Plantar fasciitis (heel pain, arch pain) is a condition that commonly affects the adult population and has been estimated to affect approximately 10% of the population.
The plantar fascia is a thick band of connective tissue under the foot that runs from the base of the heel bone (calcaneus) to the bottom of each toe. It also connects to the fascia of the calf muscles behind the leg. It is an important structure that aids in propulsion of the foot when walking and running.
Commonly the condition has been called plantar fasciitis (the suffix “itis” means inflammation). Studies done over the last decade suggest that it may be more of a degenerative condition of the soft tissue, and so some people call it plantar fasciopathy instead. It probably starts as an inflammatory process disorder, and then leads to degenerative changes later on.
What Causes Plantar Fasciitis?
Typically plantar fasciitis is caused by overuse or overloading. If the load going through the tissue is greater compared to the tissue’s ability to adapt to cope with the extra load, then damage can occur. Sudden changes in load such as increased exercise, working or exercising on a different surface, and changes in footwear can contribute to the development of this disorder.
What Contributes to Excess Load?
The fascia elongates, stretches, and stores energy when the foot lands on the ground and the arch flattens or the foot ‘pronates in’. Pronation is a necessary motion in normal foot function and is vital for shock absorption and adapting to uneven terrain. When the foot lifts off the ground or when the toes are about to leave the ground the fascia contracts and the distance between the toes and the heel bone shortens. If the foot stays in the ‘pronated’ position for an extended amount of time this causes overloading of the fascia and can lead to plantar fasciitis.
Also, if there is any tightness in the calf this can also cause tension in the plantar fascia and similarly if there is any excess extension of the toes this also causes more plantar fascia tension.
How Do We Treat Plantar Fasciitis?
The goal is to reduce the load going through the fascia, so that it can get better. Once it is better we want to prevent it from recurring.
We may use one or more of the following plantar fasciitis treatments:
* Footwear advice and changes. Footwear is important, and if we use other treatments, such as orthoses, their effectiveness is dependent upon good footwear. Flimsy mid sole shoes or shoes that are ‘unsupportive’ or where the foot moves around in a shoe will also place more tension on the plantar fascia. A good shoe will incorporate a firm heel counter, a firm midsole and laces/Velcro/buckle to hold the foot in the shoe.
* A heel raise can also be incorporated which decreases dorsiflexion at the ankle and can take tension off the calf and the fascia.
* Manual therapy such as low level laser therapy, myofascial release, ultrasound and taping can help with short-term pain relief.
Cortisone injections can also be of benefit for pain relief and can provide an anti-inflammatory effect. However, if the load/tension continues on the plantar fascia the benefits of a cortisone injection may not prove to have a lasting effect.
* Sometimes (but not often), plantar fasciitis surgery is required. Surgery for plantar fasciitis is recommended when nonsurgical treatment has not helped and the heel pain is already taking its toll on your daily activities.
Rehabilitation and Prevention of Recurrence
After the load can be decreased and the aggravated tissue has settled the next step is to look at increasing the soft tissue’s tolerance to load. The best step is to incorporate a gradual loading program – too much too soon can aggravate the soft tissue again. Both stretching and strengthening of the fascia and muscles in the foot and leg will help load the fascia and improve its tolerance to load.
The podiatrists at Perth Foot and Ankle clinic are experienced practitioners that can diagnose, treat and manage plantar fasciitis. Our Body-Tech Scanner and treadmill is the latest in foot analysis technology, allowing us to look at your foot position, balance and stability when you are standing, walking or running. Essentially, it allows us to scientifically and accurately make an assessment of your posture. It means that, as podiatrists, we can provide you with even better recommendations for treatment options, or to improve your day-to-day lifestyle or if you’re the sporty type, better performance or helping you minimise or recover from injuries.
Contact us today and let us help fix your plantar fasciitis problem and pain!