Heel pain- commonly referred to as the infamous plantar fasciitis– has been estimated to occur in around 2 million people per year, and it can affect both the avid athlete and the ordinary individual going about their day. Plantar fasciitis is also the most commonly diagnosed condition of the foot and ankle region.
In this blog we’ll explain what plantar fasciitis actually is, how it occurs, as well as what physical therapy treatments can be effective in treating this condition.
The plantar fascia is a thick band of connective tissue that runs along the bottom of the foot- attaching from the heel bone and running out into the bottom of the toes. It helps in providing arch support and aids in the mechanisms that allow for proper foot mechanics as you walk.
Irritation of the plantar fascia usually involves some sort of overuse. For example, there is a high incidence of plantar fasciitis in runners as well as those who might be on their feet a lot for work. Other risk factors include limited ankle range of motion, arches that are too low (pronated) or too high (supinated), and footwear or activities that have poor shock absorption. Rotating footwear during the work week actually reduces the risk of developing plantar fasciitis.
Recent research suggests that the condition itself is actually NOT inflammatory, but rather a degenerative process. Increases in plantar fascia thickness have been associated with these degenerative changes as well as increased pain levels.
The cardinal signs of plantar fasciitis include heel pain during the first few steps int he morning, pain when standing up after prolonged sitting, and pain that worsens with increased activity. Unfortunately, the clinical course is usually chronic, with most patients reporting that symptoms resolve around 9-12 months. The good news is that physical therapy treatment can make plantar fasciitis more manageable and help speed up recovery.
Physical therapy helps in recovery in a number of ways. Some treatments that your physical therapist will incorporate include manual therapy, taping, and guided stretching and strengthening exercises specific to the diagnosis. Physical modalities such as ice, ultrasound, and electric stimulation have no evidence to support their use and usually don’t helping the long run, so those treatments alone won’t cut it.
Manual therapy for plantar fasciitis will include joint manipulations to the foot, ankle, and even all the way up to the lumbar spine to ensure that everything is moving optimally. These treatments also help provide pain relief, allowing you to begin exercising with less pain. Gentle soft-tissue mobilization to the plantar fascia itself can also help provide pain relief.
Kinesis-Taping and low-dye taping have been proven to provide short-term pain relief in those with plantar fasciitis. These different taping techniques can help to take pressure off the sensitive structures such as the plantar fascia and heel bone. Effects of taping are also neurological, meaning the tape simply provides a different sensation to the sensitive area.
Stretching and Strengthening Exercises
When compared to passive modalities such as ice, ultrasound, and electric stimulation, stretching and strengthening exercise are far superior in eliminating plantar fasciitis. Your physical therapist will likely instruct you in a morning stretching routine of the plantar fascia and calf muscles.
Recent evidence has come out in support of high load strengthening in those with heel pain and plantar fasciitis. This involves performing sets of single-leg calf raises to fatigue, a few times per week, increasing the weight every week. The idea is that this high tensile loading of the plantar fascia helps in rebuilding collagen, allowing for healthier tissue to set in. A physical therapist can guide you in this program that has had promising results so far. Most subjects reported a significant decrease in heel pain at 6 and 12 weeks.
Physical therapy should also consist of treating impairments in other regions of the body- such as tight or weak hips that may have contributed to development of the injury.
Plantar Fasciitis can be a very painful, nagging injury which effects many active people. Fortunately, physical therapy treatment can be effective in managing symptoms as well as getting to the underlying cause of the injury. Consult with a physician or physical therapist to get started on a treatment plan.
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