Let's Talk About...Plantar Fasciitis
What is it?
Plantar fasciitis is a condition that affects the heel, arch, and toes on the sole of the foot. Plantar aponeurosis (plantar fascia) is a layer of white, strong, fibrous tissue that supports the arch of the foot. This structure is split into three bands; medial, central and lateral. It is important to remember that Plantar fasciitis is very common, however not all cases of heel pain are plantar fasciitis.
Research findings describe 3 stages to plantar fasciitis.
Stage 1 – thickening of the plantar fascia
Stage 2 – Aggravation of the plantar heel fat pad
Stage 3 – heel bone bruising (oedema)
Each stage will present differently and it is possible for 3 stages to co-exist at once.
Why does it happen?
The cause of plantar fasciitis is not entirely clear. However, there are some potential risk factors associated with this condition. These are: repetitive movements, standing for long periods of time, a sudden increase in activity, being overweight (as this can increase the load on the sole of the foot) and tight calf muscles. Sometimes the mechanics of walking can irritate the plantar fascia.
What are the common symptoms associated with this condition?
- Pain/discomfort most noticeable with initial steps
- Pain/discomfort during or after weight-bearing activity
- Sometimes heat and tenderness in the heel
- Tightness felt in the arch of the foot
Other conditions with similar symptoms include osteoarthritis, heel pad syndrome, fibroma, inflammatory arthritis
What will happen if I leave it?
There is a small body of evidence that indicates plantar fasciitis is a self-limiting condition (meaning it will get better in its own) however it is unclear how long this will take. The condition, if not treated can lead to other aches and pains in the feet, ankles, knees or hips. It is common to hear that people become frustrated and have low mood as a result of not being able to do tasks or activities they enjoy doing.
What can I do?
In the short term:
- Footwear: wearing comfortable, low heeled shoes with support in the arch can help ease symptoms.
- Stretching and strengthening exercises: can help your skeletal system to manage the activity levels and loads you place on your body. By strengthening the foot structures, you can adapt them to manage additional weight in a controlled way. This is helpful for doing daily activities such as carrying the washing upstairs, lifting a toddler to comfort them or carrying your shopping in from the car. Here is a link to some strengthening exercises for plantar fascia: Plantar fasciitis playlist
- Shockwave Therapy: Shockwave therapy or EWST is an effective tool to help manage plantar fasciitis and is recommended by NICE (National Institute for health and care excellence). It is an evidence-based treatment that gets results and is quickly becoming the first-line treatment for plantar fasciitis in some people. It is now often used before steroid injections. Here at NK Active, we always combine shockwave with a rehabilitation program and we are currently looking to see if combining shockwave and rehabilitation can get people back to their usual level of activity more quickly. If you want to learn more about shockwave, here is a little information video.
Just a side note – in the video, we say there are no risks of tendon rupture, to our knowledge, there are no reported cases, however, we still list it as a risk factor as we can’t be 100% sure.
- Taping: the use of tape (for approximately 4 to 6 weeks) can help to support the arch and heel by offloading the soft tissue structures. The tape can be an additional tool to make rehabilitation exercises more tolerable. Tape shouldn’t be used for long term management of this condition as it can irritate the skin, therefore tape should be changed at least every 2 days and skin condition should always be checked at each application. Here is the link to our taping video. If you need to buy some tape you can here Zinc oxide tape – single Zinc oxide tape – 3 pack
- Orthoses: the use of orthoses may be of benefit to help support foot function and offload tissues that are being overworked or irritated, they are used frequently, however not required for every case of plantar fasciitis. There is possibly some evidence suggesting that custom foot orthoses are better than off the shelf, however, comfort is key.
- Cold Therapies: can be used if the area is warm to touch or swollen. Relief can sometimes occur when you place a cold pack (wrapped in a towel) to the area for no more than 15 minutes (4 times a day) or alternatively using a cold bottle to roll in the arch of your foot.
- Injections: Steroid injections can be used to treat plantar fasciitis. They have been shown to reduce pain levels in the short to medium term and you can have up to 3 steroid injection a year. There some risks attached to injections, that shockwave therapy doesn’t have, however, a steroid injection is still a treatment option. Some of the risks include flair, infection, plantar fascia rupture, fat pad atrophy, skin depigmentation and pain during the injection. There have more recently been people using PRP (protein-rich plasma) injections, this is where you have your own blood spun in a centrifuge and the protein-rich plasma is injected back into you. There is less risk of complications compared to a steroid injection, however, the current evidence doesn’t support the use of PRP injections for plantar fasciitis.
- Load management: it’s helpful to consider what your activities levels are like throughout the week. The body needs to have regular breaks and sometimes if you are working too hard, for long periods of time, the body will become fatigued. Tissues such as the plantar fascia will then become overworked and this can lead to discomfort or injury. Try spreading your activity out across the week for example running or going to the gym on a Monday, Wednesday and Friday rather than Monday, Tuesday, Thursday.
- Weight loss: Losing weight can help reduce the loads being placed on the structures in the foot.
- Surgery: A fasciotomy can be used as a last resort help reduce the pain, however, it is advised to exhaust conservative measures first
We have put together a little box about what you can do to help with plantar fasciitis and some exercises which you can get from here:
Good luck and any questions please do comment below or get in touch.