Plantar Fasciitis

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Plantar Fasciitis is one of the problems that can cause heel pain. It is possibly the most common cause of heel pain. Some references claim it accounts for approximately 80% of cases of heel pain. It also used to be known as policeman’s heel. It is a thick band of tissue that runs from the balls of the feet and toes to the heel bone. Medically this is classed as an inflammatory condition. If you get pain on the bottom of your foot around the heel and arch of the foot, then it is more likely to be Plantar Fasciitis than anything else.

 

Arches of the Foot

 

The foot has three arches two longitudinal (inner and outer) or medial and lateral arches and one transverse arch. The longitudinal arch is supported by the plantar ligaments and this is what gives Plantar Fasciitis its name.

Common Causes

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  • It is suggested that Plantar Fasciitis is caused by straining the Plantar Facia which in turn sets up an inflammatory response which is the bodies own natural way of tissue repair.

 

  • The Plantar Facia connects the toes to the heel bone it is the result of the inflammatory process that causes the intense pain at the bottom of your foot and heel.  Sometimes referred to as runner’s heel as it appears to affect a lot of runners.

 

  • Overuse and strain causes inflammation on the Plantar Facia, overweight and poor fitting shoes may also be a contributing factor.

 

  • In clinic I see a host of different people that have Plantar Fasciitis and it’s not just runners or people that are overweight.

 

  • In my experience the causes of Plantar Fasciitis are still unclear, but a lot of articles go with the common causes of overuse and being overweight.

 

Other common causes likely to cause Plantar Fasciitis are:

 

  1. Training or exercises on hard surfaces like gym floor, pavements or track.
  2. Worn out shoes especially worn out heels.
  3. Tight calf muscles over a period without doing stretching exercises.
  4. Increased general activities, walking, jogging even prolonged standing.

Signs and Symptoms

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Plantar Fasciitis is usually diagnosed by GP, Doctor or physiotherapist through clinical and physical findings and characteristic signs and symptoms that go with this heel/foot problem.

The classic signs of Plantar Fasciitis are pain at the bottom of the foot, around the heel and arch. Increased pain symptoms on palpation (that is controlled inward pressure applied by GP, Doctor or physiotherapist to the bottom of the heel) Increased pain on weightbearing or from resting when starting to walk. Getting up from sleeping first thing in the morning patients describe it like walking on broken glass! The pain in the heel feels like a sharp stabbing pain. It eases after a while but is still painful. The pain eases on activity but returns after resting. Difficulty in trying to lift your toes off the floor only increases the pain. These are the most commons signs and symptoms experienced when they have Plantar Fasciitis.

Recommended Treatment

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Over the years I have treated many patients with Plantar Fasciitis, and I have to say that the outcomes to successfully treating it varies a great deal.

Some articles say recovery can be 6 months and others say 9 months to a year!

The medical profession class this as an inflammatory condition, then the answer and treatment would be rest and anti-inflammatories. In most cases that I have seen and have started treatment this way unfortunately rarely brings about the best outcomes. Treating Plantar Fasciitis with rest and anti-inflammatories would be the right course of action from the medical profession. There are two other aspects and problems to treating Plantar Fasciitis and that is;

 

  • Most of the younger generation do not like taking medication and they must be reassured that taking the right medication has no long-term problems and are not addictive.

 

  • People who are on several medications already are unsure of adding to their medication list.

 

  • Sports people do not like the words resting or stopping in their training program.

 

  • These aspects need to be addressed with the individual by the GP Doctor and physiotherapist and explained fully the importance of following the advice if they want the best shortest outcome for recovery.

 

Management Strategy  

 

  1. Correct diagnosis is the first and most important aspect to begin with.
  2. Explaining to the patient what the condition, Plantar Fasciitis is.
  3. Informing the patient, the best forms of self-help treatment.

 

We encourage all physios to:

 

  1. Advise on rest and if the person is very active then reducing the amount of walking or running even stopping these activities for a short while might be advisable.
  2. Wearing of corrective insoles or heel pads.
  3. Taking the correct analgesics to relieve pain in general. The GP Doctor or pharmacist may advise on paracetamol with or without an NSAID (Non-Steroidal Anti-inflammatory Drug) such as ibuprofen.
  4. If paracetamol alone is not enough for pain relief then your GP Doctor or pharmacist may advise or prescribe codeine.
  5. Losing weight may help recovery and prevent future episodes and problems.
  6. Informing the person that the long-term outcomes for Plantar Fasciitis are very good over a period of 12 months.

 

R.I.C.E

 

Rest: Try to reduce pressure or weight through the affected foot for the first few days. It might not resolve the Plantar Fasciitis problem, but it could help reduce the pain levels. It may also help the Plantar Fasciitis to heal at a quicker rate. I have been known to administer crutches for a few days to help reduce the strain on the arch of the foot if the pain is severe.

