Understanding plantar fasciitis, effective treatments and prevention by Ruben Van Gessel (Physiotherapy Student)

Plantar fasciitis is one of the most common causes of foot pain and can have a big impact on the day to day life, especially when walking and running. In this blog we will look at what plantar fasciitis is, what you and your physiotherapist can do to help you and how to reduce the risk of developing plantar fasciitis in the future.

What is plantar fasciitis?

The plantar fascia is a band of fascia at the bottom of the foot. Plantar fasciitis refers to a degenerative process that takes place in the plantar fascia and is a common cause of heel and foot pain. It is caused by repetitive strain of the fascia causing microtears, inducing a repair response. Plantar fasciitis is most common in women aged between 45-64. Other risk factors include:

·       Flat  or high-arched  feet

·       Long distance runners

·       Military personnel

·       Prolonged standing

·       Obesity

 

Symptoms

Symptoms can differ person to person but most people experience one or more of the following symptoms:

·       Heel pain, often stabbing and/or burning

·       Pain with first steps in the morning, or after prolonged sitting

·       Sharp pain when touching the heelbone

 

Diagnosis

The diagnosis by the physiotherapist will be based on a subjective and objective assessment, including:

·       History and onset of the injury

·       Physical examination

-              Strength assessment of the relevant muscle groups

-              Mobility assessment of the ankle, foot and toes

-              Special test- Windlass test, Hubscher test

-              Palpation of different structures in the foot

Imaging, such as ultrasounds or MRI, are in most cases not needed to diagnose plantar fasciitis but may be used in recalcitrant cases to rule out other heel pathology.

 

Physiotherapy treatment

The treatment of a physiotherapist consist of a combination of different interventions.

·       Stretching & foam rolling: Foam rolling and stretching of the plantar fascia often gives good pain relief for people with plantar fasciitis.

·       Strengthening exercises: Based on the physical assessment the physiotherapist can give you some strength exercises to target certain muscles in the foot and ankle. These often include the calf muscles, tibialis posterior and intrinsic foot muscles.

·       Manual therapy and Mobilisations: Manual mobilisations performed by the physiotherapist can help reduce pain and increase the mobility of the joint.

·       Taping: Taping of the plantar fascia may help reduce the symptoms but is not effective for a long term.

 

Prevention

There are a few things that you can do to reduce the risk of developing plantar fasciitis.

·       Load management: Building up your load progressively is key to preventing plantar fasciitis. Research suggest a 10% weekly increase reduces the risk of developing plantar fasciitis.

·       Strength exercises: Strengthening the areas around the ankle can help preventing plantar fasciitis. The main muscles to strengthen are the calf muscles (primarily the soleus muscle) and the intrinsic foot muscles that help support the arch of the foot.

·       Stretching: Stretching of the achilles and plantar fascia helps in preventing plantar fasciitis. Recent studies found that plantar fascia stretching is the most effective.

·       Footwear: Good footwear plays a big role in managing and preventing plantar fasciitis. A shoe with a good arch support and shock absorption can significantly reduce the risk of plantar fascia stress.

References

  • Boob, M. A., Phansopkar, P., & Somaiya, K. J. (2023). Physiotherapeutic interventions for individuals suffering from plantar fasciitis: a systematic review. Cureus. https://doi.org/10.7759/cureus.42740

  • Digiovanni, B. F., Nawoczenski, D. A., Lintal, M. E., Moore, E. A., Murray, J. C., Wilding, G. E., & Baumhauer, J. F. (2003). TISSUE-SPECIFIC PLANTAR FASCIA-STRETCHING EXERCISE ENHANCES OUTCOMES IN PATIENTS WITH CHRONIC HEEL PAIN. Journal of Bone and Joint Surgery, 85(7), 1270–1277. https://doi.org/10.2106/00004623-200307000-00013

  • Goff, J. D., & Crawford, R. (2011). Diagnosis and treatment of plantar fasciitis. PubMed, 84(6), 676–682. https://pubmed.ncbi.nlm.nih.gov/21916393

  • Rathleff, M. S., Mølgaard, C. M., Fredberg, U., Kaalund, S., Andersen, K. B., Jensen, T. T., Aaskov, S., & Olesen, J. L. (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 and Science in Sports, 25(3). https://doi.org/10.1111/sms.12313

  • Riddle, D. L., Pulisic, M., Pidcoe, P., & Johnson, R. E. (2003). RISK FACTORS FOR PLANTAR FASCIITIS. Journal of Bone and Joint Surgery, 85(5), 872–877. https://doi.org/10.2106/00004623-200305000-00015

  • Thompson, J. V., Saini, S. S., Reb, C. W., & Daniel, J. N. (2014). Diagnosis and management of plantar fasciitis. Journal of Osteopathic Medicine, 114(12), 900–901. https://doi.org/10.7556/jaoa.2014.177

  • Whittaker, G. A., Munteanu, S. E., Menz, H. B., Tan, J. M., Rabusin, C. L., & Landorf, K. B. (2017). Foot orthoses for plantar heel pain: a systematic review and meta-analysis. British Journal of Sports Medicine, 52(5), 322–328. https://doi.org/10.1136/bjsports-2016-097355

Stuart McKayComment