Plantar fasciitis is the most common cause of pain in the heal and will affect 1 in 10 people in their lifetime. It’s most common in runners, women who wear high heels (due to shortening of the fascia), and those overweight. Although the mechanism of plantar fasciitis is simple, it can cause a lot of pain and discomfort.
Plantar fasciitis arises from the inflammation of the plantar fascia ligament, which stretches from the heel to the toes, forming the arch of the foot. Pain often occurs due to impact or overuse of the foot.
What Is Plantar Fasciitis?
The plantar fascia is a thick, fibrous tissue similar to a ligament, connecting the heel bone to the toes. It supports the arch of the foot and plays a key role in absorbing shock. When this tissue becomes overworked, it loses elasticity, becoming easily irritated by activities such as walking and running. This results in inflammation and pain, primarily affecting one foot at a time.
Plantar fasciitis is characterized by a sharp pain in the heel, usually when the heel strikes the floor. It’s an inflammatory condition and the pain is usually worse in the morning when waking up. You can find more info about physical therapy for plantar fasciitis here.
Overnight the plantar fascia tightens up as we often sleep with our feet pointed. The pain usually decreases after stretching but increases after long periods of inactivity or long periods of intense activity like extended walking, standing, or running.
Signs and Symptoms of Plantar Fasciitis
The main symptom of plantar fasciitis is heel pain. This can be sharp, stabbing, or dull. The pain is exasperated by walking standing and running, worse in the morning and relieved by stretching the calf muscle. Common risk factors include having a job that involves walking and standing, having collapsed arches, or wearing high heels or flat shoes with not much cushioning.
Diagnosis of Plantar Fasciitis
Plantar fasciitis can be accurately diagnosed with a physical examination where the therapist presses on the ligament connecting the plantar fascia with the heel bone. Palpation for ligament and tendon injuries has been shown to have an accuracy of over 98% and is considered the gold standard.
Other imaging that can be used includes ultrasound, MRI Scans, or X-rays. These are usually only ordered in severe cases if other conditions like a heel spur, stress fracture, or fat pad atrophy are suspected.
How Physical Therapy Can Help?
Physiotherapy is the recommended first-line treatment for plantar fasciitis, with good physiotherapy, which includes stretching, ultrasound, changes in footwear, and correction of gate mechanics, I would expect most patients to recover within around 5 sessions over 5 weeks.
Plantar Fasciitis Recovery
Plantar fasciitis is an impact injury and is often linked to a pattern of movement that includes flat feet, tight hip flexors, and weak glutes. Correcting gate mechanics is an important part of recovery and can prevent reoccurrence.
As well as a long-term treatment plan it’s also important to treat acute inflammation. One of the first steps to recovery includes a calf stretch. My favorite is a calf stretch on a brick. For some reason, this specific stretch seems to work wonders.
Treatment should also include anti-inflammatories for example ibuprofen in gel or tablet or castor oil for those that don’t like to take medicines (castor oil has a very similar anti-inflammatory strength to ibuprofen but is more natural and also includes nutrients to help the injury heal). In the initial stages, icing is also important.
A good physiotherapist will not only provide exercise recommendations but will focus on education and help you find more suitable footwear or insoles which is very important in recovery.
Preventing Plantar Fasciitis
Long-term prevention of plantar fasciitis involves strengthening exercises to improve the gate. It is recommended to stretch muscles like the ITB, Hip flexor, calf, and vastus lateralis. Strengthening exercises should include the glute max and med, VMO, Hamstring, and the muscles around the foot: tibialis posterior flexor hallucis longus, flexor digitorum longus, tibialis anterior, peroneus longus, and the intrinsic foot muscles.
Physical Therapy Exercises
Reprogramming the gait usually requires a course of exercise and it’s best to visit a physio as each person is different. However, here are 5 key exercises to get you started:
- Calf stretch on a brick: The most important first step is a calf stretch. My personal preference is a calf stretch on a brick or even better on a dumbbell at the gym as you can also roll out the fascia at the same time. To recover quickly you want to be doing this for around 2 minutes at least 3 times a day
- Massage with anti-inflammatory: This is usually best done at night to prevent severe pain in the morning. Grab your foot and some castor oil or ibuprofen gel and gently massage into the area of pain. Remember that this will make your feet slippery, and you need to wear slippers to walk with oil on your feet until you have a shower.
- Hip flexor stretching: This is also one of the most important exercises. If the hip flexor is tight, it inhibits the glutes. Without the glutes firing the foot arch will drop, which is a risk factor for plantar fasciitis.
- Toe curls: These are great for strengthening the muscles at the base of the foot. Start with the foot flat on top of a towel and gently use your feet to scrunch the towel toward you.
- Single leg squats with a ball: These are a key exercise in the recovery of plantar fasciitis. Use a gym ball pressed against the wall at the level of the hip. lift the inside leg and execute a single-leg squat. For this exercise, you need to be working the glute muscles and the inner quad (VMO). If you feel your outer quad is doing the work, lift up the arch of the foot, and push the hips back. The knee should not drop in and should not bend too far forward. If you still feel the outer quad working, not the glutes, and not the inner quad. Call a physiotherapist to help you with this.
Final Thoughts
Plantar fasciitis is a common condition caused by overworking the plantar fascia, leading to pain and inflammation. About 1 in 10 people will experience this condition, often due to factors like excessive weight, improper footwear, and repetitive activities.
Physical therapy is an effective treatment option, offering exercises and techniques that can help manage and prevent plantar fasciitis.
