Plantar Fasciitis: who does it affect and how is it treated?

Doesn’t a nice walk on the beach sound amazing? Well to someone that has plantar fasciitis or plantar pain this might sound like a nightmare. You have probably heard of plantar fasciitis or have met someone with this condition, but what is it? Let’s break it down a bit and learn more about it. 

What is the plantar fascia? 

The plantar fascia is a sheath of connective tissue designed to support the muscles and bones of the arch of the foot. It runs from the inside of the heel to the toes and acts like a pulley system when the big toe is dorsiflexed (lifted up). This foot position happens quite a bit with daily activities such as running, walking, dancing, and going up and down stairs.

What is Plantar fasciitis? 

Plantar fasciitis is the irritation of the connective tissue due to lack of strength and durability to increased load (weight bearing). This condition will present as pain that runs from the inside of the heel into the arch of the foot and is worse after periods of prolonged rest. Patients will often say to me “That first few steps in the morning is really painful.”

What causes plantar fasciitis? 

The specific cause of plantar fasciitis is not well understood. There are a few risk factors associated with plantar fasciitis including periods of increased or unaccustomed activity after a period of inactivity, limited dorsiflexion range of motion, and running.

How do we evaluate plantar fasciitis? 

When assessing whether or not a person has plantar fasciitis multiple factors need to be considered. We really need to assess up and down the entire chain, meaning up and down the entire leg and even assessing into the low back or higher up in a person’s body. Sometimes things like hip tightness in a certain direction, hip weakness, or improper movement patterns from the hip can cause compensatory strategies down the chain into the foot.

Overpronation and Underpronation:

Pronation is a normal movement that occurs during walking and running and often times gets a bad rap. When you walk or run your heel strikes the ground first, and as your body weight gets directly over your foot then the foot itself will naturally ‘roll in’ or ‘flatten.’ This is your body’s way of being able to adapt to different surfaces you may be walking on, like when you are hiking for example. There may be times when someone will overpronate or underpronate, usually due to lack of control at the foot or ankle, pain, or as a compensation for something else up the chain like hip weakness for example. There is a common misconception that only people that overpronate get plantar fasciitis, however this is not the case. It really is about the duration of how long you remain in pronation, rather than pronation itself. 

• Overpronation 

  Leads to flattening of the arch of the foot causing the plantar fascia to stretch or lengthen causing microtears. Usually this type of foot has too much mobility and not enough stability. 

• Underpronation 

  Limits the shock absorption so the forces are not able to dissipate throughout the foot. This causes the plantar fascia to take the brunt of the load. This type of foot has too much rigidity or stability and not enough mobility. 

So how do we treat it?

The good news is that plantar fasciitis, most of the time, can be managed conservatively. As stated above, a thorough evaluation is crucial to determine the true cause of how the plantar fasciitis occurred in the first place. 

• Manual therapy

• Soft tissue mobilization may be performed to the calf and plantar fascia to improve mobility of these tissues 

• Joint mobilizations may be performed to the ankle joint and big toe to also increase range of motion in these areas 

• Orthotics/taping

• Taping techniques can also be applied or the use of orthotics may be appropriate. The goal of taping and orthotics is to decrease abnormal foot pronation. 

• Night splinting

• Night splinting can also be helpful in the short term to reduce pain and improve range of motion. When we sleep are feet are usually plantarflexed or pointed down. We are in this position for a long time throughout the night, and this may perpetuate the ankle range of motion limitations that are already present with this condition. Night splints help keep the foot in a neutral position, which can limit adaptive shortening of the calf muscles, as well as decrease pain that commonly occurs with the first steps in the morning. 

• Strengthening exercises 

• Exercises targeted at strengthening the muscles within the foot, surrounding the ankle, and hip are also crucial to reduce pain and help decrease compensatory strategies 

• Load management

• Decreasing excessive loading to the tissue to allow for inflammation to decrease is also key. 

Closing thoughts: 

Plantar fasciitis affects many individuals every year. It limits people being able to participate in day to day activities. Plantar fasciitis is not only uncomfortable, but it is frustrating for most people. Your treatment approach should be specific to the deficits found in your evaluation and geared towards the activities you are trying to get back to doing. Improving range of motion along with strengthening the muscles of the foot and ankles as well as the hips is crucial to overcoming plantar pain.