Plantar Fasciitis is a common condition that causes pain in the heel and bottom of the foot. Physiotherapy interventions such as stretching, manual therapy, and strengthening exercises have been shown to be effective in reducing pain and improving function in patients with Plantar Fasciitis.
As with all injuries, this information is simply a guide, and it is always best to check in with a Physiotherapist or Athletic Therapist to have a personalized assessment and hear recommendations for what you and your body may specifically need.
Plantar fasciitis is a common foot condition characterized by heel pain and inflammation of the plantar fascia, a thick band of connective tissue that runs from the heel bone to the ball of the foot. It affects 10-15% of the population and is especially prevalent among runners, accounting for 17.4% of runner-related injuries. Physiotherapy plays a crucial role in the treatment and management of plantar fasciitis, offering effective strategies for pain relief, improved function, and long-term recovery.
Plantar fasciitis is a common condition causing plantar heel pain in the lower extremity. It is a tension and inflammatory response of the plantar fascia.
The plantar fascia is a thick band of connective tissue that runs along the sole of the foot. The plantar fascia attaches to the heel bone and to the base of the toes. It helps support the arch of the foot and plays an important role in normal foot mechanics during walking, running, and climbing stairs.
It is important to get the correct diagnosis through a physical exam by a sports physical therapist or sports medicine doctor and then treat plantar fasciitis heel pain with conservative measures such as manual therapy and an exercise program to help relieve symptoms. Physical therapy, such as Physiotherapy or Athletic Therapy can help you treat this painful condition of the plantar fascia and offer health tips to prevent its return.
The main cause of plantar fasciitis is repetitive strain on the plantar fascia, which can lead to micro-tears and inflammation. Plantar fasciitis can result from a variety of factors, such as:
Symptoms of plantar fasciitis include pain and stiffness in the heel, often most severe upon taking the first steps after rest. Pain typically decreases as the tissues warm up with movement but may persist or worsen with prolonged activity.
A diagnosis can be made by your doctor or physical therapist, based on your medical history and physical examination. Your physical therapist will ask subjective questions to obtain your medical history. They will then check for areas of tenderness in your foot and plantar fascia, assess range of motion and strength and do other special tests to determine the nature and cause of your injury.
Why does plantar fasciitis hurt more in the morning? The reason is thatwhile we are sleeping, our feet and ankles naturally shift into a plantar flexed position with toes pointing downwards. This shortens the calf, Achilles tendon, and plantar fascia overnight. When we stand up in the morning, these structures are put on stretch. When they are healthy, they will have more elasticity and will stretch out quickly. When they are damaged, tight, inflamed, or adhesed with scar tissue, it will be painful to stand up and stretch out the plantar fascia in the morning.
Sometimes a night splint will be recommended to keep the plantar fascia tissues on a bit of stretch overnight.
In the early stages of plantar fasciitis, the pain can go quickly when you take weight off the foot. Over time, however, it may take longer and longer for the pain to go away. Without treatment, the plantar fascia can eventually tear partially away from the heel in the arch of the foot, causing even more pain and inflammation.
Conservative measures such as stretching exercises in sports physical therapy are some of the best treatments for plantar fasciitis. Stretching should be focused on the bottom of the foot and back of the calf or the Achilles tendon for this painful condition.
A physical therapist and your health care providers can show you stretching exercises and strengthening exercises that you can repeat at home several times a day. Along with stretching, and other conservative treatments the exercises can also strengthen your lower leg muscles, helping stabilize your ankle.
Taping techniques can sometimes be used to support either the plantar fascia or Achilles tendon to reduce pain.
Time is the biggest determinant in the type of plantar fasciitis. If you've only experienced heel pain for a few days or a couple weeks, then you are probably in the acute phase of the injury.
This is the time when you want to treat your plantar fasciitis, as recovery is often the quickest. Anti-inflammatories, ice, releasing the calves, plantar fascia stretches, orthotics and decreased activity (avoiding weight bearing) are some of the most common recommendations for acute plantar fasciitis.
If you don't listen to your body and continue to stress your feet with plantar fasciitis, your symptoms may persist, and your condition may become chronic. If symptoms last for 6 months or longer it is, then considered a chronic condition.
Recommendations for chronic conditions require understanding tissue degeneration. Helping your body's healing process with physical therapy is a big part of the chronic plantar fasciitis protocol.
Orthotics and shoe inserts made especially for plantar fasciitis can provide cushioning from hard surfaces and give arch support. They can also lift the heel and arch so that a heel or bone spur doesn’t dig into the heel. Giving good arch support while weight bearing can help with heel pain and treat plantar fasciitis.
Using night splints can gently and comfortably stretch the heel and arch while you sleep. In this way, night splints can help most patients prevent the stabbing pain in the morning.
Applying gentle pressure while rolling a ball like a golf ball beneath your heel and arch can stimulate blood flow and loosen the tissues to provide relief and stimulate healing.
Stretches can improve flexibility and strength in the arch. This can allow you to do more on your feet throughout the day and still reduce symptoms the following morning.
Anti-inflammatories like ibuprofen can reduce inflammation and bring pain relief as needed. Follow dosing instructions and consult with your doctor when taking these medications long-term, since overuse can harm the lining of your stomach.
Injury, and conditions causing inflammation involving any of the bones (bone spurs), ligaments, fat pad or tendons in the foot can cause foot pain. Arthritis is a common cause of pain. Injury to the nerves of the feet can result in intense burning pain, numbness, or tingling (peripheral neuropathy).
