Plantar Fasciitis

By: Rachel Long, PT, DPT

Plantar fasciitis is one of the most common causes of heel pain.  Plantar fasciitis occurs when the thick band of tissue that supports the arch of your foot (connecting the heel to the front of your foot) becomes inflamed and irritated. 

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Symptoms

  • Sharp or stabbing pain in the bottom of the foot near the heel
  • Pain upon first steps in the morning or after periods of prolonged sitting
  • Pain precipitated by a recent increase in weight-bearing activity
  • Pain better during activity/movement
  • Pain after exercise or exertion
  • Pain with palpation of the plantar fascia insertion (by the heel)

Causes

Because the plantar fascia is designed to provide support to the arch, repetitive strain (such as with running, certain sports, or increased activity) can create mico-tears in the fascia and/or cause inflammation.  Poor foot mechanics such as flat feet, a high arch or abnormal walking pattern can also put stress on the plantar fascia. 

Treatment

  • Stretching the plantar fascia
  • Stretching the calf muscles
  • Strengthening the ankle and intrinsic muscles of the foot (the small muscles in the foot that contribute to supporting the arch)
  • Night splints which allows a prolonged stretch of the plantar fascia
  • Orthotics
    • Off-the-shelf or custom to help distribute pressure throughout the foot more evenly
      • Has a more rigid structure and is designed to correct biomechanical problems in the foot (such as a low arch)
      • This is different that an insert that is designed to create cushioning in a shoe
  •  Manual therapy of foot and ankle
    • Joint mobilizations performed by a physical therapist to improve the mechanics of the foot and ankle if restrictions are present
    • Soft tissue techniques
      • To decrease fascial restrictions
      • Can include Graston Techniuqe or other forms of IASTM (instrument assisted soft tissue mobilization)
        • provides an increase in blood flow, reduction in tissue viscosity, myofascial release, interruption of pain receptors, and improvement of flexibility of underlying tissue1
  • Kinesiology taping
    • helps to decrease the amount of pull on the plantar fascia, while also providing foot support

Exercises for Plantar Fasciitis

  • Calf (Gastroc) stretch

Begin in a standing upright position in front of a wall with a towel roll placed along the inside of the foot. Place your hands on the wall and extend one leg straight backward, bending your front leg, until you feel a stretch in the calf of your back leg and hold for 30 seconds.  Repeat 3 times

Perform the exercise above with the back knee bent (this focuses on a different part of the calf muscle called the soleus)

  • Plantar fascia Stretch

Begin sitting in a chair with one leg crossed over your other knee. Gently pull your toes backward until you feel a stretch in the bottom of your foot and hold 30 seconds.  Repeat 3 times

  • Towel crunch

Sit with the front of your foot resting on a flat towel (Heel off the towel).  Use your toes to scrunch up the towel and make sure to keep the rest of your foot in contact with the ground.

  • Ice roll

Begin sitting upright with your foot on top of a frozen water bottle (this provides both the pressure needed to work out the tissue as well as providing the anti-inflammatory benefits of ice).  Gently roll the middle of your foot forward and backward over the roller, in between the ball of your foot and your heel.  Perform 3-5 minutes. 

Plantar fasciitis can cause pain and limit function with walking, running, or playing sports.  Physical therapists are experts at assessing movement and determining the reason for your pain.  We can address each biomechanical deficit that is contributing to your heel pain by prescribing individualized exercise programs, as well as using the manual techniques described above to achieve better outcomes faster!  Contact us today. 

References

  1. Matthew Lambert, Rebecca Hitchcock, Kelly Lavallee, Eric Hayford, Russ Morazzini, Amber Wallace, Dakota Conroy & Josh Cleland (2017) The effects of instrument-assisted soft tissue mobilization compared to other interventions on pain and function: a systematic review, Physical Therapy Reviews, 22:1-2, 76-85, DOI: 10.1080/10833196.2017.1304184

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