Plantar Fasciitis

WHAT IS IT?

• inflammation (ITIS) of the dense fibrous sheath of the sole of the foot;
• running from the heel, crossing the ball of the foot (PLANTAR FASCIA)

WHAT DOES THE FASCIA DO?

• absorbs shock
• adapts the foot to changes in terrain
• facilitates foot push off

WHAT HURTS?

• tender inside bottom of heel, may have diverse discomfort over rest of heel into arch
• often one sided
• morning pain and stiffness, pain on standing after prolonged rest
  • early stage: pain after activity
  • middle stage: pain during activity
  • late stage: pain at rest

WHAT SHOWS UP ON X-RAY?

• 20% of population has heel spurs without symptoms
• up to 75% of people with heel pain have heel spurs

WHAT CAUSES IT?

• flat feet (excessive pronation)
• high arches (excessive supination)
• leg length discrepancy
• recent impact trauma
• calf muscle shortening
• toe/foot/ankle/knee/hip/pelvis/lumbar spine/or nerve biomechanical problems
• training errors
  • increase mileage
• increase in frequency
• increase in intensity
• change of footwear or terrain i.e. running up hills

WHY DOES IT HURT?

• too much flexibility in foot; too much rigidity in foot
• both result in localized inflammation at the heel that is "squeezed out" with weight bearing
• at night or rest, inflammation is absorbed into the area, pushing on sensitive nerve endings ~ first morning steps are very painful and stiff until the inflammation is squeezed out and scar tissue is stretched
• once the inflammation and scarring are present they are difficult to remove

WHAT TO DO ABOUT IT?

• establish an accurate activity history
• implement modified/active rest with non-weight bearing activities: swimming, cycling, water running
• orthotic devices (custom made by certified orthotist) for "pronators" or "supinators"
• appropriate foot wear
• mobilizing / stretching shortened structures and strengthening supportive structures as outlined by your physiotherapist
• correct training errors
• achieve healthy body weight
• ice cube massage10 minutes three times a day

RULE OF THUMB

ice decreases inflammation | heat increases inflammation

• anti-inflammatory medication
• therapeutic modalities such as ultrasound or
• interferential current
• cortisone injection (only as required)

HOW DO I PREVENT IT?

• custom made orthotics
• proper shock absorbing footwear
• stretching/mobilizing potentially restrictive structures
• appropriate strengthening
• avoid training errors
• maintain healthy body weight

WHAT ELSE CAUSES HEEL PAIN?

• local tendon pain
• referred muscle pain
• local ligament pain
• fat pad degeneration of the heel
• stress fracture of heel bone (calcaneus)
• plantar fibromatosis
• low back (lumbar) disc protrusion with pinched nerve
• systemic medical conditions: osteoporosis, rheumatoid arthritis

YOUR PHYSIOTHERAPIST CAN HELP YOU WITH THE REST…