Winchester Sports Therapy Blog
Plantar fasciitis….it’s a pain in the foot… 26/6/2017
If you experience pain in the underneath of the foot when you walk, or stand
after prolonged sitting, then you may be suffering from plantar fasciitis
(PF). Also called runners heel, policeman’s foot, heel spurs, or just
painful heel syndrome, PF is a debilitating injury that may be linked with
running, obesity or being on your feet a lot with poor posture.
The
plantar fascia
The plantar fascia is a band of connective tissue that runs from the heel
to the toes, and gives the foot stability during the push off phase of walking.
With PF the plantar fascia becomes swollen and degenerates.
Diagnosis
As usual, it is important to get a diagnosis from your GP before you embark
on a course of treatment, and ultra sound imaging or MRI will show the state
of the plantar fascia and rule out other possible issues. An x-ray is not
recommended for this injury, as it will not reveal the state of the fascia,
and although it might show a bony heel spur, these have not been shown to
be a predictor of pain (1).
Treatment
One treatment that your GP may prescribe is corticosteroid injections. These
are used to reduce inflammation, however, inflammation is commonly not present
in PF (1), and corticosteroid injections have been implicated in tearing
of the plantar fascia, and been shown to have a low rate of success (2).
As such, it may be worth trying conservative treatment with a sports therapist
or physiotherapist before going down that path.
Unfortunately,
getting to the root of the problem can prove difficult. Flat feet or high
arches, ankle pronation or supination, tight calves or poor foot mobility,
may all play their part. Due to this complexity a multimodel approach to
treatment is recommended (3) which may involve stretching of the plantar
fascia, stretching of the calf muscles, mobilization of the ankle joint,
massage to the plantar fascia itself, and shoe inserts or taping for support.
If conservative treatment fails to aid recovery, then surgery may be indicated,
but whichever approach is taken, It’s best not to be in a rush to
get back to full activity, as PF has been reported to take between six to
12 months to resolve (4).
Bibliography:
1. Wearing, S. et al (2006) ‘The pathomechanics of plantar fasciitis,’
Sports Medicine, 36(7), pp.585-611.
2. Norris, C. (2017) ‘Plantar fasciitis: a pain in the heel,’
Co-Kinetic Journal, 71, pp.14-20.
3.
Garrett, T. and Neibert, P. (2013) ‘The effectiveness of a gastrocnemius-soleus
stretching program as a therapeutic treatment of plantar fasciitis,’
Journal of Sport Rehabilitation, 22, pp.308-312.
4. Hancock, C. et al. (2016) ‘Treatment of plantar fascia pain with
joint mobilizations and positional release therapy: a case study,’
21(4), pp.23-24.
5.
Anderson, J. and Stanek, J. (2013) ‘Effect of foot orthoses as treatment
for plantar fasciitis or heel pain,’ Journal of Sport Rehabilitators,
22, pp.130-136
6. Rathieff, M. et al. (2015) ‘High-load strength training improves
outcome in patients with plantar faciitis: a randomised controlled trial
with 12 month follow-up,’ Scandinavian Journal of Medicine and Science
in Sports, 25, pp.292-300.
7. Waclawski, E. et al. (2015) ‘Systematic review: plantar fasciitis
and prolonged weight bearing,’ Occupational Medicine, 65, pp.97-106.
8. Podolsky, R and Kalichman, L. (2015) ‘Taping for plantar fasciitis,’
Journal of Back and Musculoskeletal Rehabilitation, 28, pp.1-6.
9. DiGiovanni, B. et al. (2006) ‘Plantar fascia specific stretching
exercise improves outcomes in patients with chronic plantar fasciitis. A
prospective clinical trial with two year follow up,’ The Journal of
Bone and Joint Surgery, 88(5), pp.1775-1781.