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Plantar Fasciitis - A Pain in the Foot!


What is plantar fasciitis?













It is a common foot condition affecting the heel and sole of the foot; it will affect 1 in 10 people at some stage of their lifetime.


It is a very common complaint that the physio's see in the practice, and during the past year with COVID-19, we have seen an increased presentation of cases. Plenty of people will have tried to roll their foot out with a ball as a starting point to treat it at home.


It is important to understand what is driving this condition, as it can be a frustrating condition to treat. On average, 80% of people will be fully better after 12 months, and a further 15% after 18 months.


So why does it take so long? And what should you be doing to recover?


Lets start with the anatomy:


A healthy functioning plantar fascia will act similar to a tendon, which will shorten and lengthen with adaptive force to control dynamic load (i.e walking or running). When people suffer with plantar heel or arch pain, it is a sign that the plantar fascia structure is being placed under too much load, and is often thought of as a repetitive overload problem.











But what is actually happening?


Recent studies have begun to use the term Plantar Fasciopathy over the previous Plantar Fasciitis diagnostic term. ‘’Iitis’’ implies that the tissues of the plantar fascia are inflammed, however tissue sample studies have now shown this to be incorrect.


Plantar fasciopathy is a degenerative physiological process happening within the plantar fascia tissues, relating to overuse or repetitive overload (‘’repetitive strain’’). Increased loading of the muscles and connective tissue on the sole of the foot can over time cause pain if certain risk factors are present.


Risk factors:

  • Pes planus (pronation of talocrural and subtalar joints in the ankle)

  • Periods of prolonged standing / walking

  • Tight calf muscle groups

  • Reduced ankle dorsi-flexion range of motion

  • Recent change in activity or footwear

  • Increased BMI (body mass index)


Do I need a scan?



Thickening of the plantar fascia 4mm) seen above on ultrasound, confirms a diagnosis. An ultrasound scan is usually is not required, as standard plantar fasciitis can diagnosed based on clinical assessment alone. An ultrasound scan may be beneficial to outrule other conditions. Plain x-rays may show a heel spur– increased bone formation at the insertion point of the fascia to the calcaneus (heel bone). 50% of plantar fascia cases are found to have a heel spur, but research has shown that heel spurs do not directly influence a persons foot pain or duration for recovery.


Presentation


People will most commonly complain of pain in their heel / arch, first thing in the morning when they get out of bed. Clinical tests to stress and load the plantar fascia will confirm if it is provoking pain.


Initial management is to reduce the load through these structures, by supporting the sole of the foot with tape / shoe inserts / sometime a Moonboot being required. Ice and gentle stretching, rolling a ball along the sole of the foot will help to settle acute symptoms in most cases.


When the condition begins to improve, strengthening for foot intrinsic, calf, leg and core muscles is known to improve symptoms. Individual assessment of pain drivers is important, to ensure long term recovery and prevention of reoccurrence in each case. Here is an example of a specific exercise used very commonly to strength then plantar fascia with some single leg hip and core stability.













For persistent cases, referral to a sports medicine physician can be made to consider shockwave or PRP injection therapy. Corticosteroid is not a treatment of choice as it poses risk of plantar fascia rupture.


Equipment and services


Physiotherapy, podiatry, nutrition and pilates are all relevant services to assist management of plantar fasciitis. Individual assessment and recommendations will be made depending on the symptoms presentation.


Trigger point balls, plantar fascia rollers, massage guns and ice packs are available here and can be of great help in the early stage.


For a holistic health approach, supplements such as a collagen powder can be considered as adjunctive therapy- studies have shown that collagen disrepair and necrosis is a pathomechanical driver of this condition. Plantar fasciitis can take months to improve, so having a supportive health and recovery plan in place is important to ensure a long term recovery.


Our physiotherapist's will work towards each patient's specific goals, to ensure long term recovery and outcomes.












References

https://www.aafp.org/afp/2019/0615/p744.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4853481/

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