Plantar fasciitis 101

Plantar fasciitis would have to be one of the most common conditions that presents to any clinic. If you think about how much time we actually spend on our feet, it’s no surprise that our feet can fight back at us with some pretty nasty pain.

The plantar fascia is a thick piece of connective tissue that sits at the bottom of each foot. It starts at the heel and runs longitudinally to the ball of the foot, becoming continuous with the toes. The plantar fascia can be seen as an individual structure that helps to form the sole and arches of the feet, but it can also be looked at with a wider lens. 

The plantar fascia is known to be the beginning and/or end of an entire chain of connective tissue. If you know anything about ‘Anatomy Trains’ - a concept developed by Tom Myers (read about it here) - you will understand that the body works as one big structure of which, the plantar fascia plays an integral role. It can be the cause OR effect of dysfunction in a seemingly unrelated and distant location in the body. 

THE LOW DOWN

Plantar fasciitis:

• Refers to inflammation of the plantar fascia. 

• Generally, people will experience pain closer towards the heel or in the middle of the sole of the foot.

• Pain is commonly reported:

  • In the mornings whilst taking the first few steps after a night’s sleep

  • After long periods of immobility

    • This is because the fascial tissue becomes shortened/bound up with the lack of movement

    • Then, when you go to take a step, the fascia is suddenly forced to stretch/lengthen which creates pain

  • After intense activity

  • After wearing rigid footwear

• Causes can include:

  • Pregnancy

  • Being overweight

  • Being on your feet for long periods with poor footwear (ie footwear that provides SO much support that it causes your feet to become tight and/or rigid, OR footwear that lacks support so the plantar fascia actually becomes strained)

• Plantar fasciitis can also be associated with heel spurs

  • A heel spur is a bony prominence that occurs due to the plantar fascia pulling on the heel (its attachment). The more it pulls, the bigger the heel spur which may develop.

• Diagnosis:

  • Taking a thorough history to determine aggravating and relieving factors, onset & progression

  • Thorough physical examination of the area in addition to the lower extremities, pelvis & lower back

  • In some cases, imaging may be required to determine the presence of a heel spur

• Treatment:

  • Plantar fasciitis can respond fantastically to manual therapy given there is a well-formulated treatment and management plan

  • An Osteo consult may include:

    • Assessing the transfer of load through the lower extremities, pelvis, and lower back - perhaps there is increased weight-bearing going through the affected side?

    • Mobility techniques to increase movement directly in the foot and ankle. Indirectly, mobility techniques to the lower extremities, pelvis, and lower back are vital to assist in offloading the feet.

    • Myofascial techniques addressing the plantar fascia directly (see video below) as well as structures which are continuous with the soles of the feet including (but not limited to): calves, hamstrings, glutes, lower back, etc. (we are talking anatomy trains here!)

    • Rehab exercises to address foot and ankle strength, foot mobility, and flexibility in the muscles which impact the feet. These exercises may also become broader to include the glutes and lower back, depending on the specific needs of the patient.

  • If manual therapy does not provide adequate change over a 4-6 week interval referral to a podiatrist may be required to get an in-depth assessment of the feet specifically. The podiatrist may suggest shockwave therapy if indicated.

  • Surgical intervention is always the last resort if all other attempts at treating this condition fail. In this procedure, the plantar fascia is actually cut and ‘relieved’, so it is then forced to heal in a lengthened position.

If you have had a history of plantar fasciitis, it is always vital to let your practitioner know as it is very common for ‘trauma’ to hold in the area.  Because of this, it is a possibility that it may be related to your presenting complaint therefore, needs to be addressed.

Plantar fasciitis is a painful experience. If you need a hand, don’t hesitate to get into contact with us by calling, emailing, telegraphing, teleporting, or maybe even more conveniently, by booking an appointment online.