Feel a stabbing pain in the bottom of your foot near the heel? You might have Plantar Fasciitis.

Introduction

Plantar fasciitis is the most common cause of heel pain in athletes. The condition is usually caused by overuse and stress on the plantar fascia due to prolonged standing resulting in micro-tearing and scar tissue formation at the heal attachments. The age of onset is usually above 40 years of age, but it can also occur in athletes with strenuous activities.
The plantar fascia acts as a passive bowstring to provide shock absorption and prevent the arch from collapsing while in the mid-stance phase of the gait. Also, the plantar fascia stabilizes the foot by approximating the heel and the metatarsal during the toe-off phase of gait. During the toe-off phase of the gait, the foot supinates to stabilize the big toe while the body weight is transitioned to the big toe. During the toe-off phase, the windlass mechanism causes the first metatarsal phalangeal joint dorsiflexes, the medial longitudinal arch raises, the plantar fascia tightens, the calcaneus inverts, and the tibia externally rotates to lock the knee joint, which provides a rigid lever to stabilize the big toe while the big toe propels the body forward.

How does plantar fasciitis occur?

Plantar fasciitis occurs most commonly when the patients have excessive pronation(flat foot) or excessive supination(high arch foot) in their feet.

With excessive pronation, also called flat foot, the plantar fascia overstretches during the mid-stance phase of the gait, which leads to micro-tearing near the calcaneal attachments(heel). With excessive supination, also called high-arched foot, the foot becomes rigid and lacks shock absorption, which causes the plantar fascia to work harder to absorb more stress. In addition, with excessive supination, the calf muscle and the Achilles tendon tighten, which pulls on the plantar fascia and puts further strain on the plantar fascia. With chronic plantar fasciitis, the calcaneus bone receives prolonged traction from the plantar fascia, resulting in bone spur formation, complicating the condition further and causing more pain to the patients.

Causes of plantar fasciitis:

• Overuse during activities such as prolonged standing, running, and dancing.
  Poor techniques while training

Predisposing factors:

• Pes planus: flat foot
• Pes cavus: high-arched foot
• Tight calf muscles
• Improper footwear with inadequate arch support
• Obese
• Pregnancy

Symptoms of plantar fasciitis:

Pain occurs with the first few steps after non-weight-bearing when getting out of bed in the morning and with increased activity and standing.

Pain feels the most just before and during the toe-off phase of gait or climbing the stairs.

Pain lessens after the plantar fascia is warmed up and is generally relieved by rest. The pain is most commonly felt in the arch close to the heel, but it can be felt anywhere in the arch. The patient usually has co-existing flat foot, high-arched foot or Achilles pain.

Differential Diagnosis:

• Heel fat pad contusion
• Stress fracture of the calcaneus bone
• Tarsal tunnel syndrome

Treatment of plantar fasciitis:

90% of chronic plantar fasciitis can be successfully treated by physiotherapy alone.

With acute inflammation, the patient is advised to rest, ice, and elevate the affected foot as much as possible. Manual lymphatic drainage performed by RMT can reduce swelling caused by acute inflammation, reduce pain, and remove waste metabolite.

The followings are how our physiotherapist in Oakville can help:

Manual therapy:

The cross-fibre friction technique can be used at the plantar fascia attachment point to the calcaneus bone to decrease scar tissue formation and adhesion in the plantar fascia.

Joint mobilization, such as long-axis distraction and gliding to the ankle and subtalar joint, can be used to increase the range of motion of these joints.

The myofascial trigger point technique can reduce the muscle knots formation and tension in the foot and calf muscles.

Extracorporeal Shockwave Therapy:

Extracorporeal Shockwave Therapy is effective in reducing pain in chronic plantar fascitis and recruits immune cells to help repair the damaged tissue and reduce scar formation in the plantar fascia.

Stretch and Strengthen:

The intrinsic muscles in the foot and the leg muscles contribute to the formation of the medial longitudinal arch. Strengthening and stretching the muscles makes the plantar fascia’s work on supporting the arch much easier.

Low-dye taping:

Low-dye taping is a form of sports taping that can reinforce the medial longitudinal arch, preventing excessive stress from applying to the plantar fascia.

Custom-made orthotics or over-the-counter arch support

Other treatment:

Around 10% of the population with plantar fasciitis does not respond to physiotherapy treatment. Physicians or chiropodists can perform the other treatment, and they include:

• NSAIDs
• Corticosteroid injection
• Platelet-rich plasma injection
• Plantar fasciotomy
• Dry needling

Our experienced physiotherapists in Oakville can help you with plantar fasciitis. Visit Kefi Wellness Centre, the top-rated physiotherapy and rehabilitation clinic in Oakville, to find more.