Help My Plantar Fasciitis!
By Evan Loomis, PT, DPT
We ask a lot of our feet. They carry us around all day long, we cram them into uncomfortable shoes, we stub them against furniture; we acquire all sorts of injuries to our feet in the course of a life lived fully. But of all the foot conditions seen in a physical therapy clinic, plantar fasciitis can be a particularly painful and pernicious issue. According to the American Physical Therapy Association (APTA), plantar fasciitis will occur in 10% of our adult population during their lifetime.1 Some studies also report plantar fasciitis accounts for as much as 15% of all clinical foot issues.2 In medical terminology, anything ending in ‘-itis’ is describing inflammation of that tissue or body part. So what is our plantar fascia, and why does it so often develop its own ‘-itis’?
The plantar fascia is a thick strip of connective tissue (think ‘non-elastic’) that supports the arch of the foot. Since the arches of our feet function like a spring, absorbing energy and helping us to redirect that energy into activities like running and jumping, this thick ligamentous support provided by the plantar fascia is crucial to a healthy foot. No one can say with certainty why the plantar fascia becomes inflamed in all afflicted individuals, but we do know that this fasciitis occurs in both athletic and nonathletic populations, and that contributing factors to developing fasciitis include limited range of motion in the ankle, high body mass index, and some activities with high energy demands to the arch of the foot.1
If you have been struggling with foot pain for some time with no known prior injury, there are several key factors for correctly diagnosing plantar fasciitis. A physical therapist will perform a “windlass test”, which applies direct stress to the plantar fascia. Poor ankle dorsiflexion (bending your foot up towards your head) is also quite likely to be present during the examination process. However, the number one symptom that helps identify true inflammation of the plantar fascia is the presence of arch pain with the first few steps taken each morning. This first-step pain occurs because the inflamed fascia stiffens as you lay motionless while asleep all night, and walking on it the next morning is akin to pulling off a fresh scab over the inflamed connective tissue. A good physical therapist can help you differentiate between true fasciitis and a myriad of other conditions which can cause chronic pain in the foot (ex. Fat pad atrophy, tarsal tunnel syndrome, stress fracture, etc.).
Effective treatment of plantar fasciitis occurs in three stages. First, we need to identify which behaviors or other factors are contributing to chronic irritation of the plantar fascia and modify those behaviors if possible. Second, we apply manual therapy and other techniques to help achieve relief of acute symptoms and get you moving without pain. This might include massage, taping the foot, or other hands-on techniques such as dry needling, which has been shown to help improve symptoms.3 Third, we address any limitations to flexibility, strength, or controlled movement of the leg, foot, and ankle to help the healing process and to reduce the likelihood of developing symptoms again. Because plantar fasciitis is usually a chronic condition, resolution will not occur overnight. However, physical therapy can help speed up the recovery process, avoid speed bumps along the way that flare symptoms back up, and help to prevent chronic symptoms from recurring in the future.
Below are some examples of common stretches and other interventions that a physical therapist will prescribe to or perform with a patient. Regaining any lost flexibility, strengthening the muscles that also support the arch, and protecting the healing fascia all should occur with the help of a trained professional who knows how to appropriately progress you towards ultimately recovering from this painful condition.
One last important thing: when researchers look at all of the factors that lead to plantar fasciitis causing disability and serious dysfunction in patients with plantar fasciitis, they identified that fearful avoidance of movement, based on fears of worsening injury, led the highest number of individuals to develop more severe disability.1 While some pain and discomfort can sometimes be unavoidable, the bright side is that there are a lot of things you can do to take control of your pain and get back to doing what you love! Talk to a qualified physical therapist to help guide you through this process and maximize your rehabilitation potential. May you be well and may your feet be happy!
- APTA Clinical Practice Guideline for Heel Pain and Plantar Fasciitis - Revised 2014. https://www.apta.org/patient-care/evidence-based-practice-resources/cpgs/heel-painplantar-fasciitis-revision-2014-cpg
- Cotchett, M. P., Munteanu, S. E., & Landorf, K. B. (2014). Effectiveness of trigger point dry needling for plantar heel pain: A randomized controlled trial. Physical Therapy, 94(8), 1083–1094. https://doi.org/10.2522/ptj.20130255
- Rome, K., Howe, T., & Haslock, I. (2001). Risk factors associated with the development of plantar heel pain in athletes. The Foot, 11(3), 119–125. https://doi.org/10.1054/foot.2001.0698