We are always banging on about how a healthy body is supported by an active life, and you are listening. In the last few weeks you have decided it’s time to move that body more. Well done you. And you are feeling good for it. Woohoo!!! But now when you wake up, those first few steps in the morning are really painful. Or maybe it feels like there’s a stone in your shoe? You might have the starting signs of plantar fasciitis. Relax – things can be done! Jude Holroyd provides a run down on this condition.
What is it?
The plantar fascia is a thick fibrous band that extends from the base of the heel to the toes underneath our feet. It plays an important role in arch support, which is vital for walking and all other weight bearing activities.
Plantar fasciitis is a condition characterised by damage to and inflammation of the plantar fascia. This usually occurs at the medial or inner part of the heel bone where the plantar fascia attaches.
Plantar fasciitis is one of the most common causes of heel pain seen in the practice. It often occurs when there has been an increase in repetitive activitiy.
Plantar fasciitis can be caused by an increase compression load or an increase in tension forces.
Increased tension forces can be caused by poor biomechanics such as running style or anatomical reasons such as flat feet or poor footwear. This can lead to excessive stretching or traction of the plantar fascia and eventually cause pain under either the arch of the foot or more commonly under the heel.
An increase in compression load can be caused by specific sports or activities, such as a basketball, burpees, box jumps, or gymnastic, or can be due to a combination such as long distance running which would cause an increase in repetitive load and could be further exacerbated by poor biomechanics of the foot.
Who gets plantar fasciitis?
Plantar fasciitis most commonly occurs due to repetitive or prolonged activities placing strain on the plantar fascia. It is often seen in runners, or dancers and gymnasts who perform regular activities involving end of range foot and ankle movements. It may also occur in patients who walk excessively, especially up hills or on uneven surfaces.
Clients who spend a lot of time on their feet may also develop the condition. Plantar fasciitis frequently occurs in association with calf muscle tightness, tightness of the plantar fascia, inappropriate footwear or worn footwear, or biomechanical abnormalities, such as excessive pronation (flat feet/ rolling in) or supination (high arches/ tighter plantar fascia).
They call them “killer heels” for a reason.
Signs and symptoms of Plantar Fasciitis
Clients with plantar fasciitis typically experience pain underneath the heel and along the inner sole of the foot. They will usually complain of pain after periods of rest this may be either first thing in the morning or after sitting for some time and taking the first few steps.
We are often told that the pain decreases after the client has “warmed up” either by taking a few small steps or stretching the calf, usually this is in the early stages of the injury.
As the condition progresses, clients may experience symptoms that increase during sport or activity, affecting performance. In severe cases, clients may walk with a limp or be unable to weight bear on the affected leg.
Clients with this condition may also experience swelling, tenderness on firmly touching the plantar fascia (often on a specific spot on the inner aspect of the heel) and sometimes pain on performing a plantar fascia stretch.
Contributing factors to the development of Plantar Fasciitis
There are several factors which can predispose patients to developing plantar fasciitis. These need to be assessed and corrected with direction from a physiotherapist. Some of these factors include:
- poor foot posture (especially flat feet)
- foot or ankle stiffness in the forefoot, midfoot or ankle joint
- muscle tightness (particularly in the calf and the plantar fascia itself)
- inappropriate or excessive training
- being overweight
- poor biomechanics (excessive pronation/ supination/ poor/ incorrect running technique)
- inappropriate footwear (worn out shoes, poor arch support)
- inadequate warm up (calf stretches)
- muscle weakness
- leg length differences
- poor proprioception or balance
- poor core stability
Is it going to get better?
Most patients with this condition heal well with appropriate physiotherapy. Minor cases of plantar fasciitis that have not been present for long can usually recover within a few months. In patients who have had their condition for a long period of time, recovery can be lengthy. Early physiotherapy treatment is therefore vital to assist in recovery. Our Penrith practice also provides Shockwave Therapy which is an effective treatment option and is included as part of your treatment if deemed suitable.
Jude Holroyd is the Principal Physiotherapist at our Jordan Springs practice.