Plantar Fasciitis

Plantar fasciitis is inflammation of the tough fascia that forms the arch of the foot. This thick fascia connects the heel to the toes to provide strength and support to the bottom of the feet. The fascia itself is important in providing support for the arch and providing shock absorption. Also, the plantar fascia plays an important role in the normal biomechanics of the foot.

Characteristics/Clinical Presentation

• Heel pain with first steps in the morning or after long periods of non-weight bearing
• Tenderness to the anterior medial heel
• Limited dorsiflexion and tight Achilles tendon
• A limp may be present or may have a preference for toe walking.
• Pain is usually worse when barefoot on hard surfaces and with stair climbing.

How Does Plantar Fasciitis Develop?

This is often an overuse injury primarily due to a repetitive strain causing micro-tears of the plantar fascia but can occur due to trauma or other multi-factorial causes.

Increased risk factors for the development of plantar fasciitis:

• Loss of ankle dorsiflexion 
• Excessive foot pronation dynamically.
• Impact/weight-bearing activities such as prolonged standing, running, etc
• Improper shoe fit
• Elevated BMI > kg/m2
• Diabetes Mellitus 
• The tightness and/or weakness of Gastrocnemius, Soleus, Achilles tendon 

Physiotherapy Management:

1- Strength Training.  According to the study by Rathleff et al., 2015, high load strength training exercise improves outcomes in patients with plantar fasciitis. Similar to tendinopathy management, high-load strength training appears to be effective in the treatment of plantar fasciitis. High-load strength training may aid in a quicker reduction in pain and improvements in function.

2- Stretching: consists of the patient crossing the affected leg over the contralateral leg and using the fingers across to the 1base of the toes to apply pressure into toe extension until a stretch can be felt along the plantar fascia. Achilles tendon stretching can be performed in a standing position with the affected leg placed behind the contralateral leg with the toes pointed forward.

3- Mobilizations and manipulations – decrease pain and relieve symptoms in some cases

4- Foot orthoses: Customized foot orthotics can produce small short-term benefits in function and may also produce small reductions in pain for people with plantar fasciitis, but they do not have long-term beneficial effects compared with a sham device, whether they are custom made or prefabricated. Custom orthotics can be prescribed from a registered chiropodist and physiotherapist. It helps correct the foot and ankle biomechanics and prevents the arch from collapsing, reducing strain along the heel and plantar fascia.