Plantar Fasciitis

Plantar fasciitis refers to the inflammation of the plantar fascia, which is a thick, broad band of connective tissue on the sole of the foot. It attaches at the heel bone and runs to the base of the toes, helping to form the arch of the foot. It is a painful condition caused by overuse and repetitive microtrauma of the plantar fascia.


Figure 1- Anatomy of the plantar fascia

Plantar fasciitis can also be known as a heel spur although they are not strictly the same. A heel spur is a bony growth that occurs on the calcaneus (heel bone), where the plantar fascia attaches. Repetitive pulling of the plantar fascia on the heel can cause a heel spur, but this may not be painful. On the other hand, a painful heel does not always have a heel spur present.








Signs and Symptoms

Plantar fasciitis is characterized by:

  • heel pain, usually on the medial (inside) aspect, at the origin of the fascia
  • the pain is usually worse early in the morning, especially with the first few steps, but decreases once the foot loosens up
  • the pain often becomes more severe with increased weight-bearing activity, especially if the activity is high-impact or performed barefoot
  • a limp may be present, and patients may prefer to walk on their toes.


Causes

Plantar fasciitis can be caused by a number of factors:

  • mechanical imbalances of the foot, such as high arches or low arches (flat feet), or arches that roll in too much (over-pronation)
  • tight calf muscles
  • wearing shoes with poor support, especially for long durations
  • sudden increases in weight-bearing activities, such as running or walking
  • excessive weight load on the foot, such as during pregnancy or prolonged weight bearing


Frequency

Plantar fasciitis accounts for about 10% of running-related injuries and 11-15% of all foot symptoms requiring professional care. It is thought to occur in 10% of the general population as well. It may present bilaterally (both sides) in a third of cases. The condition can affect patients at any age and occurs equally in both sexes in young people. Some studies show a peak incidence may occur in women aged 40-60 years.


Treatment

Plantar fasciitis treatment consists of a combination of physiotherapy treatment and home exercises. For the home program, patients can perform stretches for the calf muscles, gastrocs and soleus (image 2 & 3), and for the plantar fascia (image 4)


Image 2- Gastrocs stretch
Image 3- Soleus stretch
Image 4- Plantar fascia stretch




 

 

 

Each stretch should be held in a comfortable position for 30 seconds, repeating 3x each.

Also, it would be beneficial to perform some self-massage at home by sitting down in a chair and rolling the sole of the foot over a tennis ball or pop can(Image 5), which would help to loosen up the tight plantar fascia.


Image 5- Rolling over tennis ball

After performing the exercises, it would be beneficial to apply ice to the plantar fascia for approximately 15 minutes to reduce pain, swelling and inflammation. This can be done by sitting on a chair and stepping on an ice pack. After the 15 minutes, patients should wait for the area to restore its normal body temperature (approx 45 mins) before icing again and before performing and exercises.

This home program can be performed as soon as someone recognizes the symptoms of plantar fasciitis. Hopefully the symptoms subside with these exercises/ice, but often a few sessions of physiotherapy are needed to help resolve the situation.