Plantar Fasciitis – What The Heel Pain Is Going On?
Plantar Fasciitis Quick Links
What Is Plantar Fasciitis & How Do I Get Rid Of It?
Plantar fasciitis is in short, heel pain. More specifically, it is pain that occurs underneath the heel at the point where your plantar fascia joins your heel bone.
The plantar fascia is a tough fibrous tissue that runs under your foot and has several functions in the foot during walking and running such as load distribution and maintaining stability. The pain can be acute or chronic, meaning it can have come on suddenly or you may have been living with it for months.
Many professionals consider plantar fasciitis to be an overuse injury. It has been described as a chronic inflammatory process likely due to stress, stretching and over loading of the plantar fascia tissue.
- Pain under the heel of the foot usually described as “sharp and achy”, commonly worse with barefoot walking
- Difficulty walking long distances or running
- Worse pain in the morning when taking the first few steps out of bed or after a long period of rest
Who Gets Planter Fasciitis?
Plantar fasciitis occurs in approximately 10% of people who run regularly.
- People between the ages of 40 and 60,
- Those with “flat feet”
- People who spend a prolonged time standing on hard surfaces
Evidence suggests the strongest risk factors for plantar fasciitis are obesity and equinus (stiff ankle). BMI>25 has been shown to have a 2-fold increase in risk and BMI is not only a risk factor for plantar fasciitis but also a predictor of total functional loss.
When studies relating to this subject mention equinus they are referring to an inability bend your ankle up past 10 degrees. An inability to do this is considered to put excessive strain on the plantar fascia when walking and therefore predispose you to this condition.
Treatment For Plantar Fasciitis
Conservative therapy should always the first line of treatment for typical plantar fasciitis, this means trialling non-invasive methods of therapy before moving to more invasive intervention such as shock wave therapy or surgery.
For majority of patients, evidence suggests conservative therapies prove to be beneficial in reliving heel pain. Each therapy has their pro’s and con’s, and evidence supports some more strongly than others.
Conservative Therapies For Plantar Fasciitis
Conservative therapies include:
When we talk about rest as physiotherapists, we actually mean RELATIVE rest (or rest from the aggravating activity). We do not mean lie down on your bed for a week straight, as this is more likely to bring about poorer outcomes in your recovery. Rest, with no other adjunct therapy, worked best for 25% of patients treated for plantar fasciitis in one of the studies cited. Rest is specific to your individual case and may be reduced standing hours at work for a short period of time or it may be stopping running for 2 weeks. But don’t fear, if running is your jam we would definitely get you back to it, with a tailored and graded increased running schedule.
You might hear people throw around the term “low dye” taping for heel pain. This just means taping the foot to offer passive mechanical arch support. This form of taping has been found to be effective in the short term and used as a trial period prior to formal arch supports such as orthotics. Evidence also suggests this taping to be more effective in reducing pain when combined with stretching which we will discuss below.
Insoles, off the shelf products and custom made orthotics are often prescribed in people with any type of foot pain. Whilst they can be helpful in reducing foot pain, long term benefits are not proven and they can be very costly. Interestingly, the evidence we reviewed suggests that at 12 months, there is no difference in pain or function in people with off the shelf insoles versus customised orthotics.
Most professionals will recommend stretching for plantar fasciitis (a) because short calf muscles have been shown to be a predisposing factor for getting the pain in the first place and (b) based on the idea that our calf muscles are in the shortened position at night which contributes to worsening and persisting pain. The great thing about it, stretching is free! And you can do it anywhere, no fancy equipment required. See below on how to stretch for best results.
This is a fancy acronym for “non steroidal anti inflammatory drugs”. An example is ibuprofen. Evidence in its use for heel pain is lacking and there is known side effects to utilising these drugs. In our opinion, they can be adjuncts to therapy to help with the pain early on, but they do nothing to target the cause of the pain in the first place.
These can be used in the short term for pain management and there is evidence to suggest they can be helpful in reducing pain in the short term. Whilst uncommon, there have been reported side effects after corticosteroid injections to the plantar fascia, the most common adverse event is pain. Similarly to NASAIDs, this may be a good adjunct for therapy, but in our opinion when used alone does not address the causative factors.
A fantastic, quick and easy way to reduce acute pain that doesn’t cost you money. There is evidence to suggest ice is an effective treatment for pain relief in the short term. Once again, it does not target the cause, and can be most useful in acute flare ups of your pain alongside other strategies.
Deep Tissue Massage
This can be highly useful in pain relief and assist in improving ankle range when used alongside stretching. This can be performed by your physiotherapist and we can even teach you how to do deep tissue massage on yourself at home using a trigger release ball. We often will advise our clients to place a golf ball in the freezer and to use this to assist with self-massage for added pain relief. Whilst no studies have been done to prove its effectiveness, many professionals have reported good feedback from their patients using this method.
Targetting Your Risk Factors
We believe this is a really important one! As discussed above, risk factors for plantar fasciitis include obesity, standing for long periods on hard surfaces, sub optimal foot biomechanics and age. Well, you can’t change your age (sorry to be the bearer of bad news) but you can target your weight or your standing habits or even your tight ankles (using the stretches below).
How To Stretch For Plantar Fasciitis
Stretching has been shown to have favourable outcomes across a wide variety of studies in people with plantar fasciitis. It is the evidence based, cost free, treatment option that you can do from the comfort of your own home. But, surprise surprise, if you don’t adhere to the protocol, then you will not get success with this type of therapy.
Evidence recommends a minimum of 3 times a day with at least 10 repetitions of each stretch, held for 10 to 30 seconds. We did not come across any study that reported worsening pain or adverse events with gentle stretching adhering to this protocol.
We came across some evidence in our search that found plantar fascia specific stretching (image one) in the sitting position to be better than the standard calf stretch in standing (image two).
The foot specific stretch improved patient’s pain and function in the short term more significantly. In our clinic, we find that a combination of both stretches (especially in runners) to be most beneficial.
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Do you still have heel pain? Or do you just want a comprehensive assessment so we can guide you in the most efficient road to recovery? Call us today on 9629 6169 to book an appointment or enquire online here.