Plantar Fasciitis is considered the primary foot condition treated by healthcare providers. It has been estimated that 2 million Americans are affected by Plantar Fasciitis each year (Cleland et al 2009).
What is Plantar Fasciitis?
Plantar fasciitis is a common condition that affects the heel and bottom of the foot, and is characterized by pain and inflammation of the plantar fascia, a band of connective tissue that runs along the bottom of the foot. It is one of the most common causes of heel pain, and is most often seen in middle-aged individuals, but can affect people of all ages.
Pain is almost always felt at the front edge of the heel bone also known as the medial calcaneal tubercle. Many people also have pain in the fat pad underneath the heel bone and both these locations of tenderness are shown in the picture above.
One of the most common complaints with plantar fasciitis is that of exquisite heel pain with the first few footsteps in the morning or after periods of non weight bearing. These cycles of healing and micro-tearing of the plantar fascia are thought to be one of the reasons this condition can last for such a long time.
What Causes Plantar Fasciitis?
The exact causes of plantar fasciitis are not fully understood, but the most common causes are likely related to repetitive stress and overuse of the plantar fascia, often in combination with other risk factors such as obesity, poor foot biomechanics, poor low back biomechanics, or a sedentary lifestyle.
How can Plantar Fasciitis Be Treated?
There is a lot of evidence to support the use of physiotherapy in the treatment of plantar fasciitis.
Treatment typically includes a combination of exercises, stretching, modalities such as shockwave therapy, and manual therapy, and has been shown to be effective in reducing pain, improving function, and speeding up recovery time.
Exercise is a key component of physiotherapy treatment for plantar fasciitis. Stretching and strengthening exercises for the calf and foot muscles can help to loosen tight muscles and improve flexibility, while strengthening exercises for the foot and ankle can help to support the plantar fascia and reduce stress on the tissue. Exercises that target the tibialis posterior muscle can improve foot biomechanics and are commonly prescribed. We also frequently recommend exercises that target the entire lower body to ensure that the muscles, joints and nerves that support the foot and plantar fascia are trained from the foot to the pelvis and low back.
Calf muscle strength and flexibility exercise should involve both knee straight and knee bent positions. Aerobic exercise can also help to improve circulation and reduce inflammation, however this type of exercise is generally best suited to cycling as running and jumping types of activities can often aggravate the condition.
Stretching the plantar fascia and the calf muscles with specific exercises has been shown to be effective in reducing pain and improving function in people with plantar fasciitis. Stretching is not prescribed for all people however because some folks with plantar fasciitis have excessive mobility at the ankle and for these individuals strengthening exercise becomes even more important.
3. Manual Therapy
Manual therapy, such as massage, and joint mobilization can also be effective in reducing pain and improving function. Poor foot biomechanics can increase stress to the plantar fascia and for these cases manual therapy can prove very helpful. Less common causes of heel pain can also include nerve entrapments of the inferior calcaneal nerve (Baxter’s neuropathy) and medial calcaneal nerve. Deep soft tissue work can improve symptoms significantly in these cases.
Taping or orthotics to support the foot can help to offload the plantar fascia and reduce stress on the tissue. The classic mode of taping the foot is called the Low Dye technique however there are also some modern techniques known as kinesiotaping and there is some good evidence to support the use of these methods as well.
5. Shockwave Therapy
Shockwave therapy for plantar fasciitis is supported by a number of research studies. In a study of people with over 10 months of heel pain, a series of 5 radial shockwave sessions (2500 shocks per session once per week for 5 weeks at 2.5 bars). The subjects experienced significant pain relief and improved function that continued at the 3, 6 and 12 month follow ups.
6. Dry Needling
Dry needling can be another treatment technique that provides relief. The placement of the needles can vary in locations to include larger muscles of the calf, smaller muscles in the foot and to the plantar fascia itself. The muscular stimulations improve relaxation of the tissues that connect to the plantar fascia and needling the plantar fascia itself stimulates a healing response and helps to decrease the thickening of the plantar fascia that relates to the condition.
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Research has shown that physiotherapy treatment for plantar fasciitis is effective in reducing pain, improving function and speeding up recovery time. In a systematic review of randomized controlled trials, physiotherapy treatment was found to be more effective than sham treatment or no treatment in reducing pain and improving function in people with plantar fasciitis.
It’s important to note that recovery time can vary depending on the severity and duration of the condition, but with proper treatment and adherence to a home exercise program, most people with plantar fasciitis can expect to see improvement within a few weeks to a few months.
In summary, physiotherapy is an effective treatment option for plantar fasciitis. It involves a combination of exercises, stretching, and manual therapy, and has been shown to be effective in reducing pain, improving function, and speeding up recovery time. If you are experiencing pain in the heel or bottom of your foot, seek help from a physiotherapist, who can help you to manage your symptoms and improve your function.
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Osborne HR, Breidahl WH, Allison GT. Critical differences in lateral X-rays with and without a diagnosis of plantar fasciitis. J Sci Med Sport. 2006;9:231-237.
Riddle DL, Pulisic M, PidcoeP, Johnson RE. Risk factors for plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003;85-A:872-877.
McPoil TG, Martin RL. Heel pain – plantar fasciitis: Clinical practice guidelines. J Orthop Sports Phys Ther. 2008;38(4):11-18.
Cleland JA, Abbott JH, Kidd MO, Stockwell S, Cheney S, Gerrard DF, Flynn TW. Manual physiotherapy and exercise versus electrophysical agents and exercise in the management of plantar heel pain: a multicenter randomized clinical trial. J Orthop Sports Phys Ther 2009;39(8):573-585.