PLANTAR FASCIITIS: TREATMENT AND RECOVERY

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.

Shoulder Issues: Early diagnosis and treatment.

The shoulder joint is a relatively unstable ball and socket joint that is moved and controlled by a small group of four muscles known as the rotator cuff. These muscles and their tendons surround the shoulder joint and are responsible for stabilising the head of the humerus firmly within the shallow socket of the shoulder and shoulder rotation.

The tendons run under a bony protective arch over the top of the shoulder (acromion which is part of the scapula) in between which sits the subacromial bursa (a lubricating sack) which helps protect the tendons from rubbing against the bone. It’s under this arch that the tendons are vulnerable to being damaged by being intermittently trapped and compressed during shoulder movements. Repetitive overhead activities like decorating, overhead sports like netball, heavy prolonged lifting and the development of bone spurs in the bones around the shoulder may irritate or damage the tendon resulting in a Rotator cuff impingement syndrome. This is when the damaged tendon catches under the boney acromion resulting in, amongst other things, a painful arc when lifting the arm out to the side and up.

A tear in the rotator cuff  can also be caused by a single traumatic event such as falling onto an outstretched arm or due to age related degenerative wearing of the tendon itself. The damage is common in people over 40.

A tear in the rotator cuff can severely restrict movement of the arm. The pain is described as a dull ache deep in the shoulder, sometimes radiating down the top of the arm and is common at night especially lying on the affected side. It’s  particularly painful reaching behind your back or activities like combing your hair or reaching for your seatbelt.

Your physiotherapist will suspect a rotator cuff injury based on your clinical history and the findings from a series of clinical tests. It is important to get the pain under control and promote healing of the tendon, say with ultrasound, whilst doing guided exercises to strengthen and improve the flexibility of the shoulder without aggravating the injured tendon.  Postural correction is an important part of rehabilitation especially working on the muscles that control the scapula position to help minimise the impingement of the tendon under the acromion.

Atraumatic, degenerate tears generally don’t do well with  surgical repair but shoulder movement can be recovered with specific exercises lead by your physiotherapist. On the other hand an injury causing a traumatic tear can be repaired surgically and should be considered as soon as possible for the best outcome. A diagnostic ultrasound scan is the most accurate method to diagnose the specific rotator cuff injury pathology. MRI’s may show a rotator cuff injury but sometimes they’re missed whereas X-rays are of little diagnostic value.

So, the key to recovery is . Immobility of the shoulder due to pain or weakness can cause secondary problems like a frozen shoulder so advice and the right exercises are paramount.