Summer is fast approaching, and you know what this means: flip flop season. As we spend more time walking and playing outside in bare feet, flip flops, and flat shoes, the risk of foot pain increases. Plantar fasciitis is one of the most common types of foot pain experienced. It's only June, but I've already seen a handful of these cases in the last month.
Overview
Plantar fasciitis is one of the most common causes of foot and heel pain. The plantar fascia is a thick band of connective tissue that's found on the bottom of the foot. It connects the heel and the toes, and it helps to support the arch of the foot. If the plantar fascia gets overused or strained, the end result is pain on the heel or on the bottom of the foot. It can happen in one foot or in both feet.
Causes
Plantar fasciitis is caused by strain on the plantar fascia that supports the foot. Repetitive tension and stress cause tiny microtears in the tissues, resulting in irritation, inflammation, and pain. Factors that may increase risk of developing plantar fasciitis include the following:
- Age (anyone can get plantar fasciitis, but it is most common between ages 40 and 60)
- Foot mechanics (having flat feet, excessively high arches, or abnormal walking patterns can affect weight distribution over the feet and add extra stress to the plantar fascia)
- Poor footwear
- Sporting activities (certain exercises or activities can contribute to plantar fasciitis, such as running, dancing, or jumping, etc.)
- Obesity or pregnancy (excess weight can increase the stress put on the plantar fascia)
- Occupations (factory workers, teachers, and people who spend a lot of time walking and standing on hard surfaces are at a higher risk of getting plantar fasciitis)
- Sudden increase in walking or running frequency and intensity
Signs and symptoms
- Heel pain that may radiate into the foot (arch)
- Tightness and tenderness on the sole of the foot or heel
- Tight Achilles tendon or calf muscles
- Stabbing pain with the first few steps taken in the morning
- Pain that is better after moving around for awhile
- Stiffness that returns after periods of prolonged standing or sitting
Physiotherapy Treatment
- Rest: Since plantar fasciitis is a repetitive and overuse injury, rest is necessarily in order to allow for the tissues to heal.
- Activity modification: It's important to modify your activities and avoid those that increase your foot pain. Warming up and stretching before playing sports will make the plantar fascia more flexible and decrease the chance of injury. In addition, stretching or massaging the plantar fascia first thing in the morning before getting out of bed is beneficial to lessen the heel pain that occurs when the first few steps are taken. It might also be helpful to wear shoes at all times instead of walking around in bare feet. Quality shoes or sandals are important for supporting the arches of the feet.
- Modalities: Electrotherapeutic modalities aim at decreasing inflammation in the plantar fascia and relaxing tight calf muscles that may be contributing to symptoms. Patients generally find relief with ice, so I highly recommend freezing a water bottle and rolling the foot on it.
- Acupuncture and dry needling: Similarly, acupuncture and dry needling help to release the tight plantar fascia and calf muscles.
- Manual therapy: Soft tissue release therapy and stretches are targeted at releasing the calf and plantar fascia muscles. Joint mobilizations may be performed to free up stiff joints in the ankle and foot.
- Exercise: Exercises are targeted at stretching the toes, plantar fascia, and calf muscles and strengthening the intrinsic muscles of the foot and arch. Exercise programs are also designed to correct feet biomechanical problems and fix underlying issues that may be contributing to feet pain. I find that patients with heel pain generally have weak buttock muscles which cause them to compensate and overuse their calf muscles. Generally, people with heel and foot pain have tight calves. Sport-specific exercises prepare athletes to increase their speed, power, and agility without risks of re-injury.
- Bracing and taping: Taping is beneficial to support the arch of the foot. It allows for offloading of the plantar fascia in order for healing to occur. Others might wear a night splint while sleeping to keep the calf and plantar fascia in a stretched position to prevent them from tightening up.
Other treatments
- Orthotics
- Medications (to help with pain and inflammation)
- Surgical intervention