What is Plantar Fasciitis and How Can Physiotherapy Help?

Heel pain can be an athlete’s dread. When a GP or a physiotherapist tells you that you have ‘Plantar fasciitis’ the connotations surrounding this can all seem negative.

However, you will be pleased to hear that it is not all doom and gloom! Plantar fasciitis affects more than 10% of people in the UK and is a condition seen frequently within our clinics. Together at Capital Physiotherapy we have the knowledge to help you fully answer the questions ‘What is plantar fasciitis’, and most importantly, the experience to get you back (quite literally) on your feet.

What is plantar fasciitis?

‘Plantar fasciitis’ or ‘fasciopathy’ is an overuse injury that causes inflammation of the plantar fascia. This is a strong band of connective tissue that expands the length of the bottom of your foot and helps support its’ shape.

Inflammation can occur predominantly at the site where the tendon attaches to the heel. One of the most common causes of this is repetitive stretching or tearing which can cause irritation and inflammation.

The heel is a part of the body designed to absorb impact when you are weight bearing. If pain develops, it can be very disabling and make even standing and walking difficult.

What are the main symptoms?

Plantar fasciitis can present in many different ways including:

• Sharp pain in your heel or underneath of your foot which is worse in the morning and with the first few steps after awakening
• Pain after long periods of rest where little weight has been put on your feet
• Pain which is usually worse after exercise, rather than during
• Pain that is exacerbated by stretching the sole of your foot, for example when climbing stairs

Are there factors that increase the chance of me developing plantar fasciitis?

Research has shown that there are multiple factors that can contribute to having a higher risk of developing the injury. Some of these can include:

Your Sport or Hobby

Some activities place more repetitive stress on your heel and the attached tissue, which can contribute to an earlier onset. Long-distance running, ballistic jumping activities and dancing are some examples

Your Posture and Foot Mechanics 

Having flat feet, a high arch or an abnormal pattern of walking can affect the way weight is distributed when you are standing, walking and running.

If you are Overweight

Being overweight can put extra stress on your plantar fascia.

Your Occupation 

Some jobs require more time spent on your feet than others. If you spend most of your work hours walking or standing on hard surfaces this can cause damage to your plantar fascia.

Your Training Load or Running Surfaces

This can impact your plantar fascia. If you have recently increased your load or altered the terrain that you perform your sport on. If you have a tight Achilles tendon (the big tendon at the bottom of your calf muscles above your heel) This can affect your ability to flex your ankle and make you more likely to damage your plantar fascia.

Here are some useful ways to begin to help yourself

Dynamic Rest

During the initial management stages, it is recommended that you avoid walking long distances and standing for long periods, especially on hard surfaces. The earlier you address plantar fasciitis the better. This may mean temporarily reducing the distance that you are running. Although frustrating, it will be worth it in the long run!

Whilst resting from the offending activity, make sure than you try to keep as active as possible. For example, try doing upper body workouts that do not overload your foot. Swimming and cycling could be other ways to maintain your cardiovascular fitness.

Footwear

It is important to make sure that your feet are always well supported so avoid being barefoot, especially on tile or hardwood floors.

It is well known in the running world that running shoes should always be replaced before you reach the 500 miles’ mark. Make sure that your shoes are not overly worn and are supporting your feet correctly. It is a good excuse to treat yourself every now and again.

Try to find a pair of shoes that have a good arch support in them. This applies to footwear that you wear on a day-to-day basis. Obviously if you wear heels or heavy toe capped boots for work then this will be almost impossible!

To overcome this, you can purchase and wear arch supports. Your physiotherapist at Capital Physio can advise you on the best type and style, specific to you, your biomechanics and your sport. Your therapist may also refer you to Orthotics.

Ice

Ice is commonly used for injuries, as it is well known to aid pain relief. It does this by reducing tissue temperature, cell metabolism and nerve conduction. By relieving your pain this then allows you to move the injured area, which in turn reduces the swelling.

A good tip for people with plantar fasciitis is to freeze a water bottle or a ball and use this to roll underneath your foot.
If you are worried about placing ice directly on to your skin, wrap the bottle in a wet thin cloth. It is a good idea to check your skin every 5 minutes to monitor for any skin irritation.

Application of ice varies dependent on location of the injury and how deep the injury is. As the plantar fascia is superficial then anything from 10-15 minutes will be sufficient.

Stretching and Foam Rolling

Stretching the plantar fascia and the muscles at the back of your leg including your calf muscles is important. Lunges and lowering your heels from a step are commonly used. A foam roller can also be a useful piece of kit to buy and use to target your tight muscles. Seek guidance from your physio for more specific exercises and advice regarding use of your foam roller.

Exercise and Load

In line with recent evidence, as health professionals we are becoming increasing aware that exercise and load are an essential part of plantar fasciitis rehabilitation.

Research shows that as the plantar fascia consists of Type 1 collagen and is susceptible to degenerative changes it shares traits of a tendinopathy. You may have previously heard of Achilles or Patella tendinopathy, which are also common injuries in runners.

If we use strengthening and loading exercises to manage other tendinopathies why should plantar fasciitis be any different?
Loading ideas can be simple, include heel raises, and tip toe walking.

Adjusting your training programme

If you are a runner or an athlete, you can help yourself by being smart with your training. Common errors that we frequently hear about include sudden increases in training mileage, overtraining, running on a new surface or starting speed work too early. These can be very easy to avoid and may be worth considering as both a preventative and a good management tool.

How can Capital Physio help?

Now that we have answered the question ‘what is plantar fasciitis’, we’ll address exactly how physiotherapy can help. Here at Capital Physio we believe that when managing plantar fasciitis, it is important to take a holistic management approach.

All this means is that if all factors that may be contributing to your symptoms are identified and addressed, then we are more likely to resolve your symptoms!
Our physiotherapists will complete a thorough assessment to ensure that you have an accurate diagnosis. Once the diagnosis confirms that you are suitable for Physiotherapy, our team will help you make an appointment to commence treatment.

Treatment aims may include:

• Reducing your pain levels
• Restoring the range of movement at your foot and ankle
• Identifying and addressing any biomechanical abnormalities
• Improving flexibility of your lower limb
• Improving your strength and ability to tolerate load
• Reviewing and adapting your running or walking style
• Advising and guiding your training regime
• Helping you to return to the previously aggravating activity

If you have been diagnosed with plantar fasciitis, your physiotherapist will work with you to ensure that your treatment is specific to your individual needs and your individual sport whether than be walking, running or gymnastics.

Article by Emily Jackson, Chartered Physiotherapist at Bodyset