Plantar Fasciitis Symptoms

Most people experience heel pain on the inside of the heel bone or extending into the arch of the foot. The pain is worse in the morning getting out of bed, then usually improves. It can recur during the day after periods of non-weight bearing again initially as you start to walk.
It can be worse after running or playing sport, especially after getting up from sitting afterwards.

Anatomy of The Plantar Fascia

The plantar fascia is a thick band of tissue that runs along the bottom of the foot, connecting the heel bone to the toes. It acts as a shock absorber and helps support the arch of the foot. It also shortens the foot during the propulsive stage of the gait cycle. Plantar fasciitis is essentially a biomechanical overload condition, and while there may be inflammation in the early stages of the condition, the pathology is one of degeneration of the fascia with or without micro tears. This can cause pain and discomfort in the heel or arch of the foot.

Is Plantar Fasciitis Causing Your Foot Pain?

Causes and Contributing Factors of Plantar Fasciitis

There are many factors that can contribute to the onset of plantar fasciitis, including:

1. Excessive loading: Overuse or increased loading of the foot is one of the most common causes of plantar fasciitis. This can happen with activities such as running, jumping, or standing for long periods.
2. Age: As we age, the plantar fascia can become weaker and less flexible, increasing the risk of injury.
3. Foot Mechanics: Abnormal foot mechanics, such as flat feet or high arches, can put extra stress on the plantar fascia. Reduced ankle joint dorsi flexion has also been shown to be associated with plantar fasciitis, as well as weakness in the intrinsic foot muscles which leads to less support of the arch of the foot and plantar fascia.
4. Obesity: Being overweight or obese (BMI > 27) can put extra pressure on the feet, leading to plantar fasciitis.
5. Improper Footwear: Wearing shoes with poor arch support or inadequate cushioning can also contribute to plantar fasciitis.

Plantar Fasciitis Treatments

There are many treatments available for plantar fasciitis. Some of these are considered Plantar Fasciitis treatment at home and can be quite effective.

Most of these treatments have been shown to have some impact on the pain:

1. Rest: Resting the foot and avoiding activities that aggravate the condition can help relieve symptoms in the short term. To achieve long-term gains short periods of rest,or modified loading, need to be interspersed with higher loading and strengthening exercises.
2. Ice: Applying ice to the affected area can help reduce inflammation and pain in the early stages
3. Stretching: Stretching exercises have been shown to improve outcomes in this group of patients but outcomes have been improved with the addition of strengthening exercises.
4. Footwear: Wearing shoes with good arch support and cushioning can help reduce stress on the plantar fascia.
5. Orthotics: Custom-made orthotics can be used to correct abnormal foot mechanics and provide additional support to the arch. Compared to sham orthotics, one study found an improvement in pain and function with custom-made and prefabricated orthotics.
6. Medications: Over-the-counter pain medications, such as ibuprofen or acetaminophen, can help relieve pain and reduce inflammation in the short term but do not address the causes of the condition.
7. Corticosteroid Injections: Corticosteroid injections may be used to reduce inflammation and pain in severe cases of plantar fasciitis, but there is limited evidence to support long-term results. Other risks associated with this procedure include rupture of the PF or fat pad atrophy.
8. Autologous blood injections (including Platelet-rich plasma injections) have been shown to have an 80% success rate at 3 months in one study.
9. Shockwave therapy: this procedure has gained more popularity recently and uses acoustic sound waves to penetrate the tissues and create more blood flow, and introduction of growth factors to stimulate healing. Several good-quality studies have shown that SWT can reduce pain and improve function in people with PF when compared to control groups.
   You can learn more about Shockwave Wave Therapy here.

Surgery is rarely necessary for plantar fasciitis and is only considered in severe cases that do not respond to other treatments.

Plantar Fasciitis Treatment At Home

Plantar Fasciitis Treatment- Our Physiotherapy Approach

Good physiotherapy management of PF will involve a careful and thorough assessment of all factors that may contribute to the onset of the condition, including biomechanical , social and any limiting beliefs the patient may have around pain. Once the key contributors are identified, treatment is aimed at addressing all of these, which can involve many of the options listed above, in a measured and coordinated manner.
At NWPG, we know that pain is a protective output from the brain, and where you feel your pain may not be where the main driver of the pain is. We look beyond the foot and leg to assess any dysfunctional muscle or joint in any region of the body that may also have an input to the pain.

Read here about a success story which involved remote contributors to a case of PF.

We also have a SWT unit and can administer this treatment if we determine that it is indicated for a particular person’s condition.

Plantar Fasciitis At Home Summary

Plantar fasciitis is a common condition that can cause pain and discomfort in the heel or arch of the foot. It is more common in middle-aged individuals and women. There are many causes of plantar fasciitis, including overuse, age, foot mechanics, obesity, and improper footwear. The best treatments involve through assessment of all the contributors, and a coordinated approach involving any of the treatments detailed above.

It can be a chronic condition, but responds to the right treatment, which is individual specific. Surgery is rarely necessary and is only considered in severe cases that do not respond to conservative management over a long period.
If you’ve had this condition and it has not responded to previous treatments or plantar fasciitis treatment at home, get in touch with us at the clinic and we’d be happy to discuss your case and how our approach can help you get back on your feet again!

Plantar Fasciitis References

Trojian T, Tucker AK. Plantar Fasciitis. Am Fam Physician. 2019;99(12): 744-750.

Landorf KB, Keenan AM, Herbert RD. Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial. Arch Intern Med. 2006;166(12):1305-1310.

Rathleff MS, Mølgaard CM, Fredberg U, et al. High-load strength training improves outcome in patients with plantar fasciitis: a randomized controlled trial with 12-month follow-up. Scand J Med Sci Sports. 2015;25(3):e292-e300

Vahdatpour B, Kianimehr L, Ahrar MH. Autologous platelet-rich plasma compared with whole blood for the treatment of chronic plantar fasciitis; a comparative clinical trial. Adv Biomed Res. 2016;5:84.

Lou J, Wang S, Liu S, Xing G. Effectiveness of extracorporeal shock wave therapy without local anesthesia in patients with recalcitrant plantar fasciitis: a meta-analysis of randomized controlled trials. Am J Phys Med Rehabil. 2017;96(8):529-534.

Mr C was quite distressed about his left ankle and his right ankle had also recently been painful. He feared he may not be able to continue working and support his family, as his work involved him being on his feet most of the day.

A comprehensive assessment revealed the following main findings:

1. Reduced ankle lunge- knee to wall test(dorsiflexion) 2cm vs 6cm on right.
2. Reduced left shoulder internal/external rotation.
3. Altered neural movement tests in the legs.
4. Shortened hamstrings on the left.
5. Trigger points(muscle tension) within the muscles of the left shoulder(infraspinatous and subscapularis especially).
6. Stiffness of the lumbar segments L3 and L4 from the front(palpating through the stomach).

Using the lunge test as an indicator, we did treatment trials on some of the problem areas while Mr C was performing the lunge. We found that release of the left infraspinatous improved his lunge the most in the one session, from 2cm to 5cm. Mr C was amazed, and also reassured that this problem could be fixed and that he won’t have to give up his job.

By treating this area and other dysfunctions, Mr. C’s lunge progressed to 10cm!(his left lunge also improved concurrently to 12cm!). His symptoms of pain, stiffness and swelling had also improved significantly within 4 sessions.

This is an example of how dysfunctions in some parts of the body can cause symptoms in other areas, and the problem is not necessarily where the pain is. To understand why Mr C felt the pain in his ankle when the problem was originating from elsewhere, click here.