Understanding Plantar Fasciitis - and What Helps?

25% of all the bones in the human body are located in the feet. There are 26 bones, 33 joints, 107 ligaments and 19 muscles in the foot. When running, the pressure on the foot can be as much as four times the runner’s weight.

With so many parts and processes, it’s not surprising that feet can develop issues. One very common condition we see is Plantar Fasciitis.

What is Plantar Fasciitis?

Fasciitis, as it is commonly called, is pain felt at the bottom of the heel, often through to the ball of the foot. This pain can be very debilitating at times and greatly restrict your life.

What are the Symptoms?

Heel pain is the primary symptom, often worse in the morning after periods of rest. It can feel like a stabbing pain inside the heel on the bottom of the foot. The pain is usually worse after exercise, though often not during.

With plantar fasciitis, it is generally worse standing on tiptoes, walking up stairs or standing for long periods. Swelling may be present.

What causes it?

The Plantar Fascia (connective tissue) attaches to the bottom of your heel bone and into the ball of your foot. It acts like a trampoline to the arch of your foot, giving it flexibility under load while still maintaining the integrity of the arch. It is critical to your foot stability, especially when running.

When this strong tissue gets over worked (which isn’t hard considering how hard our walkways are, the extensive daily usage of our feet and our foot neglect) that little band of tissues undergoes much stress resulting in inflammation/pain of the heel bone which often result in inflammation of the fascia of the foot. We only notice them when they hurt.

Additional Risk Factors

• Certain sports: Activities that place a lot of stress on the heel bone and attached tissue, i.e., running, ballet and aerobics.
• Foot mechanics: People with flat feet, high arches or an altered gait pattern can affect weight distribution and overload the plantar fascia
• Age: Heel pain tends to be more common with ageing as muscles supporting the arch of the foot become weaker, putting stress on the plantar fascia.
• Being overweight: Weight places a greater mechanical load on the plantar fascia. There is evidence that a combination of being overweight and inactivity leads to chemical damage to the plantar fascia, with a worsening of pain.
• Pregnancy: Weight gain, swelling and hormonal changes may lead to mechanical overload of the plantar fascia.
• Being on your feet: People with occupations that require a lot of walking or standing on hard surfaces may suffer from plantar fasciitis.
• Poorly designed shoes also contribute to problems.

What has occurred?

There are many reasons for the often sudden change in your foot condition.

1. Increase foot load – can be due to increased body weight, exercise, poor foot mechanics (flat feet), foot or calf muscular tension.

2. Poor shock absorption -insufficient footwear, hard walking surfaces, poor foot mechanics

3. Mechanical dysfunction of the lower limb – pelvic imbalances can load body weight down one leg, knee or ankle complaints can throw weight down one leg or result in rigid joints. Rigid joints decrease the function of gait, resulting in poor limb function and strain. Muscular imbalances can alter gait.

(Note: Whilst plantar fasciitis is primarily an issue of excess mechanical strain, it is sometimes found in certain pathological inflammatory conditions.

We are all unique individuals, and thus, a professional assessment is vital to determine the reasons for your pain.

What can I do to treat this condition?

Treatment is dependent on the cause, which is why a correct diagnosis is vital. Once the cause is determined, the right professional can assist you with your care. Because there are so many variables, it’s important to approach this condition with an integrated focus, which may require the assistance of a Podiatrist, Physiotherapist or Osteopath.

Treatment varies between the initial phase and more chronic cases, for example, ice, compression, massage, and elevation might be helpful initially, though more advanced cases may require orthotic therapy, splinting or cortisone injections.

Conservative Treatment

• Modification of shoes, daily habits that aggravate or cause the pain
• Rest - minimising time spent weight bearing, walking or exercising will decrease the tension on the plantar fascia
• Therapy - any lower limb joint dysfunction, muscular imbalance needs to be addressed. Hypertonic calf muscles, dysfunctional ankle joint, lower limb or LB injuries can greatly assist in better body function and better foot mechanics.
• Support - orthotics, more supportive footwear, taping, stretches of the lower limb and hydration can all reduce the pressure and inflammation on the plantar fascia.

Conservative in-clinic plantar fasciitis treatment is usually successful, and surgery is reserved for severe cases only. Don’t leave it too late. The longer you put up with the pain, the harder it can be to break the cycle of pain you feel. Seek help for your condition from a qualified team of integrated professionals today.

What is a podiatrist?

A podiatrist is a university-trained, registered healthcare professional and a key member of the allied health workforce. Podiatrists are responsible for the diagnosis and management of disorders, injuries and pain affecting the foot, ankle and lower limbs.

What does a podiatrist do?

Conditions managed by podiatrists include sports and musculoskeletal disorders, injuries, growth and development conditions, chronic diseases such as arthritis, dermatological pathologies and neurological disease.

Podiatrists use a combination of medical, surgical and rehabilitation techniques to provide personalised care to alleviate pain, restore mobility and improve a person’s quality of life.

Podiatrists have a hands-on approach and a broad range of skills to use equipment and technology for gait analysis, diagnosis, therapy, injection techniques and surgery. Podiatrists can independently request radiological imaging, administer local anaesthetic drugs and perform minor surgical procedures.

Who can a podiatrist help?

Podiatrists help people at all stages of life, from both young to old. A podiatrist working within a paediatric scope will work with babies, children and adolescents through their developmental years. Some podiatrists develop specific skills that focus on exercise and sports-related injuries. Podiatrists are essential members of the healthcare team, caring for people with chronic diseases.

Article written by ATUNE Podiatrist, Kirby Read.