Plantar Fasciitis

Experiencing a dull, sharp, or a burning ache on the bottom of your heel?

Plantar Fasciitis

Experiencing a dull, sharp, or a burning ache on the bottom of your heel?

What is Plantar Fasciitis?

The most common foot injury among runners is plantar fasciitis, a musculoskeletal injury of the foot that builds up over time and can affect people of all ages, across all activity levels. 

Plantar fasciitis occurs when the web of thick ligaments (the plantar fascia) that runs along the bottom of the foot and connects the heel bone to the bones of the forefoot is inflamed. The plantar fascia supports the arch of the foot and acts as a spring for forward propulsion. The usual signs and symptoms include pain on the bottom of the heel, which could present as dull, sharp, or a burning ache, either directly below the calcaneus (heel bone) or toward the front of it. The pain typically comes on slowly and builds over multiple days or weeks. It can be strongest when you wake up in the morning or during a run.

The injury is considered a chronic condition with symptoms lasting over a year and often becomes debilitating, significantly impacting activities of daily living, and reducing quality of life.

What causes Plantar Fasciitis?

Plantar fasciitis develops over time from excessive strain to the plantar fascia, a structure under the foot. There are multiple things that can increase the risk of developing the injury such as:

  • Abnormal ankle joint range of motion; increased plantarflexion and/or decreased dorsiflexion
  • Increased Body mass index (BMI)
  • Excessive weight gain
  • Poor shock absorption
  • Abnormal muscle function and size
  • Prolonged periods of standing
  • Sudden increases in activity levels
  • Poor foot function/mechanics
  • Inappropriate footwear

Podiatrists are experts at diagnosing conditions of the foot. An experienced podiatrists can identify the specific factors that may be contributing to the development of planar fasciitis, as well as guiding optimal recovery.

How is Plantar Fasciitis diagnosed?

An experienced podiatrist will confirm the diagnosis of a plantar fasciitis via the combination of a detailed clinical history, physical examination, and a combination of functional and manual muscle tests.

When required, ultrasound can be relied upon to confirm a diagnosis of plantar fasciitis. The primary diagnostic criteria when utilising imaging is evaluating plantar fascia thickness. A plantar fascia thickness of over 4.0mm is usually considered indicative of plantar fasciitis.

How do you treat Plantar Fasciitis?

Treatment for plantar fasciitis can vary depending on the contributing factors leading to the injury. Treatment plans are based on the evaluation of patient history, physical examination, functional and muscle testing, and the patients desired outcomes.

Effective treatment modalities for plantar fasciitis include:

  • Extracorporeal shockwave therapy
  • Weight management
  • Appropriate footwear
  • Foot orthosis / insoles
  • Myofascial trigger point needling
  • Plantar fascia specific stretching
  • Manual therapies
    • Soft tissue massage
    • Joint mobilisation
    • Manipulations
    • Myofascial trigger point releases
    • Contract-relax stretching

Extracorporeal shockwave therapy is a safe and effective long-term treatment that has shown to have better long-term pain outcomes over other treatment modalities for plantar fasciitis. Improved pain scores have been shown over corticosteroid injections from four weeks to six months following treatment. It does not share the risk of further plantar fascia rupture that corticosteroid injections carry and has demonstrated greater success rates, reductions in pain, as well as a decreased return to work time, and less complications in those treated with other interventions.

