Physiotherapy is very effective for Plantarfasciits, a condition characterised by pain on the sole of the foot usually located around the heel or inner arch. This condition is common in runners and active people. It can also be seen in the elderly and those who are over weight. We tend to more accurately refer to it as Planter fascia heel pain or Planterfasciopathy. The reason for a change in name is to reflect the current thinking in management strategies. Like Achilles Tendinopathy we tend not to associate planter heel pain with just inflammation and need to think about rehabilitating the tendon, in addition to reducing pain and inflammation. Management approaches that have historically focussed on soley inflammation have not had the greatest of success. Inflammation causes pain. Pain stops us walking properly and we rapidly get out of condition. Further loading then stresses the band and there is inflammation once more. Treatment must combine: reducing inflammation, supporting the foot and offloading, and then early and comprehensive rehabilitation.
The planter fascia is needed for balance and propulsion during standing, walking, heel raises and running. When the foot strikes the floor the heel is compressed, the foot rolls in and the band tightens. As we transfer our weight through the foot during weight bearing, the band tightens further. The shape of the foot and tension in the band lifts the arch of the foot. As we shift our weight forwards and over the toes our heel lifts and we transfer the weight to the forefoot. The band at this point is releasing the energy in the form of recoil that allows us to walk. Let us think about this.........how much weight is going through this bend?...........a massive amount!. All you need is a tiny bit of inflammation to cause pain and sensitivity. It becomes deconditioned because we modify how we walk. We stop exposing the band to the normal loads of walking. The band becomes weaker and less able to tolerate it's normal job. Changes in foot posture cause weakness in the intrinsic foot muscles, calf and leg muscles. The whole chain is needed to drive the correct forces through the foot. Therefore, whole leg rehabilitation is needed to treat the condition.
Plantarfaciitis may come on suddenly and may be associated with an acute injury. Quite often it is best thought of as an ‘over-use’ injury and typically associated with excessive training or new activity type. You may have been training for a marathon and just notice an acute onset of pain that doesnt get better, then one day you cant put the foot down. Or, it might be that you had been walking all day while doing the christmas shopping with pain the following morning. It is also common in the elderly and may be a reflection of tissue deconditioning or degeneration.
Morning pain is often becuse it takes time for the inflammation to build up and irritate the nerve endings. Hence, you may have done the exercise the day before and had no symptoms.
- Pain on walking
- Pain can be Increased OR decreased with walking
- Seems better in shoes or good fitting trainers
- Worse bare foot
- Worse in the morning with the first few steps easing pain
It is not always straight-forward to treat this condition and often patients can endure symptoms for many months. The first thing to do is to modify and change what you are doing. This halts a continuation of the pain drivers and unloads the pain sensitive structures. The tissues are sensitive and we need to give them a break. Sensitivity or symptom management can be done quickly through change in footwear, specific tape techniques or orthotics (molded insoles). These can be used to great effect but it must be the correct taping technique and if prescribing orthotics then best to get an appropriately fitted pair. Shoes and trainers are also improtant and can be an expesive venture if you make the wrong choices. You will always need footwear specific to your foot and not the most expensive! At core body clinic we can prescribe orthotics appropriate for plantar fascia pain. The taping techniques we use at Core Body Clinic are tried and tested on both premiership footballers and the keen gardener. Other treatments include massage and rolling on a bit of ice or golf ball to ‘desensitise’ the tissue. Another technique we have found to be very successful on recalcitrant (difficult) cases is that of inserting acupuncture needles into the medial calcaneal tubercle and length of fascia, and then applying an electrical stimulus. This is called dry needling and is thought to work through the release of endorphins and the stimulation of local cellular healing.
To get you back running or gardening the foot tissues need to 'adapt'. This requires weight and activity to be graduated in a logical and tolerated manner allowing the tissues to get used to loading once more. Many months of pain will result in muscle weakness and this must be rectified. For this we need to do 'exercise'. Yes! - exercise appears to be one of the best things for plantar fascia heel pain. At Core Body Clinic we know how to use exercise and understand the need for it to be tailored to your condition, your pain and designed to get you back to your chosen sport/activity.
Although stretching may help with symptoms as a short term remedy it does nothing to recondition the tissues and is not advised.
A list of Treatments include:
Ultrasound / Shockwave / Electro-acupuncture
Trigger point release
Advice can be given on:
Injection therapy (Steroid).
Surgical approaches (best avoided).
Plantarfasciits/heel pain can recover on its own given time. However, this can take anywhere between weeks to years if not assessed and treated by a professional. The key is to MODIFY activity and GRADUATE exercise in a prescribed and regimented manner.
Unsure if physiotherapy can help? Get in touch and ask the experts!