Prior to working at Glenferrie Sport and Spinal Clinic I spent 12months researching and co-ordinating a clinical trial into plantar fasciitis (or plantar fasciopathy as it should be correctly termed).
Until a couple of years ago, I personally, as a distance runner also battled this heel pain that feels like you are stepping on a piece of glass in the mornings and for the first steps of a run.
Plantar fasciopathy is one of the most common musculoskeletal disorders of the foot. It affects a wide cross-section of the community from elite athletes to the elderly. It is estimated to affect one in 10 people at some point of their life. Furthermore, it can be painful enough to restrict sufferers’ activity, mobility and general well-being
How do I treat plantar fasciitis?
Firstly, it is most important to gain accurate diagnosis. There are a number of lower limb conditions that may mimic some of symptoms. Listed are 10 plantar fasciopathy treatment options. Your physiotherapist will be able to guide through the treatment process and identify which intervention is most appropriate for you.
Strength Training
Strength training is the new frontier in plantar fasciopathy treatment and has developed a long way from short foot exercises. This treatment approach evolved in response to the pathology being identified as more closely resembling a tendinopathy. Promising results from high tensile loads being applied across the tendon on degenerative tendon disorders such as achilles and patella tendinopathies have since flowed through to plantar fasciopathy treatment interventions.
Soft Tissue massage / Myofascial Release
Trigger points are knotty, involuntary contractions of muscle bundles. They prevent the host muscle from relaxing and recovering. The foot is an intricate web of ligaments, muscles and tendons that can be a hub for trigger points to develop. Rolling the arch of the foot with a tennis ball, progressing up to a golf ball or spikey ball is often a great way to relax the intrinsic foot muscles and tension on the plantar fascia. Some more stubborn cases may respond to modalities such as dry needling or Extracorporeal Shockwave Therapy (ESWT).
Night Splints
Overnight the plantar fascia shortens in the sleeping position. Upon awakening the first few steps can be excruciating pain as the plantar is re-stretched and tugs on the heel. Night splints or a ‘Strassburg’ sock prevent the position of plantarflexion. So it prevents the plantar fascia contracting overnight and offering great relief of the most painful initial steps in the morning.
Biomechanical Analysis
Muscular weaknesses and imbalance in the kinetic chain are often the root cause of heel pain. A thorough biomechanical analysis of your movement patterns will reveal areas of compromised movement or muscular activation. As a result of these inhibitions other structures of the body such of the plantar fascia maybe subject to amplified stresses to compensate increasing their likelihood of injury.
Stretching
Historically this was the treatment of choice for plantar fasciitis. The windlass mechanism is a term used to describe how the plantar fascia acts like a pulley. When the great toe extends (dorsi-flex) it shortens the foot and raises the arch. Decreased ability to dorsiflexion of the great toe and tight calf muscles can contribute to dysfunction. This is due to the increased tension on the plantar fascia exacerbating the condition.
Taping
There are several variations of taping that may help reduce the symptoms of heel pain. These may work by controlling pronation of the foot or de-loading the arch. Your physiotherapist will be able to detect which technique is most suited to you. It is important to realise that although taping can be an effective management strategy it is not cure the underlying pathology.
Orthotics / Footwear Prescription
People displaying either a lower or higher-arched foot tend to be more prone to plantar fasciopathy. People with lower arches may have conditions resulting from too much motion (over-pronation) increasing stretch on the plantar fascia. Whereas patients with higher arch foots tend to be more rigid and result in the foot’s inability to dissipate force. Appropriate footwear and orthotics prescription may be an effective way to alleviate plantar fasciitis symptoms. In the long-term the patient must still work on rehabilitating their foot so that they are not reliant on footwear or devices to manage their condition. Our Podiatrist can assist you with the fitting of Orthotics.
Cortisone Injections
Cortisone injections are medical procedures that maybe prescribed to reduce inflammation around the fascia. Patients often report good pain relief within a couple of days with the maximum effect gained at around 10-14 days. However, this can pose some risks as cortisone is a catabolic steroid meaning that it breaks down tissue. Therefore, patients may have thinning of skin and soft tissue around the injection site, or tendon weakening or rupture. Also despite often effectively relieving the symptoms of plantar fasciopathy, reoccurrence can be high. The effect of the cortisone usually wears off within a few weeks.
ABI / PRP Injections
Autologous Blood Injection (ABI)and Platelet Rich Plasma (PRP) injections are medical procedures where a patient’s blood is drawn and then injected into an injury site to promote healing. They work by re-stimulating the healing process by supplying nutrient rich growth factors within blood platelets to the site of injury. The procedure is usually performed under ultrasound control by a radiologist . They will spin the blood before re-injection to increase the platelet concentration. ABI or PRP is without the re-rupturing/damaging risks of cortisone. However, much of the evidence is still inconclusive and the process can be quite lengthy. Often two to four rounds of injections are required, spaced out over months.
Invasive options should be a last resort. Surgery that usually consists of a release of the plantar aponeurosis (plantar fasciotomy) is rare. Most patients will make a full recovery within time with a good compliance to well-structured physiotherapy.
Load Management
Load management is often the key determinant in a patient’s successful rehabilitation from plantar fasciopathy. This covers activity modification, gait retraining and minimising weight gain to avoid placing undesirable stress on the plantar aponeurosis during its recovery. Contrary to popular belief heel spurs do not cause plantar fasciitis and usually are the result of long-term suffering.
Treatment modalities should respect the biomechanical function of plantar fascia to stabilise the arch with the intrinsic foot musculature. This provides dynamic sensory and motor control to the foot.
If you have symptoms of Plantar Fasciitis, our Physiotherapy team is only too happy to discuss and help you manage your problem.
Glenferrie Sports and Spinal Clinic is located in Hawthorn. Situated conveniently near public transport and with convenient parking it is central to Camberwell, Kew, Richmond, Toorak and Malvern.
For appointments call 03 9815 2555, or book online here