 

Ice: Apply an ice pack a quick and inexpensive form of ice pack is a bag of frozen peas wrapped in a thin cloth. This makes a great inexpensive ice pack because it moulds around the contours of the arches of the foot. The recommended timings for ice applications is 20 to 25 minutes there are slight variations on timings for ice applications some would recommend slightly longer up to 30 minutes and some authorities may suggest a 15 to 20 minutes application. Allow 3 hours between ice applications if planning to repeat the process. Ice therapy helps cool the tissue and relieves inflammation, relieving the inflammatory process assists in pain relief.

 

Compression: This can be done by wrapping a support bandage around the foot to help reduce tissue swelling. Do not tie any strapping too tight as this may limit blood flow around the foot and ankle. A compression sock or ankle support could be worn during the day if necessary. The wearing of some support may make the foot and heel feel less painful and more at ease.

 

Elevation: If you can then raise and support your foot higher than your heart. The reason for this is that it aids what is termed venous return this means it assists blood flow and helps in reducing the swelling. The easiest way of elevating the foot is to lay on the floor and place your foot on a soft covered chair and if you can keep it elevated for 20 minutes at a time. If you can do this then repeat this every few hours and certainly at the end of the day. If you have difficulty in raising your foot this high, then rest the leg slightly higher than your waist and keep it supported.

These stages depend on the severity of the Plantar Fasciitis and the discomfort experienced by the individual. The compression and the elevation stages might not be necessary. Just resting in the early stages might be all that is required. One if not the most important thing in the early stages of assisting recovery is the ice treatment as this helps prevent swelling and acts like a mild analgesia thus reducing the pain. I would recommend you avoid any heat application like hot packs at first.

 

Medical Treatments

 

  • Anti-inflammatory medications.
  • Steroid injections
  • Surgical

Other Causes of Pain around the Heel

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  • Achilles Tendinitis causes pain and tenderness at the back of the heel.
  • Stress fractures of the Calcaneal (heel bone) this causes heel pain with swelling around the heel and the heel becoming warm and tender on palpation.
  • Fat pad trauma of the heel.
  • Bursitis
  • Gout
  • Peripheral neuropathy
  • Infections
  • Low back pain with L5 – S1 radiculopathy

Exercises

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Stretches such as stretching the calf muscle may help. Stretching the calf muscle can reduce muscle tension both in the calf and foot and they may help reduce the pain.

 

Calf stretches against the wall

 

Lean your hands against the wall arms at shoulder height

Take a pace back with your painful foot and keep the leg straight

Keep both feet flat on the ground with the feet facing forwards

Slowly bend the knee of the front foot till you feel the stretch in your calf

Hold for 30 seconds before releasing the tension in the calf

Repeat this process 3 more times three times a day

 

Now repeat the calf stretch this time with the rear knee slightly bent with the same sequence and time.

 

Achilles tendon and plantar fascia stretch

 

Sitting on the floor legs out straight as in “a” using a belt, towel or exercise band.

Put the belt, towel or band around your toes & gently pull backwards till you feel a stretch in                 your calf muscle and under the sole of the foot. Hold the position for 30 seconds then let the ankle and toes relax.

Repeat ten times for 30 seconds three to four times a day x 10

 

Arch rolling for the plantar fascia

 

Sitting in a chair place put your foot on a round object like a can, bottle or foam roll. Roll your foot forwards and backwards along the arch of your foot for 1 minute then rest for 10 seconds and repeat the exercise 5 times. Repeat the exercise twice daily.

 

Toe stretches for the plantar fascia

 

Sitting in a chair and cross your affected foot over your other knee.

With your hand pull the toes upwards towards your shin.

Hold the toe stretch for 20 to 30 seconds and repeat 5 times.

 

Calf cross over plantar stretch

 

Lean your hands against the wall arms at shoulder height.

Cross your affected foot across your body and place your toes up against the wall.

Push your weight over the affected foot and hold the stretch for 30 seconds.

Repeat the exercise 5 times twice a day.

 

Towel curls

 

Place a towel, thin cloth or a news paper sheet on the floor.

Put your affected foot on it and curl your toes up grasping it with your toes.

Repeat these 10 times.

 

Marble drop

 

You can do a similar exercise this time picking up marbles one at a time with your toes and dropping them into a bowl.

Alternative Methods

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  1. Seek professional help such as a physiotherapist.
  2. Anti-inflammatories or non-steroidal anti-inflammatory drugs (NSAID) such as ibuprofen, these help to reduce pain and inflammation. You may wish to take this medication as directed on the package or as recommended by your GP, Doctor or pharmacist.
  3. Shoe inserts or orthotics these offer additional support to the arch of the foot. Find a person who specialises in feet called a podiatrist.
  4. Massage or reflexology may help with the symptoms.