Nose Creek Physical Therapy Information on Plantar Fasciitis

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Plantar Fasciitis is an inflammation of the tissue that stretches along the bottom of your foot from heel to toes, usually occurring where it attaches to the heel bone. It can be quite painful and debilitating but it can be relieved- once the level of activity has been modified and prescribed exercises and stretches have had a chance to take effect. That’s a hard pill to swallow for many people who believe keeping fit means keeping in shape by regular workouts or other activities. To have a Physical Therapist advise you to decrease running or other such activities normally associated with increasing your health is one thing. When Physical Therapy involves actually switching your exercise train of thought to do less cise, even if it is only temporary, is quite another for the fitness conscious person.

Plantar Fasciitis is an overuse syndrome that involves an inflammatory reaction at the insertion of the plantar fascia to the heel bone. The plantar fascia attaches from the front the front of the heel bone into the undersurface knuckle joints of the toes. During walking the plantar fascia is relaxed at heel strike, allowing the arch to collapse. During the push-off phase when rising onto the toes, the plantar fascia is tensed to help generate a more rigid foot for propulsion. The plantar fascia is therefore important in the generation of power during the push-off phase of running and jumping. That’s why this condition is commonly seen in running, jumping and racquet sports.

Most people cannot remember when it exactly started but often the symptoms are associated with an increase in the volume of exercise (distance or frequency), a change in the terrain (such as uphill running), or an increase in intensity (interval training or speed work). The classical symptom is pain in the heel during the first few steps out of bed in the morning. It usually decreases once the person has been weight-bearing for an hour or so, but then returns with increased activity. If the condition is left to progress on its own then you will be unable to weight-bear on the medial (inside) of the foot. Chronic plantar fasciitis will only tolerate weight-bearing on the lateral (outside) of the foot. This can lead to compensatory problems in the leg.

You should first see your family physician to make sure that your heel pain is not related to other aspects of your health. If your heel pain is purely a musculoskeletal concern, you may be advised to seek help from a physical therapist. Your physical therapist will first rule out any referred pain into your heel from other muscle and joint sources. Then he/she will passively dorsiflex (movement towards your head) the ankle and greater toe and simultaneously palpate at the attachment of the plantar fascia into the front of the heel bone. If the test yields sharp pain, you have plantar fasciitis.

The diagnosis is easy. Now it is up to the Physical Therapist to figure out why you have developed plantar fasciitis. Physiotherapy will first involve looking at all the joints in your ankle and foot. If there are joints that are stiff, then those joints will be mobilized to make them move more efficiently. The muscles in the lower leg and foot will be examined to screen out a muscle imbalance, i.e. tight gastrocnemius and soleus (toe/foot down movement) muscles and weak plantar intrinsic (toe curling) muscles in the medial longitudinal arch of the foot. If there is an imbalance, then a home physiotherapy exercise program will be prescribed.

If weight bearing is difficult a rubber horseshoe shaped heel wedge can be purchased, or your therapist can cut out a temporary heel wedge to be inserted into your shoe to take the pressure off of the plantar fascia insertion. Your physical therapist may tape your foot to support the arch in the early stages of recovery to assist in reduction of pressure on the plantar fascia. The application of ultrasound and laser treatments will facilitate further healing. In chronic cases physical therapy will involve a muscle stimulation current placed in a footbath to facilitate recruiting plantar intrinsic muscles that have become weak due to altered weight-bearing function in the foot.

Impact pressure and stress on the heel must be modified immediately. Nose Creek Physiotherapists advise that an excellent alternative is a water running program or cycling to maintain cardiovascular fitness. The pool workout should be the same length in time as the dry land training. In the gym avoid all calf raise strengthening exercises as this will aggravate the condition.

Plantar fasciitis is a condition that should only be temporary if managed properly once the onset of symptoms start. This condition should be treated immediately and aggressively for the best outcome. Chronic heel pain is difficult to treat and sometimes will not respond to the usual therapies.