Plantarfasciitis - What the Heel?

WHAT IS PLANTAR FASCIITIS?

The plantar facscia itself is a thick, fibrous band of connective tissue that runs from the heel to the toes along the bottom of the foot. This tissue has the purpose of forming the archest of the foot as well as functioning as a shock-absorber.

Plantar fasciitis is one of the most common causes of heel pain caused by a chronic overload of the plantar fascia. Although the name suggests the condition is due to inflammation of the plantar fascia (‘itis' indicating inflammation), evidence now suggests the underlying process is more common than not degenerative rather than inflammatory. For this reason, you may see it referred to as ‘plantar fasciosis’

COMMON SYMPTOMS:

Severe pain during the first few steps in the morning
Pain after long periods of rest
Pain after long periods of standing, walking or running

WHAT CAUSES PLANTAR FASCIITIS?

Plantar fasciitis typically occurs as a result of the plantar fascia being subjected to repetitive strain from long periods of standing or running, commonly with unsupportive footwear or barefoot. This commonly leads to degeneration and increased thickening of the tissue contributing to heel pain.

Other risk factors include:

Obesity
Excessive foot pronation (‘Flat feet’)
Ages 40-60

HOW TO TREAT PLANTAR FASCIITIS USING PHYSIOTHERAPY

Strengthening

Recent evidence suggests loading the calf and plantar fascia through heel drops can improve pain and activity levels.

Strengthening consists of heel-drops off a step with the toes in extension using a towel. This encourages load through the plantar fascia which may improve the structure of the tissue as well as improve calf strength throughout ankle range.

Procedure: Placing the affected foot on the edge of a step with a towel underneath the toes to encourage full toe extension. Holding on to a wall or other stable surface is encouraged for balance.

The 3 main movements of the exercise include:

Movement 1: Raising the heel above the level of the step in a slow, controlled movement taking 3 seconds to come all the way up
Hold the raised position at the top for 2 seconds
Slowly drop heel back down below step-level taking another 3 seconds.

Regressing: Continue this exercise for 12 repetitions ensuring correct form. If 12 repetitions cannot be achieved, the exercise can be modified by using both feet for more support.

Progressing: This exercise can be progressed by adding weight through a backpack until the maximum amount of weight that can be lifted 12 times correctly.

Dosage:

Weeks 1-2: 3 sets of 12 repetitions every second day for 2 weeks.
Weeks 2-6: 4 sets of 10 repetitions every second day for 4 weeks
Weeks 6+ : 5 sets of 8 repetitions every second day

Stretching

Evidence suggests manually stretching the plantar fascia can contribute to improved pain and activity levels in the long-term.

Stretching consists of crossing the affected foot on the opposite knee and pulling back on the toes towards the shin. The other hand can be used to massage through any points of increased tension whilst the stretch is applied.

The stretch can be held for 10 seconds for 10 repetitions, 3 times per day.

Taping Another treatment method for plantar fasciitis is ‘low-Dye’ taping. Taping can be particularly effective for short-term management to offload strain on the plantar fascia contributing to decreased pain. This makes taping an option as an adjunct treatment to more long-term management strategies including strengthening and stretching.

Article References:

Digiovanni, B., Nawoczenski, D., Malay, D., Graci, P., Williams, T., Wilding, G., & Baumhauer, J. (2006). Plantar Fascia-Specific Stretching Exercise Improves Outcomes in Patients with Chronic Plantar Fasciitis. The Journal Of Bone & Joint Surgery, 88(8), 1775-1781. http://dx.doi.org/10.2106/jbjs.e.01281
Martin, R., Davenport, T., Reischl, S., McPoil, T., Matheson, J., & Wukich, D. et al. (2014). Heel Pain—Plantar Fasciitis: Revision 2014. Journal Of Orthopaedic & Sports Physical Therapy, 44(11), A1-A33. http://dx.doi.org/10.2519/jospt.2014.0303
Radford, J., Landorf, K., Buchbinder, R., & Cook, C. (2006). Effectiveness of low-Dye taping for the short-term treatment of plantar heel pain: a randomised trial. BMC Musculoskeletal Disorders, 7(1). http://dx.doi.org/10.1186/1471-2474-7-64
Rathleff, M., Mølgaard, C., Fredberg, U., Kaalund, S., Andersen, K., & Jensen, T. et al. (2014). High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scandinavian Journal Of Medicine & Science In Sports, 25(3), e292-e300. http://dx.doi.org/10.1111/sms.12313
Schwartz, E. (2014). Plantar Fasciitis: A Concise Review. The Permanente Journal, e105-e107. http://dx.doi.org/10.7812/tpp/13-113
Sweeting, D., Parish, B., Hooper, L., & Chester, R. (2011). The effectiveness of manual stretching in the treatment of plantar heel pain: a systematic review. Journal Of Foot And Ankle Research, 4(1). http://dx.doi.org/10.1186/1757-1146-4-19
Thomas, J., Christensen, J., Kravitz, S., Mendicino, R., Schuberth, J., & Vanore, J. et al. (2010). The Diagnosis and Treatment of Heel Pain: A Clinical Practice Guideline–Revision 2010. The Journal Of Foot And Ankle Surgery, 49(3), S1-S19. http://dx.doi.org/10.1053/j.jfas.2010.01.001