Plantar Fasciitis – What You Need to Know

Do you have nagging foot pain? Is your pain worse in the morning, yet seems to get better as your day goes on? Are you unable to do the activities you once loved because of your foot pain? You may have a common condition known as Plantar Fasciitis. This is a common foot problem amongst the population that is diagnosed by health care professionals.

Plantar Fasciitis is defined as “a localized inflammatory condition of the plantar aponeurosis of the foot” (Riddle, et al. 2003). Common signs and symptoms of this condition are pain and tenderness on the bottom of the heel, pain when taking your first few steps in the morning and pain that is generally worse when weight-bearing. There are various hypothesized causes of Plantar Fasciitis, but none have been shown to be a definitive cause. Plantar Fasciitis is commonly seen with overuse due to prolonged weight-bearing, obesity, unaccustomed walking and running, and limited dorsiflexion (bringing your foot toward your body) in the ankle joint (Riddle, et al. 2003).

The foot is a very intimate body structure, consisting of 28 bones and 12 intrinsic muscles, as well as 12 muscles originating on the lower leg that insert onto the foot (Magee, 2014). The muscle associated with the diagnosis of Plantar Fasciitis is called the plantar aponeurosis. The plantar aponeurosis originates off of the bottom of the heel and branches outwards towards its insertion point onto each of the toes. Inflammation in the plantar aponeurosis is therefore felt with pain in the bottom of the foot that is either generalized or at one specific point along the plantar aponeurosis that is most inflamed. There are two common causes of Plantar Fasciitis:

1. Constant use of the foot through weight-bearing activities which increases inflammation in the plantar aponeurosis.
2. On-weight bearing activities that cause the plantar aponeurosis to tighten up causing the pain some individuals feel.

In order to counteract this tightness and inflammation, proper stretching and strengthening of the foot musculature is required.
Consultation with a Physiotherapist can help guide the rehabilitation of those suffering from Plantar Fasciitis. Physiotherapists help to identify the structures involved and set you up with a proper treatment plan for the rehabilitation of your foot. Treatment plans usually include stretching of the tight musculature surrounding the lower leg and foot and strengthening weak musculature of the lower extremity. Joint mobilizations are often utilized as well, in order to maintain the proper movement of the foot. Some examples of stretching exercises used are:

1. Using a tennis ball or laundry ball to roll out the bottom of the foot.
2. Calf stretches, including both stretches for the gastrocnemius muscle and the soleus muscle.

Strengthening exercises are customized to weak musculature surrounding the lower extremity. These exercises can include hip strengthening targeting the muscles that provide external rotation of the hip, as well as quad, hamstring and calf strengthening, on top of foot intrinsic strengthening. Your Physiotherapist will work with you to develop a customized stretching and strengthening program in order to maximize your potential and decrease your foot pain.

Image from: http://skorarunning.com/blog/plantar-fasciitis

Modifying your activities is also required during the rehabilitation phase in order to decrease the amount of inflammation in the plantar aponeurosis. If you are constantly causing inflammation time and time again, the healing tissues cannot progress into the next phase of healing (proliferation). The inflammatory phase of healing is generally 7-10 days, while the proliferation phase of healing is from 10 – 21 days and the last phase of healing, the remodelling phase, is 21 days onward until full recovery (Magee, 2014). Delaying progression into the proliferation phase of healing hinders the body from being able to properly heal and is the area that people most commonly become stuck in.

A progressive return to activity is also used to ensure that no inflammation is reoccurring. This is done to enable your recovery. Most clients see the restriction of activities as a bad thing in rehab, but it is actually done to ensure a client’s ability to participate in their activities in the future. Returning to sports and your activities of daily living are important considerations in your rehabilitation process, and your Physiotherapist will work with you to ensure that you are able to return to what you love doing.

If conservative Physiotherapy treatment is not working for you, your Physiotherapist can refer you back to your family Doctor to consider medical interventions, such as non-steroidal anti-inflammatory medications and cortisone injections (DiGiovanni, et al. 2003). These interventions may be used when conservative treatment is not progressing along as expected. They can be used in the rehabilitation process to aide in the recovery of your foot pain and allow the tissues to work through the inflammatory phase of healing faster. Please check with your Doctor to ensure that these measures are correct for you.

Night splints and casting are other measures taken when a lack of dorsiflexion in the ankle is the main cause of the Plantar Fasciitis (DiGiovanni, et al. 2003). Night splints help to keep the foot in the proper position at night time, when your body is in its natural rested state and the calf may be in a shortened position. Casting is also done to keep the calf at its natural length, but is done for a prolonged period of time in order to regain normal length of the calf musculature and normal dorsiflexion of the ankle. When the calf muscle is tight, dorsiflexion of the ankle is limited. Limited ankle dorsiflexion restricts the amount of length that the intrinsic muscles of the foot have. Shortening of these muscles, including the plantar aponeurosis, causes repeated stress and therefore inflammation to develop, leading to Plantar Fasciitis.

Lastly, wearing shoes throughout the day to maintain the foot’s proper arches is often suggested. Within your shoe you should be using a prefabricated or custom made orthotic to ensure that the foot’s structure is maintained. An exciting development at Nose Creek Physiotherapy is that we are now offering custom-made orthotics in Calgary!

Book an appointment today at Thorncliffe at 403.275.7728 or at Beddington at 587.205.5235 to be custom fitted and begin your recovery process to return to the activities you loved doing before your nagging foot pain started!

If your heel pain is not getting better, then you need to give Shelby Wogsberg, MScPT a call at our Beddington location 587 205-5235 to book an assessment, so she can get you “moving faster and feeling better”.

References
DiGiovanni, B. F., Nawoczenski, D. A., Lintal, M. E., Moore, E. A., Murray, J. C., Wilding, G.E., Baumhauer, J. F. (2003). Tissue-Specific Plantar Fascia-Stretching Exercise Enhances Outcomes in Patients with Chronic Heel Pain. The Journal of Bone and Joint Surgery, 85-A, 7 (1270-1277).
Magee, D. J. (2014). Orthopedic Physical Assessment. Missouri: Elsevier.
Riddle, D. L., Pulisic, M., Pidcoe, P., and Johnson, R. E. (2003). Risk Factors for Plantar Fasciitis: A Matched Case-Control Study. The Journal of Bone and Joint Surgery, 85-A, 5 (872-877).

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