Getting to the Bottom of Plantar Fasciitis
Could Your Heel Pain be Plantar Fasciitis?
Plantar fasciitis is the most common cause of heel pain in an outpatient setting and can be difficult to treat without the help of a knowledgeable practitioner like a physical therapist. Developing plantar fasciitis can be a bit scary for those experiencing the pain and discomfort of this condition, but after reading this article, not only will you have a better understanding of what is happening when pain in the plantar fascia develops, but also how physical therapy can help you to heal.
GETTING TO KNOW YOUR PLANTAR FASCIA
While most people know about the bones that create the shape of their feet and the muscles that move them, they may be surprised to learn that a third structure, the fascia, plays a pivotal role in how their feet function. The term “plantar” refers to the underside of the foot. The term “fascia” is used to describe a layer of connective tissue made up of closely packed collagen fibers. Fascia is found throughout the body and it envelops muscles, muscle groups, blood vessels, organs and even nerves. Fascia is responsible for holding some structures together while in other places allows for structures to slide and glide along one another. It is flexible but incredibly strong, and can resist tensile forces placed upon it. It also is rich in sensory nerve endings and helps our body know how it is moving and where it is in space.
The plantar fascia originates near the heel on the bottom of the foot and extends all the way to the bones at the ball of the foot. The flexibility and tensile strength of this band of fascia helps to maintain the arch of the foot when you put weight through it. There are three parts to the plantar fascia. The medial component runs along the inside of the foot near the arch. The central component makes up the center of the fascial band and the lateral band runs along the outermost part. There are also some connections between the plantar fascia and the achilles tendon at the base of the calf muscle which also inserts at the heel.
During walking, the plantar fascia stretches some as weight is transferred into the foot. As the heel lifts and weight is transferred over the big toe, the plantar fascia tightens, a process called the windlass mechanism, which helps shorten the foot and possibly conserves energy for forward propulsion. It also acts as a shock absorber for the foot. As you can see, the plantar fascia plays an important role in normal walking mechanics and experiences a great deal of strain and load with each step you take. The role of the plantar fascia in foot mechanics makes it unsurprising that people who spend a lot of time on their feet are more susceptible to developing plantar fasciitis.
PAIN IN THE PLANTAR FASCIA
Now that you know how hard the plantar fascia works to keep you walking, running and jumping, let’s explore what can happen when the plantar fascia becomes injured, a condition known as plantar fasciitis. The suffix “itis” is used to denote the presence of inflammation. Since the condition is called plantar fasciitis, it would be reasonable to think that inflammation of the plantar fascia is the underlying cause of this condition but it turns out inflammation is not the main culprit. Plantar fasciitis is considered to be a mechanical overuse syndrome. Rather than inflammation, the reason for the pain and discomfort experienced with this condition is actually repeated microtrauma or microtears of the fascial fibers. Remember, fascia is highly innervated with sensory receptors which means trauma to those fibers can be quite uncomfortable.
The area of the plantar fascia most susceptible to this microtrauma is near the heel bone which is why your therapist may suspect plantar fasciitis if you present to them with heel pain. Symptoms of plantar fasciitis include pain along the bottom of the heel that is worse in the morning or during the first steps after a prolonged rest. Initially the pain may improve as you warm up but overtime can persist throughout activities. Pain near the heel with prolonged standing or during high impact activities like running, jumping or climbing stairs is also an indicator of plantar fasciitis. It is also often felt while walking barefoot or in shoes with poor support and tenderness may be present along the medial heel.
Pain from plantar fasciitis can range from mild to severe and can impact one’s ability to walk and take part in work, exercise and recreational activities. While we can’t necessarily predict who will develop plantar fasciitis, certain factors can increase one’s risk of developing this condition. Anyone who takes part in prolonged impact activities like distance running or even prolonged standing are more likely to develop this condition than those who spend a lot of time sitting. The presence of certain foot conditions like a high arch (pes cavus) or fallen arch (pes planus) or excessive pronation during gait may also elevate one’s risk. Limitation in ankle or big toe joint dorsiflexion and tightness or weakness in the calf muscle can also be risk factors. Similarly, the presence of a subcalcaneal heel spur, higher BMI (in a nonathletic population) and the presence of Diabetes Mellitus may increase the likelihood of developing plantar fasciitis.
WHAT CAN BE DONE TO ADDRESS PLANTAR FASCIITIS
Like all conditions, getting to the root of the problem is an important step to healing from plantar fasciitis and the earlier you can seek treatment the better. Conservative measures including physical therapy are the first line treatment for plantar fasciitis and can be very effective. Reducing the offending weight bearing activity until symptoms improve is often an important step. Your doctor may recommend the use of NSAIDs or ice to alleviate some pain but your physical therapist will take a multimodal approach to improving your symptoms, allowing the plantar fascia to heal and reducing the likelihood of symptoms recurring. Physical therapy for plantar fasciitis often includes:
Stretching
Dry needling
Strengthening
Night splints or orthotics
Optimizing lower extremity biomechanics during activities like running, jumping and walking
Recommendations for footwear
Manual therapy to the plantar fascia, foot, and ankle
Other modalities to promote tissue healing
More invasive treatments like corticosteroid injections, platelet rich plasma (PRP) injections, and surgical interventions are saved as a last resort for cases that do not respond to conservative treatment. If you are experiencing heel pain or have been diagnosed with plantar fasciitis, you will want to start your recovery off on the right foot. Call Evolve Physical Therapy to schedule an evaluation with one of our experienced physical therapists today.
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