Plantar Fasciitis
By Nick Rowe, Nov 2024
What is plantar fasciitis?
Plantar fasciitis (PLAN-tur fas-e-I-tis) or Plantar Fasciopathy as it’s now commonly referred to is one of the most common causes of heel pain, affecting 10% of the population at one point in their lifetime. Males and Females are equally affected and it typically affects those between the ages of 40 and 60 years of age.
It involves inflammation of a thick band of tissue called the Plantar Fascia.
Structure and function of the plantar fascia
The Plantar Fascia is a fibrous, non-elastic structure with a primary function of maintaining the arch of the foot and assisting with shock absorption during weight-bearing activities such as walking, running, and jumping. This acts as a passive stabilizer, helping to spread the forces evenly across the foot and providing support to the structures in the foot.
Symptoms
The primary symptom for most people is pain and tenderness on the sole of the foot. This is usually located on the inside aspect of the heel (medial tubercle of the calcaneus).
Common symptoms are:
Pain and stiffness in the morning, often easing slightly after a period of gentle movement
Increasing pain with weight-bearing activities; running, jumping, dancing, long periods of walking and standing
Pain levels vary depending on the person and activity levels. Some may have lower levels of pain and feel slight stiffness. Others may experience more intense pain and describe ‘stabbing’ or ‘throbbing’ pain
Runners…
Plantar Fasciitis symptoms in runners can often present as below.
Stiffness on commencing running that reduces as you ‘warm up’. The ‘stiff and painful’ tendon ‘warms up’ after an initial period of pain/discomfort, as the plantar fascia gradually becomes a more efficient spring.
Pain that increases with greater running volume and intensity.
Heightened pain and stiffness in the heel region 24 hours after exercise (ie the next morning).
Diagnosis
A thorough subjective (questioning) and physical assessment can accurately diagnose Plantar Fasciitis. Imaging (MRI, Ultrasound Imaging) is not required routinely, unless the pain is not responding to appropriate treatment or another cause is suspected.
Recovery / Prognosis
90% of people will fully recover from Plantar Fasciitis with 3-6months, this can vary greatly between individuals. a key factor is the stresses placed upon the plantar fascia during daily activities (e.g. work, continued participation in the aggravating activity).
Treatment / Management
The key to successfully managing plantar fasciitis is
Education – improving the individuals understanding of the pain and symptoms and the mechanisms causing it are vital when planning (and following) the rehabilitation programme.
Load management – This can be in the form of modifying activities, splints, taping of the foot and possible use of orthotics/insoles. The goal here being reducing the aggravating load amount from the plantar fascia.
Strengthening Exercises – The plantar fascia has evolved to tolerate and thrive under high loads and pressure, the symptoms of plantar fasciitis are a consequence of them being overloaded. An appropriate exercise rehabilitation programme will focus on building the strength and tolerance of the foot to enable a successful return to activity.
Mobility exercises have a role to play, however, this must be done correctly and appropriate the your individual case, excessive stretching can be provocative to the plantar fascia.
In summary
Plantar Fasciitis is a mechanical symptom / pain as a consequence of excessive loads to the foot, leading to a degeneration of the plantar fascia. Imaging is not required to diagnose it but it can be useful if treatment is not found to be effective or another pathology is being considered. The best treatment is a multi-approach consisting of; education, strengthening, load management and mobility exercises. The length of time to recover can vary greatly depending on the individual and their response to treatments.
For further information feel free to get in touch either via email nick@nrphysio.co.uk or by phone 07534261106.