Plantar fasciitis is an extremely painful condition, but it can be alleviated with a variety of treatments and exercises, says physiotherapist Jane Connolly HPC CSP
Anyone who has had plantar fasciitis will tell you how painful it can be. It’s often felt as a sharp pain under the heel, sometimes radiating into the arch, that is worse first thing in the morning as you put weight through your foot or after prolonged periods of sitting. In the early stages it eases within a few minutes of walking but often there’s a tender spot under the heel or arch and it hurts pulling the toes towards the shin.
The plantar fascia is a broad band that attaches from the heel bone, calcaneus, to the toes. It serves to stabilise the arch of the foot during walking and acts as a shock absorber as the foot hits the ground. Repetitive over stretching results in an overuse injury to the ligament as it attaches to the calcaneus. Initially it may be inflammatory but with time becomes more degenerative in nature. There may also be some involvement of muscles located immediately deep to the plantar fascia.
Causative factors for plantar fasciitis include increasing the amount of running or walking you’re doing, wearing flat shoes with no cushioning, being overweight, having tight calf muscles or even flat feet can all result in more strain or effort being put throughout the ligament.
Most people who have plantar fasciitis recover with conservative treatments within several months. In the first instance rest and avoid aggravating activities. Don’t walk barefoot on hard surfaces and choose shoes with cushioned heels and a good arch support.
Ice the painful area for 15 to 20 minutes and take the appropriate medication in the early stages.
Gait analysis may identify biomechancial foot problems and orthotics prescribed.
A physiotherapist can make an accurate diagnosis and may use electrotherapy such as ultrasound to relieve symptoms, manual techniques such as massage or apply tape to support under the foot. Mostly they will advise you on exercises to stretch the plantar fascia and calf muscles which takes priority initially over strengthening. Calf muscle stretches with the leg straight (to target the larger gastrocnemius muscle) and with the knee bent (targeting the lower soleus muscles) are done three to five times per day, holding the stretches for up to 30 seconds at a time.
The plantar fascia stretch is done by pulling the foot and toes upwards aiming to feel a stretch in the arch of the foot. Rolling the foot over a ball can also help stretch underneath the foot.
A corticosteroid injection may give temporary pain relief but multiple injections aren’t recommended and in more chronic cases extracorporeal shock wave therapy is sometimes used.
For such a seemingly small problem the repercussions of walking badly can have a knock on effect higher up in the body causing problems in the knee, hip or back. Consequently, as ever, early diagnosis and treatment can be essential.