Plantarfasciitis - patience is required but not necessarily rest.
Posted on 11th October 2020 at 18:56
Plantarfasciitis is painful condition of the foot, usually felt on the inside region of the bottom of the heel.
Anatomically the plantarfascia is considered a ligament because its attachments and insertion span between bones however from a structural point of view it is more like a tendon.
The plantarfasia is a unique structure which has several jobs during motion. Passively it supports the longitudinal and medial arches of the foot. Actively its action is very much like a spring, storing energy during the transition from heel strike to stance phases of gait and then releasing this energy which contributes to propulsion as we toe off before the swing phase of gait. This mechanism is very similar to the carbon plate technology starting to be used in new generation running shoes.
What causes Plantarfasciitis ?
In general causes of plantarfascia problems fit into 3 categories. The most common cause usually is due to a sudden increase in tissue loading from intensified training or activity. The second category is poor biomechanics or muscle conditioning either intrinsically (within the body) or extrinsically (outside the body ) such as a sudden change in the familiar characteristics of running shoes eg pronation angles or shoe drop. The third which is less common is trauma which affects the structure of the plantarfascia and suddenly reduces its capacity to cope with load.
A non- irritable plantarfascia ligament prefers consistent or appropriately graduated training loads, appropriate levels of strength in the muscles which assist in propulsion during walking and running and efficient joint motion. Because of these factors an irritable plantarfascia will often respond to a reduction in training load rather than complete rest. Trying to find the optimal training/activity zone for plantarfascia recovery can be difficult. As a general rule, a training load where exercise provocation of plantarfascia pain is less than 3/10 and where any provocation of pain settles within 24 hours is considered an acceptable amount of training.
Good biomechanics during activity and strength of muscles surrounding the foot and proximal joints benefits the plantarfascia. Intrinsically making sure muscles of the lower limb are strong and able to support joint motion will allow for a reduction in unwanted movement which could contribute to extra load on the structures of the foot. Extrinsically, analysing gait or running style in someone who is suffering from plantarfascia pain can be beneficial. Characteristics of running style like overstride, narrow stride width or a lack of hip extension can cause increased loading of the structures of the foot including the plantarfascia. If changes in running style are deemed necessary these should be done slowly to allow for soft tissue to adapt to the changes. This principle should also be considered when changing characteristics of running shoes.
If there is a history of trauma to the plantarfascia then the same rules for acute injury will apply. Rest and ice for the first 3-5 days should be considered while there is potential for soft tissue to still be bleeding. Soft tissue injuries often take up to 6 weeks to heal however activity can begin earlier if the appropriate training/activity load is identified. Using tech that determines weekly step count or daily distance travelled can be helpful in identifying appropriate training/activity loads.
The use of heel cups can be beneficial in offloading forces that are transmitted to a plantarfascia ligament that is irritable however there is little evidence that these have any long term benefit. Orthotics that give good support to the arch of the foot or can add an element of control to pronation or supination can be useful during recovery however it can be argued that intrinsically improving your strength and motion control would equally benefit. To date there is no significant evidence that wearing orthotics will prevent plantarfasciitis from developing so we tend to only prescribe these if and when a patient has a problem.
Injections and shockwave therapy can sometimes be beneficial in treating plantarfasciitis however in my opinion these treatment modalities should be considered only after the appropriate conservative management detailed in this blog has been executed.
If you are suffering from heel pain and need further assistance feel free to give our clinic a call or book online at www.colchesterphysiotherapy.com
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