What is Plantar Fasciitis?
Plantar fasciiopathy, as it is technically known, is characterised by pain focused under the heel, classically at the inner part, or as it is anatomically known the medial tubercle of the calcaneus. This is the insertion or attachment point of the plantar fascia. The Plantar fascia ligament is a fibrous tissue along the bottom foot that connects your calcaneus (heel bone) to your metatarsals (toes).
It is responsible for supporting our arch and helps to propel us in walking.
Classic symptoms include:
- Start up pain – pain on starting to walk following prolonged periods immobility (i.e. sitting)
- Morning pain – worst pain experienced first thing in the morning when taking first few steps.
It can occur both in the sedentary person and the athlete and is generally thought to be caused by ‘overload’. Overload to the plantar fascia can occur due to a sudden increase in frequency, intensity or time of training per week, or a change in terrain.
The prevalence in the general population is estimated between 3.6-7%. It is most common between the ages of 40-60.
What risk factors are there?
- reduced medial arches or flat feet
- increased BMI – if you are carrying more weight than is optimal for your frame.
- reduced control around the hip and core, which can lead to increased loading at the foot
- increased pronation (rolling in with your foot when walking)
- poor footwear
- A spike in loading through the foot i.e. suddenly doing a lot more than normal for you
How do we best treat it?
It is a notoriously difficult thing to treat and there has been a significant lack of research over the last few years. Developments more recently mean that we are progressively treating it with loading based exercises as we would treat an overuse tendon problem such as with an achilles tendinopathy. Flexibility and load modification are also key components to the management.
Physiotherapists would also look to insure we treat any biomechanical factors that maybe contributing from the knee, hip or lower back. These may include reduced gluteal and calf strength and reduced control of muscles such as the tibialis posterior that controls the arch of the foot.
Gel heel inserts or medial arch supports can also be a helpful tool to help offload and support the foot to help things settle. Our biomechanist, Michael Thompson, would assess walking and running styles to see if there would be suitable orthotic adjuncts that may help the foot as well.
Rehabilitation
Strengthening your calf which is made up your gastrocnemius and soleus, is key to the treatment of plantar fasciiopathy whilst ensuring you regularly update your trainers and keep on top of stretching and foam rolling your calf muscles. If doing large amounts of walking or running you also need to ensure you keep up strength and conditioning work to maintain strong core, gluts and lower leg muscles.
Click here for a link to our YouTube Channel for form rolling ideas.
If you feel as though you are being affected by plantar fasciiopathy, it is important to get a correct diagnosis and then treatment plan. Please contact Bristol Physio to get an appointment with one of our expert physiotherapists or Michael Thompson.
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