Some common causes of foot pain include:
Achilles tendon injuries, avulsion fractures, bone spurs or heel spurs, broken foot, bunions, flat feet, corns, bursitis (joint inflammation) diabetic neuropathy, nerve damage caused by injury or disease such as botulinum toxin, fat pad injuries rheumatoid arthritis, gout, ingrown toenails, osteoarthritis, peripheral neuropathy, stress fractures, tarsal tunnel syndrome tendinitis, sprains.
This tendon is the strongest tendon in the body. It is a tendinous structure, that attaches the two calf muscles (gastrocnemius and soleus) to the heel bone.
The tendon causes the foot to push off (plantar flex) when the calf muscles tighten. The tendon is necessary for normal walking, running, and jumping. Athletic and traumatic injuries to the tendon are common.
Tendinitis or tendinopathy is inflammation of a tendon. The inflammation may be localized to the end of the tendon closest to the heel or may spread upward to affect even the muscles of the calf. Swelling occurs and pain is felt with contraction of the calf muscles. In severe cases, when offending activity is not stopped, pain may even be felt at rest.
Most tendon injuries are due to overuse or misuse. Some factors that lead misuse are improper shoe selection, inadequate stretching prior to use, a shortened Achilles tendon, direct trauma or injury to the tendon, training errors and heel bone deformity.
When the feet tend to roll inward in pronation, either due to structural alignment or a caving in due to weakness in the hips, it can put an angle and extra stress on the tendon.
A typical treatment plan to decrease pain in Achilles tendonitis from your physical therapist might include:
This is generally the result of overuse or repeated trauma to a bone causing a small crack or fracture in the bone.
Fractures in the bones of the foot are usually caused by overtraining or overuse. They can also be caused by repeated pounding or impact on a hard surface, such as running or jumping. Increasing the time, type or intensity of exercise too rapidly is another common cause of stress fractures to the feet and lower leg. Running in old or improper shoes can also lead to fractures. Changing running shoes regularly will help increase support.
Women seem to be at greater risk of foot fractures than men. This may be related to a combination of risk factors such as poor nutrition, eating disorders, and amenorrhea (infrequent menstrual cycle), that predispose women to early osteoporosis (thinning of the bones). The result of this type of decreased bone density is an increase in the risk of fractures.
High-impact sports such as running and jumping sports like basketball can increase the risk of foot fractures. With these sports and others, the repetitive stress of the foot striking on a hard surface causes trauma and muscle fatigue. Without the right shoes, good muscle strength or adequate rest between workouts, an athlete can develop a fracture.
The best treatment for a fracture is rest. Taking a break from high-impact exercise, such as running, which causes increased stress is important. While you are resting from the offending activity, you may still be able to do low impact exercise, such as cycling or swimming. This protocol may help with reducing pain and helping the fractured bone heal. If an athlete pushes through pain and trains with a stress fracture, the fracture can worsen or become a chronic injury that may never heal properly.
Physical therapists can help guide you through your recovery by offering education, therapeutic exercises, and manual therapy treatment.
Physio therapy is very good for plantar fasciitis. Most people want to know if the treatment will hurt. That depends on the type of therapy you and your physical therapist choose. However, in general, guided stretching and exercises shouldn’t hurt.
Communication between physical therapists and patients is very important. While your physical therapist is a trained professional, he or she isn’t a mind reader. If something hurts or feels wrong, you should let your physical therapist know, so your position or treatment can be adjusted properly.
The other big question many people have about what to expect from physical therapy is “how long will it take?” or “how many sessions will I need?” Again, the answer depends a great deal on a few factors, including how long you have been dealing with plantar fasciitis, whether you are recovering from surgery, your body, and other coexisting conditions, and how diligent you are about supplementing your treatment in physical therapy with self-treatment at home. Physical therapy can be a process of as little as a few sessions, or many months, depending on your unique situation.
Reducing inflammation will make being on your feet much less painful!
You can reduce inflammation with ice. Use an ice pack or fill up an empty bottle with water and put it in a freezer. Once the water is frozen, pull the bottle out, and roll it along the bottom of your feet. Repeat this practice about three times a day.
Massage and self-release can be a very good way to loosen a tight plantar fascia, foot, and calf, which can also reduce your pain.
Staying mobile and active is important. However, walking or any kind of weight bearing can add additional stress to the plantar fascia when it is in a state of injury.
It would be ideal if an alternative to walking could be found, such as exercising on a bike or elliptical machine.
If you want to or need to walk, try to avoid walking barefoot. Wear supportive shoes or orthotics. Warm up well and stretch your feet, calves, and legs before you start walking. Roll the bottom of the foot on a ball. Follow up your walk with ice to your foot.
Tight muscles are thought to be a risk factor in developing plantar fasciitis. Most directly, tight calf and foot muscles put a pull on the plantar fascia. Additionally, tight hamstrings and gluteal muscles, can indirectly pull on the plantar fascia. Tension or even weakness and imbalance in these muscles can also affect foot biomechanics, predisposing people to plantar fasciitis.
Inertia Physio+ offers Kanata and Stittsville exceptional Physiotherapy, Athletic Therapy and Registered Massage Therapy with private treatment rooms, one on one care, a maximum of two patients per hour and treatment focused on the evidence-based practices of manual and exercise therapy. Don’t suffer any longer. If you have pain or injury, our Kanata and Stittsville Physiotherapy, Athletic Therapy, and Registered Massage Therapy team is here to help you get back to living pain-free life and activities. Please reach out to us at (613) 672-2200 or info@inertiaphysio.ca for an appointment today! You are also welcome to book online. We also offer direct billing on Physiotherapy and Massage Therapy services whenever your plan allows.
