What is Plantar Fasciitis?
Plantar fasciitis is a common cause of pain in the sole or heel of your foot. It is often sharp and can be quite severe. Research suggests that one in ten people will be affected at some point in their life.
The origin of the pain is inflammation or irritation of the plantar fascia, which is a sheet of tissue that links the heel to the ball of the foot. If this continues for a long time the plantar fascia can thicken.
The role of the plantar fascia is to provide elasticity to the arches of the foot so that there is, quite literally, a spring in your step. Without it your foot would collapse and walking would be very difficult.
What Causes Plantar Fasciitis?
The causes of plantar fasciitis are varied and sometimes establishing the reason can be difficult.
Any bony abnormalities of the foot, such as bone spurs, osteoarthritis or congenital malformations can place direct pressure on the plantar fascia, but these are relatively unusual causes of plantar fasciitis.
The most common reasons can be grouped as biomechanical issues, which is great news because these can be treated with exercise and manual therapy.
Examples of biomechanical origins of plantar fasciitis include pronation, or fallen arches, tight calf muscles or hamstrings, limited mobility of foot or ankle joints and weakness of muscles within the foot.
That said, saying you have plantar fasciitis because you have tight hamstrings is of pretty limited help because the underlying cause of the tight hamstrings is left undiagnosed, and so a full body physical and neurological assessment is required to uncover underlying factors.
What Can Be Done?
Treatment for plantar fasciitis varies depending on the underlying cause, but there are some useful things anybody can do that may help.
One of the most commonly prescribed exercises is to roll a tennis ball or golf ball underneath your foot, placing pressure any sore points you find. This massaging effect can be gained by using a frozen bottle of water as well, which also provides a slight numbing effect.
Proposed reasons for doing this include loosening or stretching the plantar fascia, but this is rarely desirable. Stretching the plantar fascia will allow the longitudinal arches of the foot to drop, which will place more strain on the plantar fascia, but also on the joints of the foot.
Sometimes direct pressure on the plantar fascia can be useful, if there is a chronic, low level inflammation, or if there has been some thickening. When trying this technique, less is more. Roll your foot over the golf ball until any tenderness begins to relieve, usually around 30-60 seconds, and repeat twice a week for a maximum of three weeks.
Perhaps a better strategy is to try and reduce strain on the plantar fascia.
Temporary reductions in activity level, for a maximum of two weeks, is one way of doing this and may allow any inflammation or micro-tearing to resolve, relieving symptoms.
Stretching of the hamstrings and calf muscles may reduce tension on the plantar fascia if these muscles are involved in the first place. Stretches should be performed for 30 seconds at a time for three repetitions each leg. This approach can be tried for up to three weeks.
Prescription of orthotics or supports can reduce strain on the plantar fascia, and may also help restore the normal shape of the foot if pronation is a factor in the origin of the fasciitis. There are merits to this approach if it allows one to continue to train, or if changes to foot posture are very pronounced.
When looking at mild/moderate cases of pronation, which affects some 85% of the population and is a common contributor to plantar fascia strain, exercise to build up muscles in the foot and lower leg is a better long term solution than orthotics. Orthotics can be used at the same time as a progressive exercise program, however the aim should be for decreasing reliance on insoles over time.
Exercises for Plantar Fasciitis
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Stiff leg deadlift
Hip flexor/quad stretch
Eccentric dorsiflexion stairs
Try to avoid having the toes pointed for any length time; think about placing a pillow at the bottom of your bed when sleeping, avoid high heels, don’t slump with your bottom towards the front of your chair.
Plantar fasciitis responds brilliantly to manual therapy, as long as that therapy is carried out under a specific diagnosis that takes into account underlying factors.
Assessment should include analysis of your footwear and gait, and examination of most of the muscles and joints at least up to your lower back.
Manual therapy may include stretching or massaging of muscles that could be anywhere from the foot all the way to the neck.
It may also include mobilisation or manipulation of joints again throughout the body, but most commonly the foot, hip and lower back.
A short (less than two weeks) course of over the counter anti-inflammatories can be effective at relieving plantar fasciitis if the pain is purely inflammatory in nature. This can be done alongside other approaches outlined above.
If plantar fasciitis is being particularly stubborn and has not responded to other types of intervention, a steroid injection may be used as a last resort.
A steroid injection is a very strong anti-inflammatory that can be delivered with reasonable precision. Sometimes, when a tissue has been irritated for a long period of time, a chronic inflammatory state can be reached. This means that the body’s inflammatory reaction is self-sustaining and no longer necessarily resulting from any mechanical cause. A steroid injection can interrupt this and lead to relief of symptoms.