Plantar fasciitis (PF) is a condition that can be a nuisance if not managed properly. It is also one of the most common causes of heel pain being known to affect about 2 million people in the United States.
A little Anatomy
The plantar fascia is a thick band of connective tissue that originates from the heel and connects to the toes.
The function of the plantar fascia is as follows:
– Support the arch of the foot
– Aid in absorbing forces from impact when walking or running
– Help the foot adapt to uneven terrain
When there are small tears along the connective issue from too much stress or overuse, this may result in pain. If the pain generating source is not addressed, which may be from areas completely unrelated to the plantar fascia, a vicious cycle of pain (primarily) in the heel begins.
Acute versus Chronic
There are two main stages of PF. One is called the acute stage, which is when you may experience pain and sensitivity in the foot that develops either insidiously or from microtrauma such as running. People usually in this have constant or moderate-severe pain with low impact activities such as walking and standing. The main goal during this stage is to manage the symptoms to decrease pain/inflammation around the foot/heel area. This can be done with modalities such as ice or over the counter medications, and light stretches.
The second stage is called the chronic stage. This is where the heel pain has been lingering for months or years and discomfort may be felt with more load dominant activities such as prolonged standing or running. The key here will be progressively loading the tissue around the lower leg/foot to help remodel the tissue as well as build resilience to stress.
What are PF risk factors?
The most common risk factors include obesity or sudden weight gain, reduced ankle and/or great toe mobility, calf tightness, hamstring tightness. There are other risk factors from activities of daily living that include jobs involving long periods of standing or walking. The good news it that most of these risk factors can be modified to create a better environment to help manage/reduce pain. Without modifying or addressing these risk factors, a long term resolution becomes more difficulty, so it is imperative to be addressed as one of the first things you do on your path to recovery.
What does recovery entail?
As mentioned above, addressing risk factors associated with PF is an essential part of the recovery process. The next two items include modifying painful activities as well as loading the plantar fascia once symptoms are being managed appropriately. By performing all three items we are creating a positive environment for the plantar fascia to heal as well as building resilience to help prevent the injury from being reoccurring.
Altering painful activities
By altering painful activities can we mediate how much stress the plantar fascia receives. This is extremely important in managing the symptoms during the acute stage and just as important when we attempt to load the plantar fascia once symptoms have improved. Some options including limiting the amount of distance you can walk or run before the onset of pain, or even try pool walking/running to offload the amount of weight being distributed to the feet. If you have a standing job, try to take some time to sit briefly or shift some weight off of the involved foot to help decrease the weight being put through the foot. Wearing orthotics is another option to relieve achy feet. There have been many studies that show little to no difference between over the counter orthothics versus custom. Simply resting and avoiding activities are not going to be beneficial to help resolve this issue. Proper loading should be used to help remodel and build strength in the foot, which we will go over next.
We need to load the lower leg
It is not enough to just load the PF. As we mentioned with the contributing factors associated with PF, calf and hamstring tightness need to be addressed. Loading the posterior chain (back of the leg) as well as the plantar fascia will be imperative to ensure a complete recovery. By eccentrically loading the posterior chain we can alleviate tensile stress directed towards the foot alleviate stress on the plantar fascia. By loading the plantar fascia directly with moderate controlled force this will help remodel the collagen within the tissue to adapt and become stronger. Below are some key exercises that can help resolve PF pain.
Single leg RDL
Keep the stance leg slightly bent and bend from the waist (perform a hip hinge) until tension is felt in the back of the leg and then return to the start position. Perform 3 sets of 10 repetitions, perform once a day.
This stretch is used to stretch the Plantar Fascia and calf musculature. Wrap the towel around your foot as demonstrated. Next pull your foot towards until you feel a stretch in your calf and foot. Hold for 30 seconds, perform three times.
There is evidence to show that sustained holds and resistive exercise for the toe flexors can help relieve PF pain. Squeeze the towel and hold for 6 seconds with moderate force. Grab the next portion of the towel and continue with the 6 second hold. Perform for 5 towel lengths. Once a day.
There are many things you can do to help manage/mitigate PF pain. If you or a loved one are dealing with this kind of issue and need help, try the strategies listed in this blog. If more help is needed, contact your local physical therapist to learn more about PF and how they may be able to help you.