What is Plantar Faciitis?
Plantar faciitis (PF) is the most common cause of heel pain and the third most common running injury according to a recent article in Clinical Biomechanics.
Your plantar fascia acts as a passive limitation to the over flattening of you arch. PF is a condition characterised by damage to the plantar fascia (the connective tissue on the sole of the foot forming the inner arch). This usually occurs at the attachment of the plantar fascia to the heel bone.
During walking or running, tension is placed through the plantar fascia. When this tension is excessive (often due to poor foot biomechanics such as flat feet) or if it is too repetitive or forceful, damage to the plantar fascia can occur. As well as being common, PF can be difficult to treat and resistant to a host of different approaches. It also tends to be ‘self-limiting’ which means it can go away of its own accord but that can take over a year.
What causes Plantar Faciitis?
It can be present in sedentary, overweight individuals or very fit active runners. Generally though it is thought to occur when there is an increased load placed on the plantar fascia, either by certain activities (like running) or by a patient’s biomechanics, or a combination of both.
Like many overload problems in runners, it can be caused by training error, the common too much, too soon. Increased training volume or intensity and hill work have been identified as a potential causes.
Plantar fasciitis frequently occurs in association with calf muscle tightness, inappropriate footwear, or biomechanical abnormalities, such as excessive pronation (flat feet) or supination (high arches). Occasionally the condition may occur suddenly due to a high force going through the plantar fascia beyond what it can withstand. This may be due to activities such as a sudden acceleration or a forceful jump.
Diagnosing plantar fasciitis?
This is where physiotherapy comes in, with a thorough history taking and physical assessment. This is usually sufficient to make the diagnosis although sometimes further investigations are required such as x-ray or MRI scan to rule out any bony reasons for your pain (such as a bony spur on the heel).
Prognosis of Plantar fasciitis.
Most patients with this condition heal well with appropriate physiotherapy. Minor cases of plantar fasciitis that have not been present for long can usually recover within a few weeks. In patients who have had their condition for a long period of time, recovery can be a lengthy process and may take a number of months. Early physiotherapy treatment is therefore vital to hasten recovery.
Treatment for Plantar fasciitis.
Due to multi-factorial nature behind the condition treatment is varied, initially our main objective is to settle your symptoms and then we address the underlying cause behind your pain. This is why a thorough assessment is vital to specifically treat your pain.
Settling your symptoms:
Progressing straight to stretching may aggravate your pain; firstly aim to settle your symptoms a little if you can. Treatment to assist with this include:
- Using anti-inflammatories either orally or a gel
- Using the RICE technique (details of which can be found here)
- Avoiding the aggravating activity (e.g. running, prolonged standing, etc)
- Offloading the plantar fascia using a taping method
- Using a gel heel pad which you should find in your local pharmacy
- Off the shelf orthotics could help although we advise consulting one of our physiotherapists first
Addressing the underlying cause:
Depending on the factor(s) causing your pain treatment could be one or more of the following:
- Stretching calf/ hamstrings muscles
- Soft tissue massage
- Foam roller to affected muscles
- Electrotherapy (e.g. ultrasound treatment)
- Arch support taping
- Exercises to improve balance, strength, lower limb control or gait re-education
- Activity modification advice
- Biomechanical correction (e.g. orthotics)
- Footwear assessment
- Devising a return to activity/ running programme