There are also various ways you can help manage Plantar Fasciitis such as;

  • Reducing your training volume and intensity or, better yet, lay off running altogether for a few weeks. “If you keep running through your plantar fasciitis, it will inevitably get worse,” Schoene says, “but you can definitely cross-train.”
  • In your day-to-day life, wear shoes with ample cushioning, arch support, and elevated heels. Seriously—whether they’re 12-millimeter drop running shoes, clogs, or kitten heels, they’ll alleviate the pressure on your plantar fascia. Avoid going barefoot.
  • When you return to running, ease back into it. If you had switched to different running shoes in the weeks before your pain started, it might be wise to switch back to something like what you had before. You’ll want a shoe with ample cushioning, a high drop, and good arch support. If the heel pain returns, go see a professional, because you might benefit from orthotics.
  • As for physical therapy, do 20 reps of towel crunches once or twice per day: place a towel on the floor, put your foot on top, and curl your toes to squeeze a fold of fabric. Stretch your calves from a step. Roll out your arches with a soft massage ball or a tennis ball (as opposed to a firmer lacrosse ball), and be extremely gentle around your heel. Roll out your lower legs with a foam roller or a massage stick to release tension in your calves and Achilles.

If you are suffering from plantar fasciitis, you do not need to suffer in silence. At Bespoke Health and Performance we have the latest technology and treatment methods to help you out of pain.

Watch Shockwave Therapy In Action

FAQ's

Following the prompt treatment by an experienced podiatrist, plantar fasciitis can resolve quickly, within weeks of seeking podiatry treatment. If left untreated, plantar fasciitis can take years to resolve on its own. Healing times do not necessarily depend on the level of pain rather the contributing factors leading to the injury.

The fastest and most effective way to treat plantar fasciitis is with the early intervention of an appropriate medical practitioner such as an experienced podiatrist. By correctly identifying the contributing factors that have resulted in the injury, an experienced podiatrist can develop a bespoke treatment plan to optimise recovery.

Early podiatric intervention for plantar fasciitis may involve foot taping techniques, extracorporeal shockwave therapy, foot orthosis, myofascial trigger point needling, and manual therapies such as soft tissue release, mobilisation, manipulations, and contract-release stretching.

Extracorporeal shockwave therapy has shown to be the most safe and effective long-term treatment for plantar fasciitis with minimal to no side effects and is recommended over

Plantar fasciitis can eventually go away by itself, the pain usually becomes debilitatingly painful prior to going away. For some people, plantar fasciitis becomes a chronic condition lasting for years, where symptoms come and go, or for others the pain may remain consistent for a year or longer.

When plantar fasciitis has been left unresolved for an extended period, it is common for heel spurs to develop. Heel spurs develop to reduce the pressure in the area and are commonly mistaken as being the cause of pain rather then something that develops to reduce pain.

When suffering heel pain, it is recommended to start treatment right away, don’t just ignore the pain and hope it will go away. The duration of symptoms before seeking treatment can influence recovery times.

The longer you wait to begin treatment, the longer it will take for your feet to stop hurting.

Heel spurs do not cause plantar fasciitis. The presence of a heel spur is usually indicative that plantar fasciitis has occurred, however heel spurs commonly develop to reduce the pressure on the plantar fascia (the structure that becomes inflamed and painful in plantar fasciitis) and are not thought to be the injury itself. Studies have shown that the presence of a heel spur does not result in a poorer prognosis. In the general population, heel spurs are feared because many think that they cause the symptoms. However, studies show that a heel spur has no influence on either the development or prognosis of plantar fasciitis and that many people may have a heel spur without having any symptoms

Corticosteroid injections have shown to offer a short-term reduction in inflammation but carry risks such as plantar fascia rupture and infection, and repetitive use of corticosteroids is not advised. Treatments involving corticosteroid injections should be discussed with your physician weighing up the benefits verses the risks.

Surgical options such as plantar fasciotomy and gastrocnemius recession should be reserved for when conservative and non-invasive methods have failed. Extracorporeal shockwave therapy is recommended prior to surgical intervention as it has shown to be a safe and effective non-invasive treatment with minimal to no side effects.  

Stretch your calves
  • Stand an arm’s length from a wall.
  • Place your right foot behind your left.
  • Slowly and gently bend your left leg forward.
  • Keep your right knee straight and your right heel on the ground.
  • Hold the stretch for 15 to 30 seconds and release. …
  • Reverse the position of your legs, and repeat.

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