Millions of people suffer from plantar fasciitis each year. About 1 in 10 people will be affected in their lifetime. It is one of the toughest injuries we treat as physical therapists. It tends to be extremely painful, become exacerbated quite easily, and last for many months. It also has a high recurrence rate, meaning after it’s gotten better, it’s more prone to coming back again.
What is plantar fasciitis? It is an inflammation of the plantar fascia in the bottom of the foot. The plantar fascia is a thick band of connective tissue that attaches from the heel (calcaneus) to the midfoot (metatarsals). The significance of this hard connective tissue is that it has a strong role in shock absorption in the bottom of the foot, especially during running and jumping. It is also responsible for maintaining the arch in our foot during the loading phase of standing, walking or running. Because of its role in absorbing forces through the foot, athletes and runners can be susceptible to overuse or trauma that can irritate it.
But like many injuries, they can be more complicated than a simple inflammatory response that typically gets better with rest, ice and a deloading period. What else can cause foot pain? Some other potential foot related pain could be: bone spurs, loose body (floating piece of cartilage), neuropathy, sciatica (or other nerve related referred pain from the low back or leg), bone bruise, growth related issues (like Sever’s disease) and many others.
So what can we do about it? Do we have options for plantar fasciitis physical therapy? The answer is yes, we can treat it. But it’s important to note that there are many different possible sources of the pain and therefore treatment options may be ineffective or even worsen symptoms. Common treatment options include stretching of the ankle, foot, calf and big toe, lacrosse ball or golf ball rolling the bottom of the feet, icing, resting, and potentially orthotics. Combined, these can be very effective tools. The one I would advise NOT to do early on in a truly inflammatory condition is to beat it up with a lacrosse ball or golf ball. I’ve never understood the logic here and it rarely helps. When something is irritated, we shouldn’t be beating it up while also trying to rest it. It’s counterintuitive. But stretching, icing, and deloading are really good first steps.
In addition to some gentle stretching, icing, and deloading, I like to institute a heel lift into the shoe. This is temporary in order to help us unload stress to the bottom of the feet. What else can we do when these things don’t help? The next steps would involve increasing the load tolerance of the plantar fascia through a progressive loading program. Make the foot stronger over time with gradual introduction of more and more stress. Simultaneously, we should be looking up the chain for other possible sources of this pain. We can look at the low back, the pelvis, the hips, the lower leg etc for other possible causes of referred pain that often get missed or undiagnosed. Lastly, if continuing to struggle, we should seek out an orthopedist for imaging to rule out a more serious pathology.
Plantar Fasciitis is a very difficult injury to treat. Begin with conservative measures for a few weeks (rest, ice, heel lift, gentle stretching). If not getting better, begin a progressive strengthening program and also look for other potential sources of referred pain besides assuming the plantar fascia is the issue. Lastly, seek medical help to rule out more serious problems.
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References:
Trojian, T., & Tucker, A. (n.d.). Plantar Fasciitis. AAFP. https://www.aafp.org/pubs/afp/issues/2019/0615/p744.html#:~:text=Plantar%20fasciitis%20is%20a%20common,the%20condition%20is%20not%20inflammatory.