Plantar fasciitis

By: Marven Bani, PT

Have you ever wondered why you were experiencing stabbing pain along your heel when taking the first steps in the morning? One of the most common causes of heel pain is plantar fasciitis. Approximately 10% of people will have this condition at some point in their lifetime.

Plantar fasciitis is a repetitive strain injury to the bottom surface of the foot causing inflammation and irritation of the plantar fascia. Plantar fascia pain often starts as a dull ache and then progresses to a sharp, knife-like pain that becomes worse when putting weight on your foot.

Anatomy of the plantar fascia

The plantar fascia is a thick band of connective tissue that runs across the bottom of your foot and connects your heel bone to your toes. The plantar fascia is an important structure in helping to support the arches of your foot.  With plantar fasciitis, tenderness may be localized centrally along the tissue (orange), along the inside of the foot (red) or directly across the heel (yellow) (Baker et al., 2010).

Signs and Symptoms of plantar fasciitis

Plantar fasciitis pain typically is felt with your first steps in the morning or after prolonged periods of inactivity. Improvements are seen with continued walking. The onset of pain is often gradual.  Pain is frequently described as a dull-ache, but can also be associated with a sharp pain is reported at the plantar surface of the heel. Prior to the onset of pain, there often tends to be an increased frequency of walking, running, hiking, stair climbing or a change in footwear.

Risk factors for Plantar fasciitis

There are many factors that can contribute to plantar fascia pain.  Some of the most common risk factors include:

Over-training

If training is increased too quickly the muscles that assist with shock absorption can become overloaded.  Over-training can shift shock absorption away from the fatigued muscles to structures such as your plantar fascia.  This can be a repercussion of starting a new activity too quickly or can be caused by increasing an activity such as running faster than your body can adapt to the demands of the new activity.

Prolonged weight-bearing activity or standing on hard surfaces

Over-training does not have to be from just exercise.  Standing on hard surfaces for a long duration of time can put direct pressure on the attachment of your plantar fascia especially if the footwear being used is not appropriately absorbing this pressure.  This can be seen with inappropriate ergonomics of standing desks.

 

Tissue degeneration

As we age, tissues such as the plantar fascia can experience a reduced ability to heal from micro trauma.

 

Weight gain

Obesity is seen in 70% of those presenting with plantar fasciitis.

Biomechanical imbalances

An excessively supinated or pronated foot can increase the strain on the plantar fascia.  With increased foot pronation there can be excessive stretching of the plantar fascia.  Additionally, a foot with increased supination may have difficulty dissipating the forces that need to be absorbed by the foot with activities such as standing, walking and running.  Excessive pronation or supination may be due to local factors or injuries at the foot, but are also commonly seen as a result of biomechanical changes at the hip, knee or back.

Leg length discrepancy

The plantar fascia can become a source of pain as the body attempts to compensate for a real or functional differences in the length of your leg.

Tightness of the Achilles tendon and weakness of the calf muscles

Reduced length of the calf muscles often result in increased strain of the plantar fascia and pronation of the arches of the foot.

Inappropriate footwear

Footwear that does not help to absorb weight bearing forces at the foot or that contributes to pronated positions of the foot can be a factor in plantar fascia pain.

What can be done for plantar fasciitis?

Fortunately, research has shown conservative treatments to be effective in getting rid of your heel pain. Physiotherapists can help identify the underlying source of why you’re experiencing heel pain. With a thorough assessment, we will examine the alignment of your foot, perform a gait analysis, assess your range of motion and strength of your foot and ankle.   Based on the assessment findings we will develop an action plan to treat your heel pain.  Some of the treatment techniques that may be indicated include:

  • manual therapy techniques such as joint mobilizations or manipulation
  • recommendations on activity modification
  • deep tissue massage
  • footwear advice such as orthotics, insoles or heel pad
  • stretching and strengthening exercises
  • electrotherapeutic modalaties such as extracorporeal shockwave therapyor ultrasound.

Often the pain from plantar fascia pain can be helped by improving flexibility of the calf muscle group.  If you have sufficient ankle mobility an effective calf muscle stretch can be achieved by standing and placing both hands on a wall, with your feet about half a meter from the wall.  Place one leg behind the other and lean your body forward without bending the back knee until you feel a stretch in your back calf.  The stretch is often maintained 3 times for 30 seconds daily.

Additionally, rolling out the plantar fascia can assist with local pain.  Rolling out the plantar fascia is accomplished by standing next to a chair or wall for balance. Step over a ball with one foot and roll the ball from front to back under your foot to release the muscles attaching into the plantar fascia for 1 minute once daily.

Not sure where to start?

If you’re pain has not been responding to the traditional exercises for plantar fasciitis or you don’t know where to start let us know!  Our team of physiotherapists, massage therapists and naturopathic doctors have the training and experience to get your pain under control and back to achieving your health and fitness goals!

 

Family Physiotherapy, assessing and treating sports injuries for the residents of Thornhill, Markham and Vaughan

The physiotherapists at Family Physiotherapy have been providing high quality assessment and treatment techniques using safe and evidence based techniques to the residents of Thornhill, Markham, Richmond Hill, Woodbridge, Vaughan and Toronto. Our therapists are continually upgrading their skills and take the time to provide you with the one on one care necessary to quickly get you back to the activities you love doing.  Comprehensive assessment and treatment techniques are always one on one without the use of assistants or double booking patients to make sure that you achieve your functional and sports goals as soon as possible.  Our therapists would be happy to help you to achieve your goals, call the clinic to schedule a consultation to get you back on track.  Don’t let pain ruin your day!

