Physiotherapy Treatment For Plantar Fasciitis
Patients with heel pain often have plantar fasciitis. The “-itis” suffix implies inflammation, but plantar fasciitis is more accurately described as degeneration of plantar fascia collagen. Plantar fascia is tissue on the bottom of the foot that supports the foot’s arch and absorbs impact. As a result, some clinicians prefer the terms “fasciosis” or “fasciopathy.”
Patients often describe plantar fasciitis as pain on the inner heel, but it often has a different, more specific pattern. Fewer symptoms are experienced during physical activity, with the majority of symptoms presenting after a period of rest. This condition can persist for over a year if not treated. Early diagnosis and treatment is essential.
What Causes Plantar Fasciitis?
This condition is primarily attributed to overuse injuries that cause chronic micro-tears in the plantar fascia. Trauma and other factors also play a role. I commonly see limited ankle dorsiflexion and stiffness of the big toe. I also see flat and high-arched feet. Foot over pronation, high impact activities, standing for long periods, and stress from poor and/or inadequate footwear also adds to the pain and injury. Increased body weight also seems to contribute to this condition more in the general population compared to athletes. Heel bone spurs and leg-length discrepancies also contribute as well as diabetes, other metabolic disorders, and tight and/or weak calf muscles, Achilles, and the small foot muscles.
Who Is Most Likely To Get It?
This condition makes up approximately 15% of foot injuries, and is the most common injury in the 40 to 60 year age group. Among the running population, this injury is also very common, making up about 17% of the injuries. Women are more likely to present this condition compared to men.
How We Diagnose It
A thorough plantar fasciitis diagnosis relies on patient history combined with an effective clinical exam. I first assess tenderness along the plantar fascia insertion at the heel along with pain along the plantar fascia with dorsiflexion of the toes. I consider this the Windlass test, and pain during the test strongly supports plantar fasciitis as the diagnosis.
I further assess for the presence of other contributing factors such as pes planus, pes cavus, and a shortened Achilles tendon, as well as examine the gait for any other contributing factors. If the exam is inconclusive, plantar fasciitis is most commonly diagnosed via ultrasonography, which assesses the thickness of the plantar fascia.
How Physiotherapy Helps
The majority of patients diagnosed with plantar fasciitis respond positively to conservative management, which is typically the first line of treatment. The goal of this management is to lessen the plantar fasciitis symptoms by reducing and modifying the exacerbating activities and by the use of anti-inflammatory medications and deep friction massage along the arch and heel.
Following this, physiotherapy is essential for the management of plantar fasciitis. Deep friction massage, soft tissue and joint mobilization, and myofascial release are all forms of manual therapy that play a major role in the reduction of pain. Stretching the gastrocnemius and plantar fascia is particularly important in the treatment of plantar fasciitis. A simple style of this is performed by crossing the affected leg over the other and pulling the toes back until the position of the plantar fascia is felt.
Low-dye taping can provide a short-term solution to excessive pronation, but it is beneficial primarily when used with other treatment methods. Foot orthotic supports can be purchased ready-made or be prescribed and custom-made. They are beneficial to the arch and heel.
There are many “treatments” for plantar fasciopathy that do not have supporting evidence or support from current clinical guidelines. These methods include dry needling, electrotherapy, and ultrasound therapy. Recommended treatment options include low-level laser therapy, weight management, a change to a therapeutic footwear, neuromuscular re-education, and therapeutic exercises. High-load strength training is especially useful because it is similar to the recommended treatment for tendon injuries.
If conservative treatment methods do not provide a solution, other treatment options like corticosteroid injections, platelet-rich plasma (PRP) injections, and an endoscopic plantar fasciotomy may be considered.
Frequently Asked Questions
No. Degeneration of the collagen in the plantar fascia is more accurate as fasciitis implies inflammation of the fascia.
It is felt in the heel and in the inner region and is most painful the first thing in the morning.
Yes, conservative physiotherapy is the most common and effective treatment method.
Many people who experience plantar fasciitis report a lengthy recovery, with symptoms sometimes lasting over a year if the condition is not treated. Therefore, the best thing you can do is take this condition seriously and see a physiotherapist consistently.
One of the most annoying things about plantar fasciitis is its persistence. Fortunately, you can manage the condition with conservative physiotherapy methods like stretching and strengthening exercises, manual therapy, and supportive shoes. If the pain in your heel has disrupted your daily routines, you should book a physiotherapy assessment right away to help you regain your mobility.
About the Author
Dr. Seenath, A, MPT, CDNT, COMT, CMCT is a physiotherapist from Kottakkal Ayurvedic Treatment Centre with expertise in therapy for muscular, respiratory, and cardiac conditions, and also has certification for clinical dry needling, manual therapy, and musculoskeletal cupping therapy.
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