Physiotherapy in Action

Physiotherapy In Action: Plantar Fasciitis

by: - February 20, 2017
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By: Dr Lucia Corriette
Physiotherapist

PLANTAR FASCIITIS

Overview
Plantar fasciitis is an inflammation of the plantar fascia or fibrous connective tissue that runs from the heel to the toes. This fascia is responsible for providing support to the arch of the foot. Inflammation of the plantar fascia leads to pain in the heel.

Signs and Symptoms
• Sharp, stabbing pain that is felt during the first few steps after getting out of bed in the morning.
• Heel pain
• Pain felt after, rather than during exercise

Risk Factors
• Being female
• Being overweight
• Being between the ages of 40-60
• Walking or standing a lot on hard surfaces
• Walking or running for exercise
• Tight calf muscles
• Pes cavus – high arches
• Pes planus – flat feet

Medical Management
An x-ray may be recommended by the attending physician in order to rule out bony problems such as heel spurs or a stress fracture.

• Try to stay off your feet when possible and avoid activities that cause pain. Avoid walking or running on hard surfaces.
• Pain relieving medications such as ibuprofen and naproxen (Aleve) may be of some help.
• Ice pack application to the heel is also recommended.
• Stretches should be performed regularly to address tightness of the fascia.
• Heel cups or insoles can be used in shoes. Use in both shoes even if only one heel is painful.
• Wear shoes with a cushioned sole and good arch support.
• Surgery is not usually recommended but your physician may suggest an injection (steroid) to help alleviate the pain.

Surgery
Surgical release of the plantar fascia (plantar fasciotomy) may be considered in cases where pain is not alleviated with conservative management. There is a success rate of 70 to 90 percent in patients with plantar fasciitis. Risk factors include flattening of the longitudinal arch and decreased sensation at the heel, as well as possible complications due to rupture of the plantar fascia and complications of anesthesia.

Physiotherapy
Physiotherapy uses treatment techniques to help reduce painful symptoms. Treatment also includes a stretching regime that targets the plantar fascia and Achilles tendon. A physical therapist can instruct you in a series of exercises to stretch the plantar fascia and Achilles tendon and to strengthen lower leg muscles, which stabilize your ankle and heel. A therapist might also teach you to apply athletic taping to support the bottom of your foot.

Stretches

Take Away
Plantar fasciitis is a condition that usually goes away within 6 to 18 months. Rest is an important part of treatment, along with conservative management including physiotherapy.

References
1. American Family Physician. Treatment of Plantar Fasciitis. http://www.aafp.org/afp/2001/0201/p467.html Accessed 10.02.17
2. American Orthopedic Foot and Ankle Society. A Step in the Right Direction. http://www.aofas.org/footcaremd/conditions/ailments-of-the-heel/Pages/Plantar-Fasciitis.aspx Accessed 10.02.17
3. Foye PM. Physical Medicine and Rehabilitation for Plantar Fasciitis. http://emedicine.medscape.com/article/308917-overview#a2 Accessed 10.02.17
4. Heel Spurs and Plantar Fasciitis Treatment in Augusta GA. http://www.georgia-clinic.com/blog/2013/10/heel-spurs-and-plantar-fasciitis-treatment-in-augusta-ga/
5. Lewis RD, Wright P, McCarthy LH. Orthotics Compared to Conventional Therapy and Other Non-Surgical Treatments for Plantar Fasciitis. The Journal of the Oklahoma State Medical Association. 2015;108(12):596-598.
6. Mayo Clinic. Plantar Fasciitis. http://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/dxc-20268536 Accessed 10.02.17
7. Plantar Fasciitis. http://sutherlandpodiatry.com.au/services/plantar-fasciitis/ Accessed 17.02.17