Plantar Fasciitis is a common foot issue involving heel pain (Kamonseki et al., 2016; Scheuer et al., 2016; Whittaker et al., 2019). Symptoms can include burning pain from the heel to the calf and discomfort around the medial heel on the underside of your foot spreading out towards the toes (Bagcier & Yilmaz, 2020; Huffer et al., 2017).
This is a common painful, heel condition in adults aged 40 – 70 years and athletic populations including dancers and runners (Kukreja et al., 2017; Sun et al., 2020; Whittaker et al., 2019). It can be caused by obesity, excessive exercise, weakness of intrinsic muscles in the foot, foot posture with too much weight bearing on the inside part of the foot or flat feet when the longitudinal arch of the foot is flattened (Cinar, et al., 2020; Scheuer et al., 2016).
The Plantar Fascia is comparable to a large tendon that originates on the medial heel bone and extends to the toes (Huffer et al., 2017; Singh et al., 2017). It forms the longitudinal arch of the foot supported by deep and superficial muscles (Huffer et al., 2017; Kamonseki et al., 2016). The arch is important for the ability to create momentum when walking (Kamonseki et al., 2016; Singh et al., 2017). During gait, a person will come up on their big toe (Hoefnagels & Weerheijm, 2019; Huffer et al., 2017). As they push off, the plantar fascia helps to shorten the distance between the bones in the toe and heel which assists movement (Huffer et al., 2017). The Plantar Fascia also has a role in shock absorption helping disperse the weight on the feet (Singh et al., 2017).
The Plantar Fascia originates on the heel bone on a landmark called the medial calcaneal tuberosity and this is its weakest point (Bagcier & Yilmaz, 2020; Kukreja et al., 2017; Singh et al., 2017). This is where a patient will experience pain if they have Plantar Fasciitis (Bagcier & Yilmaz, 2020; Hoefnagels & Weerheijm, 2019; Singh et al., 2017). The ‘itis’ component of the fasciitis implies inflammation is present and there is contention if there is inflammation or not (Huffer et al., 2017; Kukreja et al., 2017). Muscles working with the plantar fascia to form the longitudinal arch may become inflamed but perhaps not the Plantar Fascia itself which may simply fray with degeneration around its insertion point on the heel (Cinar et al., 2020; Kamonseki et al., 2016; Kukreja et al., 2017). The ‘RICE’ protocol can be employed for an inflammatory condition (Mayo clinic, 2019). RICE stands for rest, ice, compression, and elevation (Kukreja et al., 2017; Warren, 1990). These methods may assist symptoms but reducing tension in overactive muscles and strengthening weaker structures with exercise is key to recovery (Hoefnagels & Weerheijm, 2019; Kamonseki et al., 2016).
Common symptoms of Plantar Fasciitis include pain on first steps in the morning, pain after getting up from sitting for a prolonged period, standing up or walking for a long duration (Cinar et al., 2020; Huffer et al., 2017; Singh et al., 2017; Sun et al., 2020). Bone spurs can also develop especially when symptoms last longer than 6 months (Dinar et al., 2020; Kukreja et al., 2017; Singh et al., 2017).
In the early stages of Plantar Fasciitis, conventional treatment can assist recovery (Cinar et al., 2020; Kukreja et al., 2017; Scheuer et al., 2016). Treatments include soft tissue treatment such as massage to the Gastrocnemius and Soleus muscles (calf muscles) and plantar fascia (underside of the foot), taping the bottom of the foot to improve blood flow to the area and the removal of waste products, dry needling to the calf muscles and strengthening of the deep muscles of the feet that help support the longitudinal arch (Bagcier & Yilmaz, 2020; Hoefnagels & Weerheijm 2019; Kamonseki et al., 2016; Kukreja et al., 2017; Singh et al., 2017). Scrunching a towel under foot to strengthen the small foot musculature or using resistance bands can be helpful to address any imbalances in strength (Kamonseki et al., 2016).
Of course, if someone is overweight, losing weight will reduce the load on the Plantar Fascia (Scheuer et al., 2016; Singh et al., 2017). Wearing correct footwear can also encourage proper movement and functioning of foot muscles (Cinar et al., 2020).
Pronation of the foot is when a person weight bears on the inside part of their foot more and they flatten their longitudinal arch (Hoefnagels & Weerheijm, 2019; Kamonseki et al., 2016; Singh et al., 2017). This can be caused by a biomechanical issue that could originate from weakness in the hip and knee (Kamonseki et al., 2016). Strengthening these areas may also give a better long-term solution and reduce the pain caused by this condition (Kamonseki et al., 2016). In some cases, orthotics may be necessary to assist with proper foot positioning (Cinar et al., 2020).
Most cases of Plantar Fasciitis resolve in 6-18 months (Hoefnagels & Weerheijm, 2019; Sun et al., 2020). It is a stubborn condition so often it can make a person feel frustrated with slow recovery times (Sun et al., 2020).
