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 therapy or 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 and massage therapists have the training and experience to get your pain under control and back to achieving your health and fitness goals!
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.
