PLANTAR FASCIITIS

The plantar fascia is a band of connective tissue that runs from your ankles to the balls of your feet. The plantar fascia is extremely durable and supports the arches of your feet with all forms of weight-bearing activity like walking, running, and jumping. When the plantar fascia becomes irritated and inflamed symptoms of plantar fasciitis may be felt. 

 

WHAT IS PLANTAR FASCIITIS?

Plantar fasciitis is a degenerative condition of the plantar fascia caused by overuse and repetitive strain to the bottom of the foot. Long periods of running, walking, or even standing can cause the degeneration seen in plantar fasciitis. Plantar Fasciitis is reported to affect over 2 million people in the United States and makes up 15% of all foot symptoms (1). 

plantar fascitis.jpg

 

 

WHAT ARE THE SYMPTOMS OF PLANTAR FASCIITIS?

Symptoms of plantar fasciitis may range from mild to severe. The most common symptom is pain on the inside of the bottom of the foot near the heal. The pain is often most severe in the morning or after not standing for a long period of time. Symptoms may also get worse after prolonged weight bearing. Secondary symptoms may include reduced ankle motion and calf tightness. 

 

WHAT ARE THE RISK FACTORS AND CAUSES OF PLANTAR FASCIITIS? 

Plantar fasciitis is extremely common in runners and those with jobs that cause them to stand or walk all day. It most commonly affects those ages 40-60 but may be seen in younger or older populations. Risk factors which increase the likelihood of developing plantar fasciitis include the following (2):

  • Obesity
  • Flat Feet
  • Inward Roll of ankle while walking/running (overpronation)
  • Weak foot muscles
  • Prolonged weight-bearing
  • Poor footwear
  • High-Arched Feet
  • Improper stretching of the foot and ankle joint

 

TREATMENT & MANAGEMENT:

Plantar fasciitis rarely requires extreme interventions and a full year of conservative treatment is recommended before considering surgery (3). There are many small changes that can be made to help treat and heal this condition as well as many natural therapeutic strategies to employ. 

 

1. STRETCHING:  

The use of plantar fascia and calf muscle stretching has been shown to help relieve pain (4). Here are some stretches that can be employed to help improve the symptoms of plantar fasciitis:

 

Standing Gastroc Stretch

 

Plantar Stretch

 

2. SOFT TISSUE MOBILIZATION:

This type of manual therapy applies pressure on muscle and connective tissue to improve flexibility, break up connective tissue adhesions, reduce pain, and improve overall function. There are many forms of soft-tissue mobilization with trigger-point therapy being the most common. Soft-Tissue mobilization is commonly performed by a chiropractor or physical therapist but can also be done on your own through the use of "foam rolling" or in this case, "golf ball rolling". 

 

Golf Ball Rolling

 

3. FOOTWEAR MODIFICATION & ORTHOTICS:

Custom-fitted shoe insoles known as orthotics have been shown to help improve function and reduce pain in those with plantar fasciitis (5) (and low back pain!). Poor footwear choices may also cause plantar fasciitis symptoms due to lack of foot-support. When choosing footwear it is important to have shoes with good arch support, replace shoes with worn soles or heels, and avoid shoes that may cause increased discomfort like high-heels or boots. For exercise and every-day use, flexible cross-training shoes may be the best option. In a 2009 study, those who exercised in the minimally cushioned and ultraflexible Nike Free 5.0 training shoes had greater improvements in plantar fasciitis compared to those who wore a conventional running shoes (6). 

4. ENERGY THERAPIES:

These therapies are used for various conditions to help relieve symptoms and promote healing. They are commonly performed by chiropractors and physiotherapists and include different devices which emit energy to provide a therapeutic benefit. Studies have shown some of these therapies to be effective for treating plantar fasciitis including low level laser therapy (LLLT/"cold-laser") (7) and electrical stimulation (e-stim) (8). 

5. ACUPUNCTURE & DRY NEEDLING:

Acupuncture, dry needling, and trigger point needling have been shown to be very effective at improving symptoms of plantar fasciitis (9, 10). 

 

Plantar Fasciitis can be a painful condition that interferes with many activities of work, exercise, and daily living. It is a condition that is difficult to prevent because it is usually unexpected and occurs when people are forced to stand or walk for long periods of time. Conservative and natural treatments are the first option for plantar fasciitis while surgery should only be reserved for extreme cases that do not respond to conservative treatments (3). A good chiropractor or physical therapist that has experience managing this condition can offer great value when treating plantar fasciitis through the employment of stretches, exercises, manual therapies, and other therapeutic modalities.