Plantar Fasciitis
Plantar fasciitis is an inflammation of the plantar fascia of the foot and is the most common cause of heel pain. The plantar fascia is a thick connective tissue that supports the arch on the bottom of the foot. It extends from the front of the heel bone (calcaneus) to the base of the ball of the foot.
What causes plantar fasciitis?
Common causes of plantar fasciitis include overuse, poor biomechanics, improper footwear and weight gain.
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Overuse in athletes can be due to over training, poor technique, and running on hard surfaces. Overuse in non-athletes can be due to prolonged standing or walking, where poor pelvis, hip leg ankle and/or foot biomechanics exist.
Poor Biomechanics such as excessive foot/ankle pronation (flat feet), supination (high arches) or muscle and joint imbalances coming from the lumbar-pelvic-hip complex can cause the onset of plantar fasciitis.
Flat Feet
aka pes planus, pronated feet A pronated foot stretches the plantar fascia, the supporting ligaments and the intrinsic muscles of the foot. This leads to microtearing of the plantar fascia at its attachment at the heel and subsequent inflammation and pain. After the initial period of acute inflammation, chronic inflammation sets in and tissue adhesions, fibrosis and a thickening of the plantar fascia occurs. At the chronic stage (six weeks after onset), healing can be very slow due to the limited blood supply to the plantar fascia.
High Arches
aka pes cavus, supinated feet High arches can cause excessive compressive forces to occur at the heel, especially with increased body weight. A high arched foot is rigid (decreased movement within the joints) which results in decreased shock absorption. This means that the plantar fascia and fat pad of the heel must absorb more stress.
Lumbar-Pelvic-Hip Complex Imbalance
Muscle and joint imbalances in the lower back, SI joints and/or hip joints can cause compensatory changes in the knee, lower leg and foot, and may result in a flat foot or high arch.
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Improper Footwear can include shoes or sandals that are too old or worn out, too flexible or provide an inadequate arch support.
Weight Gain and rapid weight gain during pregnancy can place excessive stress upon the plantar fascia and lead to a flattening of the arch of the foot.
Who is at risk?
Plantar fasciitis most commonly affects adults aged 40+, both men and women, as well as younger athletes. Other factors that may increase your chance of developing plantar fasciitis can include:
- increased body weight, or a sudden rapid weight gain, as with pregnancy
- flat feet or high arches
- tight posterior calf muscles
- prolonged standing or walking on a hard surface
- wearing shoes with poor support and cushioning
- repetitive sports/activities such as running
- over training or a sudden increase in training
Onset & Symptoms
- onset is usually gradual, with no history of injury or trauma
- pain is mild to severe and can affect one or both feet
- pain is most intense with the first steps after a period of non-weight bearing, such as getting up from bed in the morning or after a period of prolonged sitting. Usually this pain gets less intense with movement, but can get worse again with too much activity (2-3 hours)
- pain is located on the bottom of the foot at the heel and may extend along the arch.
- swelling and point tenderness at the bottom of the foot may be present
Treatment
Depending on the severity of the condition and whether it is in the acute or chronic stage, several treatment options are available for dealing with plantar fasciitis, including:
- rest
- ice
- stretching and strengthening exercises
- anti-inflammatory medications
- orthotics
- night splints
- massage or physiotherapy
- shockwave therapy
- surgery
Acute Stage
onset less than 6 weeks For acute stage plantar fasciitis, we usually suggest a more conservative treatment using massage therapy, ice and exercises. Ice is usually applied during your massage therapy treatment to reduce pain and inflammation at the heel. Massage techniques including swedish, myofascial and joint mobilizations will be applied to the affected foot and any compensatory structures.
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Chronic Stage
onset over 6 weeks ago We use a more aggressive treatment approach when dealing with chronic plantar fasciitis, which may include shockwave therapy as well as massage therapy and exercise. Usually, three shockwave treatments are required, scheduled one week apart. Healing of the plantar fascia then continues for the next three months following treatment.
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The ultimate goal of treatment is to correct the cause, wherever possible. Dysfunction in the lumbar-pelvic-hip complex and lower leg can be causative of platar fasciitis, so it is very important that these areas are addressed in treatment when necessary.
Exercises & Homecare
Plantar fasciitis exercises are available in our video library.
Please remember that stretching, strengthening and other exercises should be used under the supervision of a physician or other qualified healthcare practitioner, such as a Registered Massage Therapist, Chiropractor or Physiotherapist. It is not advisable to begin any new diet or exercise program without first discussing it with your primary healthcare practitioner.
Please remember that stretching, strengthening and other exercises should be used under the supervision of a physician or other qualified healthcare practitioner, such as a Registered Massage Therapist, Chiropractor or Physiotherapist. It is not advisable to begin any new diet or exercise program without first discussing it with your primary healthcare practitioner.