Physiotherapy is very effective for Plantarfasciits, a condition characterised by pain on the sole of the foot usually located around the heel or inner arch. We tend to more accurately refer to it as Planter fascia heel pain or Planterfasciopathy. The reason for a change in name is to reflect the current thinking in management strategies. Like Achilles Tendinopathy we tend not to associate planter heel pain with inflammation. Management approaches that have historically focussed on inflammation have not had the greatest of success. The condition, while painful, does not appear to exhibit much in the way of inflammatory markers and thus we must adopt a different treatment pathway or risk prolonging recovery.
Planter heel pain is associated with pain on walking with patients often limping and walking on the outside of the foot to avoid pain. The condition can also be associated with a Heel Spur. A Heel Spur is a protrusion of bone that is believed to rub on the fascia and cause irritation and pain. However, it is not clear whether heel spurs are significant or just incidental findings. A spur may just be a non relevant bit of extra bone. People often worry about the potential rubbing or cutting caused and this in itself can be obstructive because patients become fearful of walking and exercise incase they damage the structure. Therefore, we try to apply the same principles of treatment even if a heel spur is present. In any case the pain felt by plantarfaciitis is caused by the development of sensitivity in the long band that extends across the base of the foot. We need the band for propulsion during walking and running. Upon heel lift during walking the band tightens, stretches and therefore becomes compressed to enable forward movement. Stretching or compressive loading can therefore cause sensitivity and this can occur whenever the foot is placed on the ground. The condition should be differentiated from 'Tarsal Tunnel Syndrome', a condition affecting the tibial nerve as it enters the foot.
Plantarfaciitis is best thought of as an ‘over-use’ injury and typically associated with excessive training or new activity type. It could be that you had been walking all day while doing the christmas shopping It is also common in the elderly and may be a reflection of tissue deconditioning or degeneration - in which case the tissue becomes intolerant to loading.
- Pain on walking
- Pain can be Increased OR decreased with walking
- Seems better in shoes or good fitting trainers
- Worse bare foot
- Worse in the morning with the first few steps easing pain
It is not always straight-forward to treat this condition and often patients can endure symptoms for many months. The first thing to do is to modify and change what you are doing. This halts a continuation of the pain drivers and unloads the pain sensitive structures. The tissues are sensitive and we need to give them a break. Sensitivity or symptom management can be done quickly through change in footwear, specific tape techniques or orthotics (molded insoles). These can be used to great effect but it must be the correct taping technique and if prescribing orthotics then best to get an appropriately fitted pair. Shoes and trainers are also improtant and can be an expesive venture if you make the wrong choices. You will always need footwear specific to your foot and not the most expensive! At core body clinic we can prescribe orthotics appropriate for plantar fascia pain. The taping techniques we use at Core Body Clinic are tried and tested on both premiership footballers and the keen gardener. Other treatments include massage and rolling on a bit of ice or golf ball to ‘desensitise’ the tissue. Another technique we have found to be very successful on recalcitrant (difficult) cases is that of inserting acupuncture needles into the medial calcaneal tubercle and length of fascia, and then applying an electrical stimulus. This is called dry needling and is thought to work through the release of endorphins and the stimulation of local cellular healing.
To get you back running or gardening the foot tissues need to 'adapt'. This requires weight and activity to be graduated in a logical and tolerated manner allowing the tissues to get used to loading once more. Many months of pain will result in muscle weakness and this must be rectified. For this we need to do 'exercise'. Yes! - exercise appears to be one of the best things for plantar fascia heel pain. At Core Body clinic we know how to use exercise and understand the need for it to be tailored to your condition, your pain and designed to get you back to your chosen sport/activity.
Although stretching may help with symptoms as a short term remedy it does nothing to recondition the tissues and is not advised.
A list of Treatments include:
Trigger point release
Advice can be given on:
Injection therapy (Steroid).
Surgical approaches (best avoided).
Plantarfasciits/heel pain can recover on its own given time. However, this can take anywhere between weeks to years if not assessed and treated by a professional. The key is to MODIFY activity and GRADUATE exercise in a prescribed and regimented manner.
Unsure if physiotherapy can help? Get in touch and ask the experts!