Plantar fascia, or plantar fasciopathy, is one of the most common causes of foot and heel pain particularly in the 40-60 year old age group and of course in runners!

Characteristics:

• Pain located on the medial plantar aspect of your heel where the plantar fascia inserts onto the heel bone.
• Morning pain and stiffness on waking that can often improve as your foot “warms up.”
• Aggravated by weight bearing activities such as walking, running and prolonged standing.
• As the injury worsens the pain can be quite debilitating and very intense.

Why?

• Changes in activity and load on the plantarfascia which is beyond the capacity of the tissue. For example, a sudden increase in type or intensity of activity.
• Flat feet have been commonly been thought to contribute to the condition due to lowering of the medial longitudinal arch which increases the tensile loading within the plantar fascia.
• Sudden changes in footwear can increase the workload on the plantarfasia. A classic example of this is when a patient returns from their beach holiday after wearing thongs for two weeks straight. Transitioning from wearing heels/work boots/dress shoes to thongs places a very different demand on the plantar fascia which results in overload of the tissue and pain.

Treatment:

Phase 1: Managing the pain:

• Modify/Reduce activity levels
• Education around footwear
• Ice
• Isometric exercises
• NSAIDs (non steroidal anti-inflammatory medication)
• Taping

Phase 2: Rehabilitation and building the plantar fascia activity tolerance.

• Staged and progressive exercise-based program to help manage the pain and restore the loading capacity of the tendon.
• Appropriate stretching of the calf and plantarfascia.
• Address movement restrictions at the big toe and ankle to optimise long term recovery.
• Improve the strength of the foot intrinsic muscles which help support the foot structure.

Things you might be thinking:

Are heel spurs the cause of my pain?

• Heel spurs are very common and research has indicated there is no correlation to heel pain and having heel spurs. So best to just leave them alone.

Should I use gel shoe inserts?

• Gel inserts can provide a lovely cushion for your heel when it is feeling sore. They won’t be the magical cure but can help manage your symptoms.

What about Shock Wave Therapy?

• Extracorporeal shock wave therapy (ESWT) is designed to stimulate cellular repair. Studies indicate that shock wave therapy can be effective in reducing the pain associated with plantar fascia.
• Shock wave can be an effective treatment option when used in conjunction with activity modification and a rehabilitation program.

Should I get foot orthotics?

• Foot orthotics have been shown to help reduce pain in patients with a 6-12 week history of heel pain.
• Anecdotally there is evidence to support the prescription of orthotics if the patient feels it helps to alleviate their symptoms.

How long will it take?

• Average recovery time is 3-6 months. A small percentage of the population can take years to fully recover. Addressing the symptoms early is key to reducing the chronic nature of the condition.

Key tips:

• Get early management and guidance from your physiotherapist or podiatrist.
• Respect the pain.
• Remember our body likes steady and progressive changes in activity to allow strength adaptation.

If you need to book and appointment email Cara at cara@infinitehealthco.au. Or book online via the Nick Hose Fitness website.

You can also book online by clicking the link below.