Plantar Fasciitis: Tips to Manage and Prevent Debilitating Pain

Derik Elmore, PT, DPT, OCS, COMT

Plantar fasciitis is an orthopedic condition that affects the foot. The condition is the result of degenerative irritation and primarily starts at the heel and can progress towards the front of the foot. The fascia also blends with the Achilles tendon, intrinsic foot musculature, and subcutaneous tissue.

How Does It Function:

The plantar fascia has many important roles: arch support, shock absorption during standing, walking, and running, and contribution to normal biomechanics of the foot. We create tension through the plantar fascia when we are in a standing or weight bearing position. The tension created in the plantar fascia adds stability to the loaded foot.

This condition is often caused by overuse and repetitive strain that causes micro-tears in the tissue. There are several risk factors that contribute to plantar heel pain that we should be on the lookout for as clinicians.

• Loss of ankle dorsiflexion – bring the top of your foot towards your shin bone. Prolonged standing, running, other weight bearing activities
• Improper footwear
• Elevated BMI
• Excessive high or low arch conditions

Signs and Symptoms of Plantar Fasciitis:

Plantar fasciitis is a clinical diagnosis that is based on patient history and physical exam. A comprehensive exam of bilateral lower extremities should be performed by your physical therapist. It should include assessment of the feet/ankles, knees, and hips.

Symptoms May Include: 

• Point tenderness to the sole of the foot at inner part of the heel
• Pain on first steps in the morning
• Pain with forced passive dorsiflexion and toe extension
• Increased pain following barefoot walking, climbing stairs, and toe walking Limited dorsiflexion and tight gastrocnemius/soleus muscle

Role of Physical Therapy

• Strength training –  Your physical therapist will provide graded exercise prescription that includes high-load strength training can be effective in the treatment of plantar fasciitis. Strengthening of the gastrocnemius/soleus, foot intrinsics, quadriceps, and gluteal muscles all aid in reduction of pain.
• Stretching – Stretching of the gastrocnemius/soleus complex and stretching the toes into extension to apply stretch to plantar fascia.
• Joint mobilizations – Talocrural joint mobilizations and subtalar joint distraction manipulation can be used in hypomobile joint instances. Also subtalar and midfoot joint mobilizations.
• Night Splints – These can be worn overnight and provide constant stretch to plantar fascia as foot is held in dorsiflexion and toe extension.
• Custom foot orthotics – Foot orthotics produce short-term benefits when implemented with stretching program.
• Patient education – Patient education is perhaps the most important aspect of your rehab process. Your physical therapist can help you understand your condition more for the best course of action.

Sources:

Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003;93(3):234–7.
McPoil TG, Martin RL, Cornwall MW, Wukich DK, Irrgang JJ, Godges JJ. Heel pain–plantar fasciitis: clinical practice guildelines linked to the international classification of function, disability, and health from the orthopaedic section of the American Physical Therapy

Riddle DL, Pulisic M, Pidcoe P, Johnson RE. Risk factors for Plantar fasciitis: a matched case-control study. J Bone Joint Surg Am. 2003;85-A(5):872–7
Thomas JL, Christensen JC, Kravitz SR, et al. The diagnosis and treatment of heel pain: a clinical practice guideline-revision 2010. J Foot Ankle Surg. 2010;49(3 Suppl):S1–19. doi:10.1053/j.jfas.2010.01.001

Rathleff, M.S., Mølgaard, C.M., Fredberg, U., Kaalund, S., Andersen, K.B., Jensen, T.T., Aaskov, S. and Olesen, J.L., 2015. High‐load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12‐month follow‐up. Scandinavian journal of medicine & science in sports, 25(3). DioGiovanni BF, Nawoczenski DA, Lintal ME et al. Tissue-specific plantar fascia-stretching exercise enhance outcomes in patients with chronic heel pain. Journal of Bone and Joint Surgery. 2003;85-A:1270-1277.

Anat Shashua, Shlomo Flechter, Liat Avidan, Dani Ofir, Alex Melayev, Leonid Kalichman. The Effect of Additional Ankle and Midfoot Mobilizations on Plantar Fasciitis: A Randomized Controlled Trial. Journal of Orthopaedic & Sports Physical Therapy. 2015, Vol. 45, 265–272.