What is plantar fasciitis?

Response Physio | 01.02.23

What is Plantar Fasciitis ?
How Can a Physiotherapy Help?

What is plantar fasciitis?

The plantar fascia is a thick portion of connective tissue that runs the longitudinal length of the underside of the foot. Although its name says otherwise recent studies suggest that the plantar fascia is an aponeurosis rather than a true form of fascia. This, therefore, means the plantar fascia has properties that are more suited to being a fibrous form of connective tissue with tendinous-like characteristics. The relevance of this greatly changes how it should be managed as a condition as different forms of bodily tissues require different types of physiotherapy management.

Plantar fasciitis in general is the result of the breakdown “degeneration” of the collagen that makes up the plantar fascia. Although the word “itis” means inflammation, plantar fasciitis is characterized by an absence of inflammatory cells and is therefore understood to be a more degenerative rather than an inflammatory condition (Latt et al, 2020).

What can cause plantar fasciitis?

As a result of the repetitive load or use of the plantar fascia, the primary cause of this condition is of overuse. There are many reasons why the plantar fascia may become overloaded which is why it is essential to work with a physiotherapist to identify potential factors contributing to your pain. At your initial assessment, it is worth thinking about previous injuries that you have had regardless of how small and insignificant they may have felt to you at the time. The human body is exceptionally clever at changing the way it moves without you being aware because of previous injuries to the surrounding structures. The most common factors that contribute to the development of plantar fasciitis are.

1. Loss of ankle range of motion – This could be the result of an old ankle injury that you have completely forgotten about.
2. Changes to the dynamic posture of the foot – All humans have natural variations in the shapes of their feet and different arch positions are just one of these variations. It is however important to assess how your arch changes when moving as it may be a potential factor contributing to the development of plantar fascia pain.
3. The types of activity that you take part in – Activities such as prolonged weight bearing on your feet or high amounts of walking or running. Movement is by far the best medicine for the body, but the amount and how quickly we increase the amount are both factors we need to be aware of when assessing plantar fascia pain.
4. Shoe fit and type – Ensuring we have supportive and well-fitted footwear is essential to the health of our feet. Spending long times in work boots or rigid footwear can change how our feet naturally move.
5. Raised BMI – We are all aware of the increased risks that come with excess levels of body fat and this is just another factor to be aware of when looking at how much force our feet and plantar fascia have to tolerate.
6. Diabetes and inflammatory conditions – Some metabolic disorders increase our risk of changes to the collagen in our body, so it is worth being aware of the increase in risk you are at.
7. Tightness or weakness through the muscles of the lower limb – It is incredibly important that our bodies can deal with what we throw at them. Having good levels of strength through the muscles of the lower limb is essential to being able to absorb force.

How do I know if it is plantar fasciitis?

Plantar fasciitis accounts for 10% of running-related injuries however it is just as normal in the non-sporting population.
1. Females are at a slightly greater risk of plantar fasciitis
2. Localized tenderness along the medial arch of the foot at any point between the ball of the big toe down to the heel bone.
3. Pain when first taking a step in the morning or even pain when first walking after being sat for long periods
4. Walking, pushing off the toes and walking upstairs may all cause pain.
5. Tightness through the calf muscles
6. Pain when stretching your arch by pulling your big toe backwards towards yourself
7. A limp may be present
8. Difficulty walking barefoot or on hard surfaces
9. Usually there has been an increase in the amount of walking or standing you have done in the days, weeks and months before the pain started to come on.

How is plantar fasciitis managed conservatively with physiotherapy?

The great news is that 90% of patients with plantar fasciitis have successful treatment with conservative management, meaning that it gets better by making small changes to your lifestyle.
Seeing a qualified Physiotherapist is always the first line of treatment as conservative management has some of the most successful outcomes. Some of the conservative measures that may be used for managing plantar fasciitis are.
1. Relative rest from the activities that are causing you pain – of course, this does not mean stopping what you are doing but a period where we reduce the amount we do may be beneficial.
2. Managing your pain with pain relief medication – This should always be discussed with your GP or Pharmacist to find what is most suitable for yourself
3. Shoe inserts or custom-made orthotics
4. Night splints to wear on the foot whilst you sleep
5. Stretching & Strengthening – As physiotherapists, our main role is to identify the structures that may be contributing to your pain. After a full assessment, your physiotherapist may identify muscles that may need to be stronger or have more range of motion, in which case specific exercises will be prescribed.

Do I need imaging or onward referral for plantar fasciitis?

It is highly unlikely that with the above measures your condition will not respond positively. In the eventuality that it does not get better, it may be beneficial to refer you for specialist input to decide on the best course of care for you. Plantar fasciitis can be accurately diagnosed without the need for imaging such as X-rays or MRI scans. However, in the eventuality that your physiotherapist feels it would be beneficial to gain a greater analysis of the condition of your foot then it may be recommended that referral for a scan is advised. Many patients get a great benefit from steroid injections to help with the pain, but this is always an adjunct to good quality rehabilitation and exercise. It is highly unlikely that surgical intervention will be suitable but, in the instance that it is then a high-quality foot and ankle orthopedic surgeon can be recommended to you.

What is the outlook for my recovery?

As previously mentioned, many patients do exceptionally well with conservative management and make full recovers usually within 3-6 months. It is essential though that you work with a good quality physiotherapist to help create a specific treatment plan that is tailored to your specific needs which can be identified with a thorough assessment. Like any condition, if you are worried or concerned about your immediate health it is recommended that you utilize your GP and or your local emergency department. If your pain started following a traumatic incident or you’re worried about the levels of pain you are in then it is best to be seen by specialist care as soon as possible.

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