Plantar Fasciitis

Plantar fasciitis / fasciopathy , or now more commonly known as plantar heel pain due to the lack of evidence for any inflammation occurring, can affect up to 10%-15% of the population and in the US generates up to 2 million patient visits to orthopaedic clinics.

The plantar fascia resides underneath the foot and is comprised of a fibrous connective tissue that runs from the underneath of the heel to all five toes. It has similar properties and make up to that of a tendon, and that is why treatment is usually similar to the way we would treat a tendon problem.

The main role of the plantar fascia is to create tension when the foot is loaded to create stability with minimal muscle activity.

It was been reported that there may be some risk factors that increase someones risk of developing plantar heel pain:

• Loss of ankle range of motion (particularly bringing toes towards you)

• Increased / decreased foot arch

• Excessive rolling in of the foot

• Impact/weight bearing activities such as prolonged standing, running, etc 

• Improper shoe fit 

• Elevated BMI 

• Diabetes Mellitus (and/or other metabolic conditions)

Like any tendon problem, symptoms usually arise when there is a sudden increase in activity in excess of what the tissue is capable of, and some people may be able to relate to this. This could be an sudden increase in running or walking distance, or having to work harder such as walking up hills etc.

Some common symptoms are:

Heel pain with the first few steps in the morning or following long periods of sitting

Tenderness on the sole of the foot, towards the inside

Tight calf(s)

Development of a limp

More painful walking barefoot on hard surfaces

Diagnosis

Taking a thorough history of the condition will identify some of the symptoms already mentioned. Through the hands on assessment, we will be able to identify:

Altered walking pattern with the development of a limp / avoiding putting heel first

Reduced range of motion when bringing toes towards you

Pain when pressing the sole of your foot, where the fascia inserts into the heel bone

Positive Windlass test

It is also important to rule out other potential problems that may present similar to plantar heel pain, such as fat pad irritation or a nerve irritation.

There are a number of ways in which Physiotherapy can help:

Advice and education

Activity modification

Stretching

Myofascial release / MET / Massage

Progressive exercise programme

Footware advice / provision of insoles.

Manual therapy

Taping