Plantar Fasciitis

What is it?

The plantar fascia is a broad band of connective tissue which connects the underside of the base of the toes to the heel pad. Plantar fasciitis is a condition whereby this band of tissue becomes painful and inflammed especially at the point where it inserts into the heel bone. It is an overuse condition whereby excessive loading has caused repetitive microtrauma to the tissues.  Occasionally this may be associated with the formation of a bone spur where the tissue joins the heel bone.  It is characterised by pain especially in when the fascia is contracted and cold i.e. first thing in the morning and after prolonged rest. Stretching the underside of the foot by walking will usually reproduce the pain.

Causes

Usually causes of plantar fasciitis fall into one or more of the following categories:

• Biomechanical i.e. overpronation of the foot, tight calf muscles or even weak muscles around the hip can place excessive load through the fascia

• Anatomical i.e. leg length differences, abnormal foot alignment and bony deformities

• Environmental i.e. inappropriate or worn out  footwear, new or uncharacteristic activity such as working on ladders or squatting for prolonged periods of time. Even a sudden change in a running or walking training regime can trigger a bout of plantar fasciitis 

 Treatment

Following a thorough examination and assessment of the presenting problem, advice and treatment may include the following:

• Advice to rest from aggravating activities and taping to offload injured tissues

• Provision of heel cushion pads for comfort and/or orthotics to restore normal foot alignment

• Electrotherapy i.e. Ultrasound and Laser therapy to control pain, swelling and inflammation

• Acupuncture for pain relief and restoration of normal muscle tone

• Soft tissue and joint manipulation to restore normal biomechanics

• Individually tailored rehabilitation programme to include graded stretching and specific strengthening exercises