What is plantar fasciits?
Plantar fasciitis or fasciopathy is a painful condition of the sole of the foot often characterised by pain on the middle underside of your heel. The plantar fascia consists of thick and strong interwoven bands of collagen which run from the heel bone to the front of the foot, helping to support the arch of the foot and dissipate load when we walk or run. It is a condition caused by repeated overload which causes microtrauma over a sustained
period of time eventually leading to inflammation and pain where the plantar fascia inserts into the calcaneum (heel bone) – see below.
Risk factors
Being overweight.
Poorly supporting footwear or a sudden change in footwear e.g. flip flops, wellington boots or pumps.
Tight and/or weak calf muscles.
Flat feet or high arches.
Age (40-65).
Long periods of standing (occupational/lifestyle).
Previous injury/foot problems leading to overload of the foot.
Management strategies
Change your footwear – try and wear supportive, comfortable shoes such as walking boots or running trainers which provide adequate cushioning and support.
Consider orthotic insoles – both gel/soft layered insoles to help reduce pressure on the plantar fascia or more rigid insoles with arch support (if flat footed) can be helpful in reducing the load going through the plantar fascia.
Ice therapy – applying a cold compress to the painful area 2-3 times per day for 10-15 minutes to help reduce pain and swelling.
Self-massage – roll your foot along a frozen bottle of water or hard ball to help reduce tension in the plantar fascia and alleviate pain twice a day for up to 5 minutes.
Calf & plantar fascia stretches – The calf muscle, Achilles tendon and plantar fascia are all intrinsically linked and tension in one area can cause overload in another. Stretch each 3x per day for 1 minute.
Weight loss – if you are overweight, then weight loss can help to reduce the load transmitted through the plantar fascia and thus reduce pain and inflammation.
Calf strengthening/plantar fascia loading – Similarly to Achilles tendon problems, there is an ever-growing body of research supporting the benefit of strengthening exercises in the reduction of pain and future recurrence of the condition.
Activity modification – In the early stages of the condition reducing walking distance or high impact activity is important to help reduce pain and inflammation. Alternative activities for fitness such as cycling or swimming are great alternatives during this stage.
Anti-inflammatory medications – oral drugs such as ibuprofen or naproxen or topical gels such as voltarol are often prescribed to help reduce pain and underlying inflammation. You will need to first consult your doctor to ensure that these are appropriate for you as they can negatively interact with other drugs such as anti-hypertensives and asthma medication and can sometimes give you side effects including gastric irritation.
Prognosis
In most cases plantar fasciitis is a self-limiting disorder which means it will get better with time (often 6-12 months). Physiotherapy can help to reduce pain and resolve the condition more quickly by adopting treatment modalities such as: massage, therapeutic ultrasound, acupuncture and exercise therapy to ease the condition. Your physiotherapist will also advise you on the most appropriate footwear and insoles for your foot type. Here at Thorpes Physiotherapy, we stock orthotic insoles which can help to immediately reduce pain by reducing the pressure and load going through the plantar fascia. In a small percentage of cases (less than 10%) alternative treatments may need to be considered such as corticosteroid injections or in very rare cases surgery.
If you are suffering with persistent heel pain, do not delay, give our team a call today and we will be happy to assist in getting you back to full health as soon as possible!
Unsure if physiotherapy is right for you? Give our reception team a call and they can arrange a free 15-minute telephone or face-to-face discovery consultation with one of our physiotherapists to see if we can help.
