Plantar fasciitis is a musculoskeletal condition of the foot and lower leg causing pain in the heel and/or bottom of the foot. Most basically, plantar fasciitis is an irritation of the tissue on the bottom of the foot. The fascial tissue is tight, fibrous connective tissue than runs from the front of the heel bone(calcaneus) and extends to the base of the toes(metatarsals). This tissue has several roles in foot function. The fascial tissue, in conjunction with muscles within the foot, supports the arch of the foot, attenuates shock as the foot hits the ground and transforms the foot into a rigid lever to propel the body forward as walking or running occurs.
Research tells us that plantar fasciitis is most prevalent in women in their 40’s, however, all individuals can develop irritation of this tissue. Often, increases in activity level, like walking, running or even standing, can lead to this irritation. More aggressive exercise regimes, new job requirements or a significant change in activity level can lead to the microtrauma that causes pain in the heel or bottom of the foot. Plantar fascia pain is often worst for the first few steps out of bed in the morning, due to the fact that the fibrous connective tissue is often in a shortened position during sleep. The first steps in the morning create an aggressive full body weight stretch to this tissue, recreating the microtrauma and pain.
Physical therapists are trained to evaluate this type of foot pain, to help determine if further diagnostic testing is appropriate, or if physical therapy treatment is the best option for an individual. Other conditions that may create similar symptoms are Achilles tendon issues, plantar fibroma, nerve compression and even stress fractures. Treatment in physical therapy for plantar fasciitis can include stretching exercises to increase the length of tight structures, night splinting, temporary orthotic devices or taping techniques to facilitate the needed rest for the damaged tissue, soft tissue massage to increase the extensibility of the tissue, strengthening exercise instruction to create more strength in weak muscles, and/or modalities like ice and heat to help manage pain and inflammation. Treatment may also include education regarding activity modification, training intensity and progression, footwear and arch support choices.
The latest research on the efficacy of physical therapy interventions for treatment of plantar fasciitis show favorable results. Studies from 2011 show improved treatment outcomes with less pain and improved functional abilities with the use of temporary foot orthoses and trigger point massage to the bottom of the foot by physical therapists.
My experience with treatment of this type of foot pain is that a multifaceted approach including relative rest, manual therapy massage, progressive stretching and strengthening and education regarding self care and activity modification/progression are the keys to successfully treating plantar fasciitis. If you have questions regarding plantar fasciitis or any other foot and ankle aches and pains please contact me at Chris.Clock@JointVenturesPT.com.
Resources:
Renan-Ordine et al, Effectiveness of Myofascial Trigger Point Manual Therapy Combined with a Self Stretching Protocol for the Management of Plantar Heel Pain: A Randomized Controlled Trial. Journal of Orthopaedic and Sports Physical Therapy 2011;41, 2
Drake, M., Bittenbender, C., Boyles, R. The Short Term Effects of Treating Plantar Fasciitis With a Temporary Custom Foot Orthosis and Stretching, Journal of Orthopaedic and Sprots Physical Therapy 2011;41, 4
McNally, EG et al, Plantar Fascia: Imaging, Diagnosis and Guided Treatment. Semin. Musculoskeletal Radiology 2010, Sept, 14
APTA website www.apta.org/moveforward