Plantar Fasciitis – What is it ? & What causes it ?
by Sarah Garbellini
This is a term used to describe inflammation and pain along the plantar fascia, which is a band of connective tissue running along the under surface of the foot from the heel to the base of the 5 toes. While it is separate from the Achilles tendon, they do act together functionally in some movement patterns.
The causes of plantar fasciitis is most often associated with overuse. As physio’s we see this overuse pattern from a variety of causes.
You may have had a change in loading on your foot from
function eg increased running loads (distance or speed) or
from weight changes eg associated with pregnancy or gaining weight , or
even changes to your work loads of carrying heavy objects.
Changes in foot wear or foot wear without arch support / tight calf muscles / having flat feet or high arches are also commonly listed as causes and these all fall into the bracket of over use from over loading.
As you can see from the diagram – your Google searches for the plantar fasciitis often describes the pain to be at the base of the heel, and often associated with a bone spur. While totally accurate, it is also important to note that you can have pain anywhere along the length of the fascial structure and also not have any structural changes such as neuromas or bone spurs within the structure.
Clinically we see tenderness along the mid section of the fascia or at the attachment to the big toe, and while we still label it plantar fasciitis it can also be inflammation and muscle strains of any of the small interconnecting muscles in your foot.
Following from the idea that overuse or over loading of the fascia leads to pain, a common overuse component is when there is a change in the biomechanics of the small bones that make up the foot.
This can be from the changes seen in growing adolescent feet , or maybe you have had an ankle sprain in the past which has changed how the foot biomechanics function (even a year or more prior to your plantar fascia becoming sore). Your body can experience changes in the loading of your feet from an injury in another region of the body – eg after injuries where there may be a change in your walking patterns or even an injury to your shoulder where you may change the way you use your torso and rib mechanics. Yes – for all my regular clients I can always find a way to treat your ribs and thorax 😊
Treatment is always best when we target the why and the cause of you pain, so you may find me looking at your feet a lot – even if you don’t have plantar fasciitis – so we can assess the movement of the small bones of your feet to make sure they help spread the load evenly along your foot to reduce overuse injuries such as tendonitis in the many tendons in your foot or plantar fasciitis.
So what are treatment options?
Once we have assessed and made a diagnosis then we will focus on :
Reducing the local pain – local electrotherapy , home icing and possible advice to see your GP about anti-inflammation pain medication. In some cases we may refer to Sport Medicine for further local investigations and possible treatments such as cortisone injections, local shock wave ultrasound therapy and also PRP injections may be an option
Support the local tissue – manual therapy to achieve correct alignment of the foot bones , kinesio taping and where applicable tech home self taping. We will look at your shoes and also discuss referral to podiatry if indicated. On some occasions a moon boot may be prescribed to fully support the tissue and reduce your pain.
Slowly begin stretching local structures – home program of stretches without load , stretches with load and then gradually incorporate local releases using a roller or small ball
Look at how you move plus start gradual tendon loading exercises for the fascia and Achilles – this may also include looking at how you garden or play golf, or squat at work or climb a ladder. It may be how you are sitting at work and what your upper torso is doing during the day.
During these phases of treatment we will also look at how you move as a whole person and add any additional exercise to your program – so your exercise program will have some for your foot and maybe some for your shoulders and torso for example. We will always include simple hip and abdominal exercises to your foot program , as any foot pain no matter how small, can change how your brain tells you to move – after all we are hard wired to not hurt ourselves and to find a way to move painfree, so we don’t want you to end up with a sore hip after your foot gets better!
So, if you are still with me ……you can see how sometimes these new movement strategies to avoid pain and unload an injured area, can be the beginning of pain elsewhere.
Mmmmm … = a full circle moment on potential causes of your plantar fasciitis. 😊