Plantar Fasciitis
What is Plantar Fasciitis?
Plantar Fasciitis is an overuse, degenerative condition causing stabbing, non-radiating pain on the plantar-medial (inside) portion of the foot from the heel, to midway through the longitudinal arch.
Due to Plantar Fasciitis being a degenerative condition, findings are suggesting Plantar Fasciitis should be Fasciopathy.
The Plantar Fascia (also known as the plantar aponeurosis) originates from the posteromedial calcaneal tuberosity and divides into five separate bands to insert into each of the five metatarsal heads. The Plantar Fascia supports and forms the medial longitudinal arch of the foot.
Plantar Fascia also helps to absorb forces through the foot and when the fibres begin to deteriorate, there seems to be a secondary inflammatory reaction , which is what triggers the pain and discomfort.
It is believed increases in activity, harder training surfaces and increased load through the area causes the overuse response in the region.
Plantar Fasciitis is often worst when walking for the first time after sleep, after standing still for an extended duration or after walking or running. It is typically a sharp pain, to begin with, but eases after light activity.
What can cause Plantar Fasciitis?
Excessive periods of being on your feet as this can cause excessive use of the stretch-shorten cycle which can cause an overuse reaction
Decreased Dorsiflexion in the non-athletic population
Increased BMI
Can also affect the sedentary population
There also appears to be a risk for military personnel
What are the associated risk factors of Plantar Fasciitis?
BMI
Excessive running/ loading
Tightness in the foot and calve musculature
Leg length discrepancy
Pes Cavus (High Arch)
Pes Planus (Excessive pronation at the foot)
Decreased Dorsiflexion
Occupations requiring prolonged periods of standing or walking
Sedentary lifestyle
Testing for Plantar Fasciitis
There will be a sharp pain over the anteromedial aspect of the heel
The pain will begin after a period of walking after a period of inactivity
The pain will typically decrease with the increase of activity but will most likely return at the end of the day
Pain increases with increase in volume such as sudden increases of activity
Pain on palpation of the origin on the posteromedial calcaneal tuberosity
Possible pain with the windlass mechanism
Pain reproduced with passive dorsiflexion at the metatarsophalangeal joint with the ankle stabilised
There’s often no need for imaging as the patients subjective and objective assessment should provide sufficient evidence, however imaging may be used to rule out other causes
Treatment of Plantar Fasciitis
80% of patients treated conservatively should recover within 12 months
Activity management plays an important role in the treatment of plantar fasciitis
Ice-massage has been recommended in the early stages
Crutches may be beneficial to begin with depending on patient symptoms and severity
Plantar fascia stretching is more successful within the first eight weeks of treatment when compared to Achilles stretching
An appropriately designed Calves strengthening programme is advocated, but again needs to be tailored to each individual
Strong evidence to support orthotics but may not be tolerated at the beginning
Addressing causes such as biomechanics and training loads is vital to success and to prevent reoccurrence
Taping has some evidence to support those who suffer from excessive pronation; however, it is only recommended for the first week of treatment
Night splints to hold foot into a dorsiflexed position has some evidence to decrease pain, but again, the evidence is conflicting
There is no evidence for electrotherapy
Injections may be considered when guided via ultrasound in cases where the patient does not improve
Surgery may be considered if a patient does not respond to conservative treatment within one year
Interesting facts
The most common cause of heel pain in adults
10% of adults will suffer from Plantar Fasciitis at some point in their lives
Women aged between 40 – 60 years old appear most at risk
Occurrence is most common in recreational and elite level runners
Differential Diagnosis of Plantar Fasciitis
A differential diagnosis for Plantar Fasciitis is an acute Calcaneal Fracture due to the location but the pain will cause an inability to weight bear and is usually caused by a high-energy event.
This blog has been an educational introduction for Plantar Fasciitis and is not to be used as medical advice, book in to see a professional if you suffer from heel paining get tailored advice for your needs.
All the best,
Ethan
Ultimate Recovery
References
Comfort, P., 2010. Sports Rehabilitation And Injury Prevention. Chichester, West Sussex, UK: Wiley-Blackwell, pp.497-499.
Luffy, L., Grosel, J., Thomas, R. and So, E., 2018. Plantar fasciitis. Journal of the American Academy of Physician Assistants, 31(1), pp.20-24.
Muth, C., 2017. Plantar Fasciitis. JAMA, 318(4), p.400.
Trojian, T. and Tucker, A., 2020. Plantar Fasciitis. American Family Physician, 99(12), pp.744-750.
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