If you have been diagnosed with plantar fasciitis, the good news is there are strategies and treatment options available to you. Plantar fasciitis pain management involves simple, non-invasive treatments and the prognosis is good, if you are seeking treatment for this issue. However, if left untreated, it is possible to develop more serious conditions such as plantar fasciosis, which is a great reason to seek help as soon as possible following injury.
What Causes Plantar Fasciitis Pain?
Plantar fasciitis is a condition that results in inflammation (swelling) to the tissue that runs along the bottom of your foot (plantar fascia). The plantar fascia is responsible for supporting the arch of your foot and is a connective tissue that spans from your heel to your toes.
Although the plantar fascia is designed to take impact your whole life, increased pressure on the plantar fascia over long periods can cause damage to the tissue. The damage resulting from tears or stiffening can result in periods of increased plantar fasciitis pain.
Plantar fasciitis is considered a degenerative disorder, meaning your fascia starts healthy and gets injured over time, possibly due to repetitive strain or trauma. For example, runners are at an increased risk of developing plantar fasciitis due to prolonged periods of high impact through the feet.
Typically, the origin of the plantar fascia (near the heel) is irritated and has inflammation and micro tearing. But injury can also be due to injured vasculature or non-inflammatory conditions such as calcifications along the fascia.
Risk Factors & Symptoms of Plantar Fasciitis
Plantar fasciitis is caused by numerous factors but is considered an overuse injury. Causes or risk factors may include, but are not limited to:
Prolonged pronation (walking with your foot inward)
Arch issues – either flat feet or an increased arch
Weak plantar flexion muscles
Being overweight or pregnant
Prolonged standing, walking or running, especially on hard surfaces
Improper footwear – including worn out soles or improper arch support
Tight calf muscles or Achilles tendon
Increased periods of high intensity athletics, or recently beginning a workout program
These causes may occur alone or in multiples. Approximately 50% of people with plantar fasciitis will also present with heel spurs, though plantar fasciitis is not caused by heel spurs.
If you are experiencing any of the following symptoms, you could have plantar fasciitis:
Pain with the first few steps in the morning or after prolonged periods of rest in a non-weight bearing position
Progressive onset of pain within the heel
Sharp heel pain
Tenderness within the calcaneus
And, Increased pain after physical activity
Symptoms can occur bilaterally (in both feet) or unilaterally (in one foot).
How to Diagnose Plantar Fasciitis
Plantar fasciitis can be diagnosed clinically and usually does not require imaging, unless ruling out other injuries or if conservative treatment is not beneficial. Within a clinical session, a physiotherapist will take client history to get a background of physical activity, type of activity, previous injuries and family history, to start.
The physiotherapist will also complete a physical assessment of the feet, a gait assessment and special tests in an attempt to recreate the pain for diagnosis. This can include the special test referred to as the “Windlass Test.” This test passively stretches the plantar fascia which, in cases of a plantar fasciitis diagnosis, would reproduce pain within the heel for a positive test.
Despite plantar fasciitis being a common injury, other injuries that could present similarly and be neurological, soft tissue or skeletal in nature. Some common conditions include:
Tarsal Tunnel Syndrome
Baxter’s Nerve Entrapment
Plantar Fascia Tear
Calcaneal Cysts or Spurs (Heel Cysts/Spurs)
Calcaneal Stress Fracture
Or a Bone Bruise within the foot
Plantar Fasciitis Pain Relief
Plantar fasciitis is the leading cause of heel pain in adults aged 18-65, affecting 1 in 10 people in Canada in their lifetime. It is most common in the older populations, but you can experience plantar fasciitis pain any age.
Plantar fasciitis, in most cases, can resolve within one-year with conservative treatments. Conservative plantar fasciitis pain treatments can include, exercise, stretching, manual therapies and modalities will assist in resolving pain and injury.
Exercises for plantar fasciitis can include strengthening exercises for the fascia and calf strengthening exercises, while stretches will include calf and Achilles stretches, foot stretches and foam rolling. Other methods for treatment include: manual therapy, shockwave therapy and bracing. Icing and NSAIDs can be used for basic pain management as well.
If plantar fasciitis pain lasts longer than one year with traditional therapies, a differential diagnosis may be assessed for to ensure proper treatment.
Approach to Plantar Fasciitis Pain Management
The best time to seek advice is if symptoms lasts longer than a few days. Early treatment allows for maximizing the stages of healing that our body is going through and decreasing the likelihood of dysfunctional changes to your plantar fascia (e.g., excessive thickening).
The first place to start is a thorough assessment by a trusted health professional. Orthotists and physiotherapists are good resources. They can recognize what is contributing to your plantar fasciitis and establish a clear plan of action.
A physiotherapist can assess your foot and ankle structure, strength, mobility, and tissue length to determine if you have any dysfunction with your plantar fascia. A physiotherapist can also point you in the right direction if they suspect there are other issues involved with your foot/heel pain.
If you believe you suffer from plantar fasciitis, call or email Propel Physiotherapy to book an assessment.
Sabrina La RosaRegistered Kinesiologist
Sabrina La Rosa’s approach to her practice comes from her understanding of neuroplasticity and the brain’s ability to adapt and grow beyond expectations. After completing a literature review on Modified Constraint-Induced Movement Therapy in Chronic Stroke Patients, she developed an interest in constraint training and using it to treat multiple injuries and not just strokes. She is excited about using this knowledge and her training to help her clients achieve their goals.