 

References:

Baker, J., Bouche, R., Christensen, J., Kravitz, S., Schuberth, J., Thomas, J.,  Vanore, J., Weil, L., & Zlotoff, H. (201). “The diagnosis and treatment of heel pain: a clinical practise guideline” The Journal of Foot & Ankle Surgery 49, S1-S19.

 

 

 

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How to Run Injury-Free

By Peter Poon, PT

Running injuries

Now that summer is in full swing, many of us will want to enjoy the sunshine by going for a casual jog or more vigorous run around the neighbourhood. Some may think running is not an exact science: just pick up a pair of (brightly-coloured) running shoes and…go. However, poor running form can lead to injuries down the road, much like how riding a bike with misaligned wheels will eventually wear down the bike and the rider. It has been estimated that between 4 – 18% of individuals have some kind of running injury at any given time.[1] Common injuries such as patellar tendinopathy, tibialis posterior tendinopathy, tibial stress syndrome (shin splints) and achilles tendinopathy are usually due to improper loading during lower body exercises and may not yet be impacting you enough to seek out a physiotherapist.  

 

Can technique be resulting in painful runs?

If you have been experiencing pain either during or after a run, ask yourself the following:

  • Where is my pain? What does it feel like?
  • I am in pain during my run. Does it go away quickly (with rest) or does it linger for days?
  • I am in pain after my run. How long after does the pain start?
Pain with running can be improved with a proper assessment and treatment plan
Pain with running can be improved with a proper assessment and treatment plan

The above are all plausible signs that your body is not agreeing with your running routine. When your body experiences pain, it is generally a sign  that it cannot cope with the stresses from that activity.  You can reduce your risk of ending up with severe injuries if you identify subtle movements or habits that could lead to injuries and develop a proactive long-term injury-prevention strategy.  During an assessment, physiotherapists can identify these factors and prescribe individualized exercises and tips to get you moving efficiently.

 

Could previous injuries be causing me running pain?

Imagine you have just sprained your ankle, instead of walking with a heel-toe pattern, your body compensates by doing a stutter step. Compensations are one of your body’s natural defense mechanism. Short term compensations are necessary to keep you moving with less pain. However not all compensations are ideal; in the previous example, walking with a stutter step will lead to decrease use of your calf and hip muscles to propel you forward. If left unchecked, it will lead to future muscle imbalances which could affect your running form. Even though you may feel no pain from your previous injuries, you could have developed subtle compensations, which could have abolished the pain but only “band-aid” the problem. During a gait assessment, physiotherapists can identify these changes and give you specific advice to keep you running on all cylinders.

 

Am I a heel, midfoot or forefoot striker (am I pounding away at the pavement or landing light as a feather)?

Different landing patterns will create different stresses on your foot and body; some patterns are better at absorbing shock than others and some can lead you susceptible to injury.

 

Am I taking laboured or big strides?

Taking laboured or big strides is an inefficient method to run or to run faster. This is due to a greater energy loss from lifting your leg (versus shorter strides) which decreases forward propulsion. Not surprisingly, big strides will increase impact on your feet when you land. While it may be okay for some sprinters, imagine the impact on your feet if you were to repeat this for 5-10km. Physiotherapists can easily identify this fault and give you specific tips to help improve your efficiency.

 

Did I suddenly change or increase the volume (time, distance or # of runs per week) or intensity of my run?

Sudden increase in volume of training is a catalyst for sprains and strains. Daily to weekly adjustments of the applied mechanical stress (either volume, or intensity) is the best way to avoid injury.

 

Calluses or getting black toes can be a sign of inappropriate shoes

The fit of the shoe is essential to stay injury free. Shoes that are too small or too narrow could lead to unwanted bunions and black toes. 

 

Am I running the same circles in a track or same route every time? Do I run on different types of surfaces?

Not only does cross training on irregular surfaces or trails keep your muscles guessing, but it also helps improve balance and adds variety to your workout. The variation will increase strength and endurance in your foot and ankle muscles, which leads to less repetitive strains in the future.

 

A few final thoughts on Running

These are all valid questions to consider whether you are just picking up running, coming back from an injury or wanting to stay injury-free. A running gait assessment by a physiotherapist can help you with answers to the above questions. Not only do we conduct an interview at the beginning to find out your running routine, we look at your running form from head-to-toe to identify possible areas that need to be addressed. With this information, physiotherapists can assist runners in developing individualized long term solutions to stay running injury free.

As always, contact us if you need any tips or advice.

 

Family Physiotherapy serving the residents of Thornhill, Markham and Vaughan

The physiotherapists at Family Physiotherapy have been providing high quality assessment and treatment techniques using safe and evidence based techniques to the residents of Thornhill, Markham, Richmond Hill, Woodbridge, Vaughan and Toronto. Our therapists are continually upgrading their skills and take the time to provide you with the one on one care necessary to quickly get you back to the activities you love doing.

Peter Poon is a registered physiotherapist at Family Physiotherapy.

[1] Lopes A, Hespanhol JLC, Yeung SS, Costa LO. What are the main running-related musculoskeletal injuries? A systematic review. Sports Med. 2012; 42(10): 891-905