Other treatment options include cortisone injections, PRP injections and even surgery (Bagcier & Yilmaz, 2020; Kukreja et al., 2017; Scheuer et al., 2016; Sun et al., 2020; Whittaker et al., 2019). Cortisone injections may give short term relief, but research shows they may also damage the Plantar Fascia (Kukreja et al, 2017). PRP stands for Platelet Rich Plasma injections where a person’s own blood is drawn which is spun in a centrifuge to separate the plasma from the red blood cells and then the plasma is injected back into the injury site to promote healing (Kukreja et al., 2017). PRP injections have been shown to have better outcomes than cortisone minus the damage (Kukreja et al., 2017).
Another treatment option is Extracorporeal Shockwave Therapy (ESWT) which is a small machine that a practitioner such as a Podiatrist may use on the bottom of the foot sending shock waves at the insertion point of the Plantar Fascia on the heel (Melbourne Foot Clinic, 2018). A small hand held instrument is held against the bottom of the foot applying a pounding pressure (Cinar et al., 2020; Melbourne Foot Clinic, 2018). This treatment is thought to improve blood flow to the area and desensitise local nerve receptors that transmit pain messages (Bagcier & Yilmaz, 2020; Cinar et al., 2020; Sun et al., 2020). ESWT is best for chronic Plantar Fascia when a person has experienced the condition for more than 6 months (Kukreja et al., 2017; Scheuer et al., 2016).
For more information about Plantar Fasciitis and treatments available, please speak to your Myotherapist.
Bagcier, F. & Yilmaz, N. (2020). The Impact of Extracorporeal Shock Wave Therapy and Dry Needling Combination on Pain and Functionality in the Patients Diagnosed with Plantar Fasciitis. The Journal of Foot & Ankle Surgery, 59(2020), 689-693. https://doi.org/10.1053/j.jfas.2019.09.038
Cinar, E., Saxena, S., Akkurt, H.E., & Uygur, F. (2020). Extracorporeal shockwave therapy in the management of plantar fasciitis: A randomized control trial. The Foot, 44(2020), 101679. https://doi.org/10.1016/j.foot.2020.101679
Hoefnagels, E.M., & Weerheijm, L. (2019). The effect of lengthening the gastrocnemius muscle in chronic therapy resistant plantar fasciitis. Foot and Ankle Surgery. https://doi.org/10.1016/j.fas.2020.07.003
Huffer, D., Hing, W., Newton, R., & Clair, M. (2017). Strength training for Plantar Fasciitis and the intrinsic foot musculature: A systematic review. Physical Therapy in Sport, 24(2017), 44-52. https://www.doi.org/10.1016/j.ptsp.2016.08.008
Kamonseki, D.H., Gonçalves, G. A., Yi, L.C., & Júnior, I.L. (2016). Effect of Stretching with and without muscle strengthening exercises for the foot and hip in patients with plantar fasciitis: A randomized controlled single-blind clinical trial. Manual Therapy, 23(2016), 76-82. https://doi.org/10.1016/j.math.2015.10.006
Kukreja, T., Agarwal, T., Singh, A., & Bhugra, H. (2017). Comparative study for the treatment of plantar fasciitis by corticosteroids versus platelet rich plasma. Medical Journal of Dr. D.Y. Patil University, 10(3), 252-256. https://doi.org/10.4103/MJDRDYPU.MJDRDYPU_109_16
Mayo clinic. (2019, December 11). Plantar Fasciitis: Diagnosis & Treatment. Retrieved October 24, 2020 from https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/diagnosis-treatment/drc-20354851
Melbourne Foot Clinic. (2018, November 23). Shockwave Therapy at Melbourne Foot Clinic. https://melbournefootclinic.com.au/shockwave-therapy-at-melbourne-foot-clinic/
Scheuer, R., Friedrich, M., Hahne, J., Holzapfel, J., Machacek, P., Ogon, M., & Pallamar, M. (2016). Approaches to optimise focused extracorporeal shockwave therapy (ESWT) based on an observational study of 363 feet with recalcitrant plantar fasciitis. International Journal of Surgery, 27(2016), 1-7. https://doi.org/10.1016/j.ijsu.2016.01.042
Singh, A. K., Kumar, S., & Sharma, A. (2017). A Comparison between Kinesiotaping and Tissue Specific Plantar Fascia in Stretching Exercise Treatment in Plantar Fasciitis. Indian Journal of Physiotherapy and Occupational Therapy, 11(4), 6-10. https://doi.org/10.5958/0973-5674.2017.00111.3
Sun, K., Zhou, H., & Jiang, W. (2020). Extracorporeal shock wave therapy versus other therapeutic methods for chronic plantar fasciitis. Foot and Ankle Surgery, 26(2020), 33-38. https://doi.org/10.1016/j.fas.2018.11.002
Warren, B.L. (1990). Plantar Fasciitis in runners. Treatment and Prevention. Sports Medicine, 10(5), 338-345. https://doi.org/10.2165/00007256-199010050-00004
Whittaker, G.A., Munteanu, S.E., Menz, H.B., Bonnano, D.R., Gerrard, J.M., & Landorf, K.B. (2019). Corticosteroid injection for plantar heel pain: a systematic review and meta-analysis. BMC Musculoskeletal Disorders, 20(1), 1-22. https://doi.org/10.1186/s12891-019-2749-z