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Plantar Fasciitis

Wednesday, July 17, 2019

Most of us have either experienced the symptoms of plantar fasciitis or know someone who has.  Plantar fasciitis is the most common foot condition seen by physical therapists in the clinic.  Unfortunately, many people who experience these symptoms never see a physical therapist to help resolve their pain.  Most people try to manage their symptoms with over the counter medications, gel heel pads, poor arch supports or some trendy new shoe product.  Occasionally this approach will work, however, most of the time it results in frustration. 

Individuals who suffer from plantar fasciitis typically complain of pain at the front inside portion of the heel bone (the anterior medial calcaneus). This pain has a gradual onset with no specific injury or incident that produced it.  It is characterized by “First Step Pain,” which is sharp pain and stiffness that is worse first thing in the morning when a person stands up to get out of bed. It will also present after a long period of rest such as driving or sitting in a movie theater.  These sharp symptoms will decrease slightly as the person “loosens up” with light activity and walking, but will increase with more stressful activities throughout the day.  

It is not uncommon for individuals suffering from plantar fasciitis to blame the pain on a heel spur that was seen on an X-Ray.  The myth that a heel spur is the cause of the pain is a common misconception.  Calcaneal spurs may be associated with plantar fasciitis, but are no longer believed to be the cause of those symptoms.  Current studies demonstrate no clear association between heels spurs and plantar fasciitis pain.

So what is the “Plantar Fascia?”  The plantar fascia is a dense, fibrous connective tissue that starts at the base of the heel bone and passes under the arch of the foot to attach at the base of the toes.  It functions as a support structure for the large arch on the inside of the foot.  As we age the elasticity of this tissue decreases and is not as efficient at absorbing the body’s force that is placed through the arch.  When excessive strain is placed on the arch of the foot as the result of poor biomechanical alignment, recent weight gain or an abnormal walking pattern, the plantar fascia is the recipient of large amounts of biomechanical stress which overloads the tissue, causing microtears in the fascia that cause pain.   These microtears are the result of repetitive microtrauma that occurs slowly over time.

Fortunately most cases of plantar fasciitis can be treated conservatively and do not require steroid injections or surgery.  Most people who suffer from this condition experience a fallen arch.  Occasionally a custom orthotic will be needed to help support the arch to the point that it decreases the stress placed on the plantar fascia. However, the larger majority of people will benefit from an inexpensive, quality over the counter orthotic to help support the arch.  But Beware!!! There are more over the counter arch supports than you can ever imagine.  Most of them will say they are made for treating plantar fasciitis.  Most of those also lack adequate arch support.  We are firm believers in using an orthotic that fully supports the arch to take the stress off the plantar fascia.  However, even an effective orthotic with good arch support, can be useless if your calf muscle and Achilles tendon do not have enough flexibility to make the orthotic function appropriately.  Many individuals who suffer from plantar fasciitis do not have enough ankle dorsiflexion range of motion (ability to bring the foot up toward you) to allow the orthotic to work correctly.  The other challenging issue I see in the clinic is that when people try to stretch their calf to gain flexibility, they are typically stretching incorrectly.  It is very important to not allow your arch to collapse when performing these stretches.  At times it is also necessary to perform manual mobilization of the bones of the foot and ankle to help assist in gaining proper mobility.

If you have been suffering from plantar fasciitis, we can help.  Contact us for more information or to set up an appointment today.

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