Plantar Fasciitis

A hand holding their foot in pain from plantar fasciitis, with a red pain locator on the heel

What is plantar fasciitis?

The plantar fascia is a thick fibrous band of tissue in the bottom of the foot. It starts from the heel and extends to the base of the toes. The plantar fascia helps to stabilise and support your foot while moving through life's activities. When it becomes overloaded and strained, the plantar fascia can become inflamed and injured. Your body then elicits pain and discomfort to let you know that something is wrong. This is known as plantar fasciitis.  The onset of this injury usually occurs when something has changed in your daily or training regime. It is generally chronic in nature as the plantar fascia constantly has to deal with a load that it cannot manage from your activities of daily living.

Diagram of a skeletal foot showing where plantar fasciitis occurs


It is not uncommon for heel spurs to occur simultaneously with plantar fasciitis due to the stress and strain the heel bone is being placed under. Although in the majority of plantar fasciitis cases, the heel spur is NOT the cause of the pain and is often asymptomatic.

Causes & risk factors

As mentioned, the most common cause and risk factor of plantar fasciitis is a change in the way you load your foot.

When repetitive high loads are placed on the heel bone and surrounding soft tissues structures, they sit in a constant state of fatigue. This results in a diminished ability to absorb the excessive shock forces that they are being placed under, causing plantar fasciitis.

Your risk of developing plantar fasciitis is often a combination of the following factors; 

  • Overuse and over-training 
  • Wearing thongs/slip ons for prolonged periods of time, especially after wearing appropriate footwear all winter
  • Lots of time spent barefoot
  • Inadequate footwear for activity or worn out footwear
  • Poor levels of strength, mobility and flexibility in the lower limbs
  • Muscle imbalances and dysfunction
  • Rigid feet with poor mobility and flexibility that are inadequate to absorb shock 
  • Overpronation of the ankle and feet (when your foot rolls inward excessively)
  • Leg length difference 
  • Abnormal walking and running patterns that place extra stress on the heel bone and ligaments
  • Weight gain and sedentary lifestyle
  • Careers and hobbies that involve standing on your feet for prolonged periods of time
  • Age; unfortunately the older you become the less elastic your tissues become

Symptoms

Plantar fasciitis symptoms can be quite debilitating. Pain is often localised to the heel and you are sorest when you first walk in the morning and at night after sitting down to rest. 

Other symptoms included: 

  • Localized pain, swelling and tenderness over the heel bone
  • Pain can be dull, sharp or intermittent and often feels "bruised"
  • Inability or struggle to bear weight for your first few steps as you are getting out of bed 
  • Pain that worsens with initial activity e.g. running, hopping or jumping and gradually improves as you warm up
  • Inability to be barefoot
  • Arch stiffness and tightness

Diagnosis 

The signs and symptoms of plantar fasciitis closely resemble those of other heel pain causes, so it's important that our podiatrists are able to correctly diagnose your condition.

To diagnose, we would firstly complete a physical assessment of the area and further specialised assessments. Ultrasound imaging may be used to confirm the diagnosis or to assess the extent of the injury's damage. 

Treatment

Plantar fasciitis is one of the most common conditions that we see in the clinic.

When treating plantar fasciitis, we will often suggest a personalised combination of the following treatments to allow you to achieve the fastest and most effective recovery.

  • The RICE protocol - rest, ice, compression & elevation
  • Strengthening and stretching exercises to rehabilitate and prevent re-injury
  • Adapt and modify your training program
  • Supportive footwear with cushioning soles
  • Custom prescribed foot orthotics may be recommended to ensure your training regime is minimally impacted, whilst allowing your injury to heal
  • Foot and ankle strapping 
  • Shockwave Therapy is a non-invasive effective therapy that accelerates and facilitates the healing process. It works by emitting high energy acoustic wave pulses directly into the injured area. These waves stimulate;
    • New blood vessel and collagen formation 
    • Increased blood flow 
    • Resolution of calcium build up 
    • Pain reduction 
  • Dry needling of surrounding soft tissues structures to release tension in the muscles, by targeting trigger points
  • Short term use of Anti-inflammatory medication
  • Foot mobilisation technique to mobilise the joints and bones of the foot and ankle to facilitate restoration of movement

      Your condition is likely to improve in a few days or weeks if you rest and treat the affected area, however, if you don't stretch and strengthen the muscles around the joint and modify your daily activities or exercise, it may return. 

      Things you can do yourself

      1. Before you get out of bed in the morning and take your first steps, write the entire alphabet with your feet. This will warm up the stiff structures before you throw your entire body weight on top of them.
      2. Alternating daily activity levels, by swapping aggravating activity for lower impact ones, such as cycling or swimming. Thus allowing you to stay active while you rehabilitate your injury. 
      3. Avoid being barefoot or in thongs, this is when your plantar fascia has to work the hardest. 

      Exercises you can try at home 
      Strength exercise - Calf raises with a twist.

      • If needed, stand next to a chair or bench for balance
      • Place a rolled up towel underneath your toes so they are lifted off the ground, making sure you keep the ball of your foot on the ground
      • Slowly raise both feet off the ground (going onto the ball of your foot), to as high as you can manage 
      • Slowly lower yourself back to the ground over 3 -4 seconds.
      • Start with 2 x 20 repetitions, as this becomes easier increase repetitions, and then move to single leg. 

      Self massage

      A man using a trigger point roller to massage the bottom of his foot
      A man using a trigger point roller to massage the bottom of his foot
                 
      •  This exercise is done best sitting down with your feet on the floor.  
      • You can use a smooth trigger point ball or frozen water bottle and place it underneath your arch 
      • Slowly massage your arch out using your seated body weight, within tolerable limits 
      • Please keep discomfort under 4/10 pain wise, if it is more painful than that, reduce the force you apply to your foot.
      • We also recommend to avoid using the spiked trigger point ball as the arches of the feet are quite sensitive, making this very uncomfortable. 

      What happens if I ignore my plantar fasciitis 

      Unfortunately this is not an injury where you can ignore the pain. The longer you leave it untreated, the longer the recovery period. If you continue without making any changes to your routine, the pain and injury will continue to get worse until you end up possibly tearing or rupturing the plantar fascia. If this happens, you'll generally require extended periods of time in a moon boot. 

      Prevention

      You shouldn't wait to experience pain before making changes to your lifestyle that would help in preventing plantar fasciitis. Here are a number of simple, preventative measures you can implement to help reduce your risk of developing this injury.

      • Get the right advice regarding what footwear you should be wearing
      • Reduce the time you spend barefoot and in thongs 
      • Continually strengthen and condition your lower leg muscles by completing a number of podiatrist-recommended exercises
      • Get a podiatrist to analyse your movement patterns and footwear to ensure it's functioning correctly
      • Warm up and stretch before engaging in sports or strenuous exercise
      • Start or increase training slowly by gradually increasing time and intensity
      • Regularly stretch and maintain mobility and strength of the muscles of your lower limbs with podiatrist-recommended exercises.

      FAQs

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