Written by: Gillian Lyttle, BPE, BHSC(PT) / Registered Physiotherapist
It is connective tissue located on the sole of the foot. It is attached to the heel and spans out attaching to the base of the toes. The plantar fascia helps to create a more stable arch to allow the foot to remain stable during the toe-off phase of walking and/or running.
Pain is usually experienced on one foot and is most often noticed in the morning when first getting out of bed. Pain also occurs with the onset of activity such as walking and running. The pain may decrease as activity progresses and the plantar fascia is stretched out, but it usually returns after resting and then resuming activity. The pain usually occurs on the bottom of the heel forcing people to walk on the outside of the foot, or to walk with a limp. It is typically more painful to walk with bare feet than with shoes on.
There are a number of factors that may contribute to the development of plantar fasciitis.
Some of the factors are:
• Change in the duration or type of training
• Ill-fitting or poorly constructed footwear
• Biomechanics i.e. stiffness or too much movement at the heel joint; decreased motion at the big toe joint
• Physical characteristics e.g., leg length discrepancy; tight Achilles tendon; tight calf muscles
• Weight gain
• Age
The key is to try to determine the cause of your plantar fasciitis. Since there may be more than one factor contributing to your injury, it is a good idea to address the easy things first – footwear, for example. Icing 15 to 20 minutes after activity or at the end of the day helps to relieve pain and reduce swelling in the short run. Stretching the plantar fascia before getting out of bed in the morning and before walking, after rest, can be extremely beneficial.
Ongoing treatment is very individualized – it depends on the factors that contributed to your condition.
The following is a list of the many treatment interventions for plantar fasciitis:
1. Footwear:
(a) Determine what shoes would be most appropriate for your foot type
(b) Determine if your shoes are worn out
(c) Don’t wear shoes in which the heel is lower than the front of the shoe (called a negative heel) …it is often more comfortable to wear a shoe that has a positive heel.
2. Stretching:
(a) Stretching the calf muscles, the achilles tendon and the plantar fascia 3 to 5 minutes before standing in the morning, and after any period of rest (such as sitting at a desk or driving a car), will help to prevent further injury.
(b) Use a night splint to stretch the plantar fascia and calf muscle while sleeping.
(c) Taping may help to support and unload the plantar fascia
3. Strengthening:
(a) Strengthening of muscles in the pelvis/hips, lower limb and foot to create optimal muscle balance
(b) Strengthening muscles at the sole of the foot to help the plantar fascia support the bones of the foot
(c) Balance exercises are very helpful. Try to stand on one foot (very tall – no slouching) for 30 seconds
4. Physiotherapy:
(a) Foot joint mobilization (making sure all the bones in the foot and pelvis/hip/lower limb are moving optimally)
(b) Big toe mobilization (making sure the big toe joint moves enough)
(c) Myofascial release of lower limb soft tissue
(d) Education regarding Dos and Don’ts for your daily activities
5. Analysis:
(a) Analysis of training duration and type
(b) Analysis of running/walking mechanics
(c) Analysis and treatment of any low back/pelvis/hip dysfunction which may be a contributing factor
6. Orthotics:
(a) To help control excessive mechanics
(b) To control for improper foot mechanics and reduce compensatory movements (due to pain or limping), to reduce pressure points, to provide shock absorption
7. Massage Therapy:
(a) Massage/release of the plantar fascia and the muscles at the back of the leg
(b) Myofascial release of lower limb and soft foot tissue
8. Medication:
(a) Anti-inflammatory medication may be prescribed.
(b) In extreme cases, cortisone injections may be recommended.
9. Shockwave Therapy (Radial pulsed)
Ensure an appropriate assessment is completed to determine if you are a candidate. Click for more info on Shockwave
Stretches:
Perform the following stretches before getting out of bed and during periods of rest:
Ankle Rotations
Arch Stretch
Foot Massage
Phone Book Stretch
Gillian is a co-owner and physiotherapist at GRSM. Gillian graduated from McMaster University in 1995 with a Bachelor of Health Sciences in Physiotherapy. Her interest in orthopaedics lead her to become a certified manual and manipulative therapist (Part A) in 2000. Gillian has been working as a registered physiotherapist in sports medicine since 1995. Her interest in treating lower extremity dysfunctions and biomechanical and pathological conditions of the foot and ankle lead her to become a Certified Pedorthist CPed(C) in 2004.
Gillian’s educational background has provided her with a unique perspective when assessing and treating lower extremity dysfunction. Gillian has also presented at several conferences on the biomechanical and functional relationship between the pelvis, hip and foot due to her extensive clinical background.
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