Plantar Fasciitis- what is it?
What is plantar fascia?
A thick fibrous aponeurosis starts from the calcaneus, and composed of medial, central, and lateral segments. It provides static and dynamic shock absorption for the longitudinal arch. (Ayse Abit Kocaman, Sulenur Yildiz and Nilgün Bek, 2017)
What is plantar fasciitis?
Plantar fasciitis is a chronic degenerative process involving the plantar aponeurosis of the foot, most commonly at its insertion into the medial tubercle of the calcaneus. The process involves repetitive strain that seems to cause micro tearing, which induces a repair response. (Thompson et al., 2014)
What are the signs and symptoms?
1. Severe heel pain especially on the first few steps out from the bed in the morning Heel
2. pain is aggravated by long periods of weight bearing
3. Tenderness to palpation over the medial tubercle of the calcaneus
4. Pain with the passive dorsiflexion of the first toe
(Emily N Schwartz and John Su, 2014)
What are the risk factors?
It affects both sedentary and athletic people and is thought to result from chronic overload either from lifestyle or exercise.
Intrinsic Risk Factor
Shortened Achilles tendon
Limited ankle dorsiflexion movement
Weak intrinsic muscles of the foot
Weak plantar flexor muscles
Extrinsic Risk Factor
Prolonged weight bearing
What are the conservative treatments?
Approximately 85% to 90% of patients with plantar fasciitis can be successfully treated without surgery. Although treatment may be required for 6 months or longer, 80% of them treated conservatively have no long-term recurrence of pain.
1. Medical management
· Local steroid injection
Both the corticosteroids injection and extracorporeal shock wave therapy (ESWT) could be preferred as the primary treatment of patients with acute plantar fasciitis (< 6 weeks), although the corticosteroids injection had significantly better treatment outcomes.
In another study comparing the effect of Platelet Rich Plasma (PRP) injection with corticosteroids in chronic cases, it has been shown that PRP is as effective as corticosteroids in reducing pain at 3 and 6 months after the injection, but PRP is significantly more effective at 12 months. (Jain K, Murphy PN and Clough TM, 2015)
2. Physiotherapy management
It is part of the treatments in the early period. Progressive stretching exercises of plantar fascia and gastro-soleus muscle groups were shown to reduce pain. Healey et al. found 52% improvement in the group exercised only plantar fascia stretch, while there was 22% improvement in the group exercised only gastro-soleus muscle stretching in a 2 months of study.
Plantar fascia stretching – 10 seconds hold, 10 repetitions, 2 times per day
Gastrocnemius muscle stretching – 15 seconds hold, 10 repetitions, 2 times per day
Soleus muscle stretching – 15 seconds hold, 10 repetitions, 2 times per day
(Back knees slighlty bent)
The most effective exercise in intrinsic muscle strengthening has been shown to be short foot exercise that allows the isolated foot intrinsic muscles to contract. With the training of intrinsic foot muscles, it is possible to prevent plantar fasciitis due to better control of foot arches
Short foot exercise – 3 seconds hold, 10 repetitions, 2 times per day
High load strength training was achieved using the windlass mechanism in combination with loading of the Achilles tendon. The plantar fascia is made up of collagen type 1 ﬁbers and this type of collagen responds to high-load through increased collagen synthesis (Langberg et al., 2007).
Heels raise with big toe extension - 3 sec up, 3 sec down, 2 sec rest.
12 repetitions, 3 times per day
Soft tissue mobilization and joint mobilization are the common techniques applied by the physiotherapists to treat relevant lower extremity joint mobility and calf flexibility deficits and to decrease pain and improve function in individuals with plantar fasciitis.
Taping with elastic or non-elastic tapes using different techniques helps in reducing the load on the plantar fascia and controlling the pronation of foot. It has also been noted that taping of the calf muscles and plantar fascia for one week with a flexible tape is more effective in reducing the pain and the thickness of plantar fascia compared to physiotherapy treatment only.
Dry needling is one of the alternative methods that used to treat heel pain in recent years. It is minimally invasive method applied by physiotherapists to break down the myofascial trigger points in the plantar extrinsic foot muscles and plantar proximal muscles that cause heel pain.
(Ayse Abit Kocaman, Sulenur Yildiz and Nilgün Bek, 2017)