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What is plantar fasciitis?
Plantar fasciitis is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia).
Plantar fasciitis commonly causes sharp pain that often occurs with your first steps in the morning or when you've been sitting for long periods and try to walk. As you get up and move, the pain normally eases after a few steps.
What causes of plantar fasciitis
Your plantar fascia is a band of soft tissue on the bottom of the foot supporting the arch of your foot and absorbing shock when you walk. If tension and stress on this soft tissue become too great, small tears can occur in the fascia causing inflammation and pain.
Risk factors for developing plantar fasciitis
Even though plantar fasciitis can develop without an obvious cause, some factors can increase your risk of developing this condition. They include:
Age: Plantar fasciitis is most common between the ages of 40 and 60.
Certain types of exercise: Activities that place a lot of repeated stress on your heel and attached tissue such as long-distance running, hiking and ballet dancing.
Foot mechanics: Flat feet, a high arch or even an abnormal pattern of walking can affect the way weight is distributed when you're standing and can put added stress on the plantar fascia.
Obesity: Excess weight puts extra stress on your plantar fascia when you weight bear.
Occupations: Nurses, teachers, gardeners and others who spend most of their work hours walking or standing can inflame the plantar fascia.
Diagnosing plantar fasciitis
Plantar fasciitis is diagnosed based on your medical history and physical examination. During the exam, your physiotherapist will check for areas of tenderness on the bottom of your foot. The location of your pain can help determine its cause.
Usually no tests are necessary. It might be suggested that you have an X-ray or ultrasound to make sure another problem, such as a stress fracture, is not causing you pain, but this is very uncommon.
Sometimes an X-ray may show additional bone growth (spur) on the heel bone. In the past, these bone spurs were often blamed for heel pain and removed surgically. But many people who have bone spurs on their heels have no pain.
Treating plantar fasciitis
There are a number of different ways to treat plantar fasciitis. Often one or a combination of the following are used:
Medication: Anti-inflammatory medication can help manage your pain whilst you recover. Discuss this with your doctor/GP before taking any to make sure you are safe to do so.
Weight Loss: losing weight will reduce the stress on the plantar fascia and therefore improve pain levels.
Correcting Footwear: Ensure you wear supportive footwear with support built into the inside of the foot for your arch.
Modify your Activities: Whilst you are recovering try to avoid any aggravating activities if you can. For example if running gives you pain try substituting it for cycling which has less impact on the plantar fascia.
Physiotherapy Exercises: After being assessed by your physiotherapist they will likely recommend some exercises to help improve the strength of the plantar fascia and stretch it. Watch this video to see some exercises we recommend for plantar fasciitis!
Acupuncture and Sports Massage: Both of these treatment options can be really effective at settling down plantar fasciitis. They settle your pain so you can do more of the exercises that will prevent it in the long term!
Arch Support Insoles: There are a couple of different types of insoles that can help with plantar fasciitis. One of these insoles is one that supports the arch of the foot to reduce the stress on the plantar fascia. Follow this link to see insoles we would recommend to support your arch: https://amzn.to/3g1hryV
Gel Heel Cups: If you have a stable ankle that doesn't require the above insoles and your pain is only over the heel of the foot then heel cups may be a better option for you. They provide cushioning to the heel as you strike the ground, reducing the stress on the plantar fascia. Follow this link to see the heel cups we would recommend: https://amzn.to/3tc6Nct
Gel Insoles: Similar to the gel heel cups, if your ankle is stable and doesn't require arch support but the pain travels from the heel down to the ball of the foot then a 3/4 gel insole may be more appropriate for you! Similar to the heel cups these provide cushioning to the foot as your stake the floor. Follow this link to see the gel insoles we would recommend: https://amzn.to/3dVmw9j
Ice: Applying ice to the area can help with reducing inflammation and improving pain. Wrap the ice pack in a towel and apply for up to 15 minutes, check your skin regularly to avoid any ice burn to the area. Here is a link to the reusable ice packs we recommend: https://amzn.to/3s7sPf2
Invasive treatment options
Steroid Injections: These are sometimes considered for plantar fasciitis. This help to settle down the inflammation in the soft tissue and improve your pain. However, they are often avoided as they can weaken the plantar fascia and increase the chances of plantar fasciitis reoccurring in the future.
Shockwave Therapy: is a procedure where shock waves are passed through the skin to the injured part of the foot, using a special device. The shockwaves are mechanical and not electric; they are audible, low energy sound waves, which work by increasing blood flow to the injured area. This accelerates the body’s healing process.
Surgery: It is very uncommon to require surgery for plantar fasciitis but it can be considered as a last resort. The most common surgery performed for plantar fasciitis is an Endoscopic Plantar Fasciotomy. This is an outpatient surgery that takes 15 to 20 minutes to perform, it involves a small incision (roughly one centimeter) on either side of the heel. A surgical scope, or small camera, is placed in one incision and a small surgical hook is placed in the other incision. While fully visualizing the plantar fascia with the camera, the hook is used to cut a portion of the fascia. The hook and the camera are removed, and the incisions are closed with one or two stitches. There are no implanted materials during this procedure. The purpose of this procedure is to release a tight or contracted plantar fascia. The cut portion lengthens roughly one inch and heals in this lengthened position during the recovery.
How long does plantar fasciitis take to get better?
Unfortunately plantar fasciitis can take some time to get better. It is largely dependant on how painful it is when you start treating it, how long it has been going on for and how much stress you put through it on a daily basis. Often it takes 8-12 weeks of completing the physiotherapy exercises regularly before you begin to see any improvement and 6 months or more to fully resolve.
You may see some improvements sooner if this is combined with other treatment options such as sports massage and acupuncture as well as using insoles.
Book An Assessment
If you feel you would benefit for an assessment by our physiotherapist please get in contact. They will be able to provide you with an accurate diagnosis as well as recommend and provide treatments appropriate to you. If you wish to contact us follow this link to our bookings page: https://www.kinetixphysiotherapy.com/contact
