What is Plantar Fasciitis?
The plantar fascia is a band of connective tissue (ligament) that runs along the sole from the heel to the ball of the foot and supports the arch of your foot. It enables you to push off from the ground. Bruising or overstretching this ligament can cause inflammation and heel pain. If you strain your plantar fascia, it gets weak, swollen, irritated and inflamed.
Repeated strain can cause tiny tears in the ligament. This is more likely to happen if:
• Your feet roll inward too much when you walk (excessive pronation).
• You have high arches or flat feet. People with flat feet may have reduced shock absorption, increasing strain on the plantar fascia. High arched feet have tighter plantar tissue, leading to similar effects.
• You walk, stand, or run for long periods, especially on hard surfaces.
• You are overweight, including pregnancy. Weight places a greater mechanical load on the plantar fascia.
• You wear shoes that don't fit well or are worn out. Wearing shoes with poor arch support or stiff soles.
• You have tight Achilles tendons or calf muscles.
• Certain sports. Activities that place a lot of stress on the heel bone and attached tissue, i.e. running, dance and aerobics.
• Middle-aged or older. Heel pain tends to be more common with ageing as muscles supporting the arch of the foot become weaker, putting stress on the plantar fascia.
Plantar fasciitis can happen in one foot or both feet and is often associated with a heel spur.
Most people with plantar fasciitis have pain when they take their first steps after they get out of bed or sit for a long time. You may have less stiffness and pain after you take a few steps, but your foot may hurt more as the day goes on. It may hurt the most when you climb stairs or after you stand for a long time.
You may need to take an X-ray of your foot if there is a possibility of a stress fracture.
Signs and symptoms
Pain is usually felt on the underside of the heel, and is often most intense with the first steps of the day or after rest. It is commonly associated with long periods of weight bearing or sudden changes in weight bearing or activity.
You may experience:
• Sharp pain in the inside part of the bottom of the heel, which may feel like a knife sticking into the bottom of the foot.
• Heel pain that tends to be worse with the first few steps after awakening, when climbing stairs or when standing on tiptoe.
• Heel pain after long periods of standing or after getting up from a seated position.
• Heel pain after, but not usually during, exercise.
• Mild swelling in the heel.
• Maintaining a healthy weight to minimise the stress on the plantar fascia.
• Choose supportive shoes. Avoid stiletto heels and shoes with excessively low heels. Buy shoes with a low to moderate heel, good arch support and absorption. Not going barefoot, especially on hard surfaces. Patients should avoid open-back shoes, sandals, thongs and any shoes without raised heels.
• Not wearing worn-out runners. Replacing old runners before they stop supporting and cushioning the feet. If a sport involves a lot of running, replacing shoes after about 650 kilometers of use.
• Starting activity slowly. Warming up before starting any activity or sport, and starting a new exercise program slowly.
• Allowing adequate recovery time between workouts or training sessions.
• Avoiding activities that cause pain.
• Stretching the calves and Achilles
Myotherapy treatment for you
Aims of rehabilitation
• Decrease initial pain and inflammation.
• Identify biomechanical dysfunction.
• Improve flexibility.
• Strengthen the plantar fascia.
• Return to full fitness.
• Injury prevention.
Initial treatment includes gentle stretching of the Achilles tendon and plantar fascia, myofascial release and scar tissue breakdown of the plantar fascia. This can be done using a variety of techniques such as Myofascial Release, Cupping, Dry Needling and Trigger point Therapy.
Be aware that treatment may increase soreness initially, but persistence should be rewarding.
Reducing pain and inflammation
• Reduce activities that cause pain.
• Maintain fitness by swimming or cycling. Take the opportunity to work on upper body strength.
• Apply cold therapy. Ice massage for 10 minutes to the site of pain – several times a day if possible. A frozen drink bottle used like a rolling pin is an easy way of performing ice massage.
• Taping gives excellent support while allowing the foot to heal.
• If taping is effective then it is likely that orthotics will also be effective in correcting foot biomechanics and helping to prevent the injury returning once normal training has resumed.
Other treatments may include:
• Night splints. Wearing a splint fitted to the calf and foot while sleeping. This holds the plantar fascia and Achilles tendon in a lengthened position overnight.
• Orthotics. Either off-the-shelf or custom-fitted arch supports (orthotics) to help distribute pressure to the feet more evenly, and to stimulate the small foot muscles.
• Medication, injection and surgery. These measures are for the most persistent cases, and do not replace the need for the treatment methods detailed above.
Return to activity
• Follow the advice given by your Myotherapist.
• After a week of no pain running can be gradually re-started. If pain is felt at any time then ease up. Running time should be gradually increased.
• Ensure the correct shoes for your type of running style or sport are worn.
• After every training session apply ice for about 10 minutes.
• Stretch properly before each training session and after. Hold static stretches for about one minute and repeat several times.