Plantar Fasciitis – What is it and how do we treat it?

What is Plantar Fasciitis?

Plantar fasciitis is inflammation of the thick band of tissue that runs along the bottom of the foot from the toes to the heel. It is one of the most common causes of foot and heel pain. According to the American Physical Therapy Association (APTA) plantar fasciitis “occurs in as many as 2 million Americans per year and 10% of the population over their lifetimes.” It affects people of all ages, both athletes and non-athletes as well as men and women equally.

How the fascia works

The plantar fascia supports the arch of the foot and absorbs shock when walking. Tension and stress on the fascia can cause small tears resulting in irritation or inflammation from those repeated stresses. Although the cause remains unclear in many cases of plantar fasciitis, ignoring it can result in chronic heel pain that may interfere with your daily activities and altered gait patterns to avoid pain may lead to further foot, knee, hip, or back problems.

Factors that increase risk of developing this condition include:

• Age – most common between 40-60 years old.
• Certain types of exercise – Activities that place a lot of stress on your heel and attached tissue, i.e., long-distance running, ballet dancing and aerobic dance.
• Foot mechanics – Flat feet, a high arch or even an atypical pattern of walking can affect the way weight is distributed when you’re standing and can put added stress on the plantar fascia.
• Obesity – Excess pounds put extra stress on your plantar fascia.
• Occupations that keep you on your feet – Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces.

Signs & Symptoms

Plantar fasciitis is typically characterized as a stabbing pain in the bottom of the foot near the heel, but can also be felt along the arch or ball of the foot. The pain is usually the worst in the morning after taking the first few steps of the day. It can also be triggered by long periods of standing or when you get up from sitting.

Physical Therapy Treatment Options

There are a few different approaches when it comes to treating plantar fasciitis. Physical therapy is typically considered the most conservative approach. Your therapist may also suggest supportive insoles for your shoes or orthotic shoes that provide additional support.

• Stretching exercises to improve range of motion and flexibility of your foot and ankle
• Strengthening exercises to improve the strength of the muscle that support your foot
• Gait assessment & training – analysis of how you walk and subsequent re-training if necessary
• Modalities

  • 

    Ice to decrease pain and inflammation, i.e., ice pack or ice massage

  • Ultrasound therapy or iontophoresis
    • Ultrasound uses sound waves to promote healing and reduce inflammation of the desired tissues
    • Iontophoresis uses either equipment or patch with medicine, lidocaine or dexamethasone, applied to the desired tissues and uses current to administer the medication through the skin
  • Application of Kinesio or athletic tape to the bottom of the foot for additional arch support and pressure relief
• A type of manual therapy called soft tissue mobilization with or without assistance from additional instruments to apply increased pressure, i.e., Graston scraping tool, theragun, tennis ball or roller. Cross friction massage may also be applied.

Can plantar fasciitis be prevented?

Some ways to help manage or prevent plantar fasciitis include:

• Shoes with proper arch support and height
• Replace shoes before they wear out
• Use of a thick mat to stand on if you need to stand in one place during the day
• Adjusting your exercise program to include a warmup and a gradual buildup, to avoid straining the plantar fascia
• Stretching your calves and feet before and after running or walking
• Maintaining a healthy body weight

Resources

GUIDE: Physical therapy guide to plantar fasciitis. Choose PT. (2020, March 25). Retrieved October 2, 2022, from https://www.choosept.com/guide/physical-therapy-guide-plantar-fasciitis

Mayo Foundation for Medical Education and Research. (2022, January 20). Plantar fasciitis. Mayo Clinic. Retrieved October 2, 2022, from https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846

Plantar fasciitis: Causes, symptoms & treatment. Cleveland Clinic. (n.d.). Retrieved October 2, 2022, from https://my.clevelandclinic.org/health/diseases/14709-plantar-fasciitis

Effect of iontophoresis vs. ultrasound in plantar fasciitis”. plantar fasciitis” – full text view. Full Text View – ClinicalTrials.gov. (n.d.). Retrieved October 2, 2022, from https://clinicaltrials.gov/ct2/show/NCT04917406

Yelverton, C., Rama, S., & Zipfel, B. (2019, September 25). Manual therapy interventions in the treatment of plantar fasciitis: A comparison of three approaches. PubMed. Retrieved October 2, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6917457/

KT tape plantar fasciitis. Kinesiology Tape Info Center. (2020, January 16). Retrieved October 2, 2022, from https://www.kinesiologytapeinfo.com/how-to-apply-kinesio-tape-precut-foot-tape/