hypothyroidism, ankylosing spondylitis, rheumatoid arthritis and compression neuropathies like tarsal tunnel syndrome. 

TREATMENT

First-line conservative approaches for plantar fasciitis include rest, heat or ice and wearing supportive shoes at all times

More targeted strategies used by physiotherapists include:

1.      Taping - some people initially find taping very beneficial. Specific taping techniques are used to off load the painful plantar fascia.

2.      Stretching Exercises - are taught to stretch the calf muscle, Achilles tendon and plantar fascia.

3.      Strengthening Exercises – may be indicated for the hips and legs, as well as your calves.

Other

4.      Treating other factors contributing to your pain e.g. nerve compression, arthritis or bursitis.

5.      Weight reduction is recommended in over weight or obese people.

6.      In some cases, you may be referred to a podiatrist to be fitted for orthotics, and some people benefit from night splinting to prevent excessive soreness in the morning.

What our Naturopath has to say

"The name of this condition plantar fasci-‘itis’ suggests that it's an inflammatory disorder but there's little evidence to confirm that inflammation causes the heel pain. It's therefore interesting that herbal medicines most used to treat plantar fasciitis have a strong anti-inflammatory action on the body. For example; White Willow, Turmeric, Meadowsweet, Ginger or Feverfew.

This seems contradictory to the pathology but makes sense when you understand how herbs work. The interesting thing about medicinal herbs is that they have multiple actions on the body. For example, Turmeric also has anti-oxidant, hepato-protective and mild anti-depressant actions. Willow and Meadowsweet are also potent analgesics; and Ginger promotes micro-circulation to the small blood vessels."

Natural Medicines can help reduce pain in the short term but also treat any other factors that may be contributing to the development of plantar fasciitis.

This includes, weight management and treatment of underlying conditions such as osteoarthritis or hypothyroidism.

Written by Stephanie Lock (Physiotherapist) and Sasha Wray (Naturopath & Occupational Therapist) Copyright Next Wave Therapy