Do You Have Plantar Fasciitis?
Learn how these 4 simple at-home exercises can help you remedy the pain caused by Plantar Fasciitis.
By: Stephanie Beckel, DPT and Eric Alexander, DPT, OCS, Cert. MDT
If pain occurs with your first steps in the morning, chances are you may have plantar fasciitis. In fact, plantar fasciitis is the single most common foot condition treated by healthcare practitioners, affecting about 2 million Americans each year. This type of injury is especially prevalent in runners, as studies have found that over 30% of runners struggle with this condition. The good news is that greater than 95% of cases will heal non-surgically with the correct application of skilled physical therapy by a state licensed doctor (DPT).
So what exactly is the plantar fascia?
The plantar fascia consists of three bands of dense connective tissue that run along the bottom of the foot. All three bands originate from the calcaneus (heel bone) and then spread out as they run forward to connect to the base of each phalynx (toes). This fascia is responsible for tightening during the push-off phase of walking to elevate and support the medial arch, so that the foot may become a rigid lever propelling the body forward.
Plantar Fasciitis describes a condition that is often associated with overuse, resulting in a chronic degenerative process. The condition begins with repetitive strain, which leads to microtears ultimately inducing an inflammatory response. Over time, this leads to degeneration of the plantar fascia, primarily at its attachment site to the heel. When looked at under a microscope, there is evident thickening and fibrosis as well as damaged collagen and calcification of the fascia.
Plantar Fasciitis Symptoms:
Symptoms include pain in the medial heel, usually most noticeable with first steps out of bed in the morning, standing after a period of inactivity, and also after prolonged weight-bearing. Pain is also present with deep palpation of the heel at the insertion of the plantar fascia.
While 80% of heel pain stems from the plantar fascia, several other conditions can mimic this pain and may need to be ruled out. In one retrospective study of 250 individuals with plantar heel pain, the majority were diagnosed with plantar fasciitis. The next most common diagnosis was fat pad atrophy (approximately 15%). Those with fat pad atrophy were more likely to have pain primarily after long periods of standing, pain at night, and lacked the characteristic first-step pain in the morning. Les common conditions include Ankylosing spondylitis, Reiter’s syndrome, and osteoarthritis. If symptoms are in both heels, rheumatoid arthritis becomes a likely culprit in women, while ankylosing spondylitis or Reiter’s is more common in men. For patients with a history of diabetes, an abscess in soft tissue must be ruled out. Rarely the condition may be caused by entrapment of nerves (usually the first branch of the lateral plantar nerve or the medial calcaneal nerve), proximal plantar fibroma, lumbar herniation causing S1 radiculopathy, or a hidden fracture. These conditions can be ruled out during the evaluation process with your physical therapist.
Risk Factors:
There are several categories of risk factors, some of which can be mediated and others which are more difficult to change. Anatomic risk factors are those that are inherent characteristics that you may be born with. These include flat feet, high arches, or a shortened Achilles tendon. Limitations in hamstring flexibility and the difference in leg length have also been associated with this condition. Biomechanical risk factors are those that describe faulty movement patterns. These include an inward roll of the foot (overpronation), poor alignment of the lower extremity, limitations in ankle dorsiflexion, and weak plantar flexor and intrinsic muscles of the foot. The condition also frequently occurs after a recent increase in activity, such as a recent increase in walking mileage or training for a run, so make sure to increase activity slowly. Lastly, there are environmental risk factors, which are often the easiest to eliminate. These include poor footwear, walking barefoot, hard surfaces, unusually long weight-bearing, lack of stretching, and being deconditioned/ overweight.
How can physical therapy help?
A full biomechanical evaluation is warranted in all cases of plantar fasciitis. Often times it is not the tissue at the bottom of the foot that is faulty, but something up the chain that is driving increased or aberrant forces through the fascia on the bottom of the foot. What is often seen clinically is dysfunction in the calf musculature, weak stabilizers in the lateral hip preventing proper control of the femur, and stiffness through the thoracic and lumbar spine driving aberrant forces through the chain from a top-down fashion. These are just a few examples of biomechanical faults that may be present. Failure in addressing the cause of the biomechanical dysfunction and only treating the irritated tissue will lead to failed treatment. Addressing deficits of the entire lower extremity often result in improved biomechanics and correction of the underlying cause of dysfunction. Some of these interventions include correction of gait mechanics, joint mobilizations to improve the mobility of the first metatarsalphalangeal joint (big toe), talocalcaneal/talocrural (ankle), knee, and hip, as well as stretching to restore optimal muscle length to the calf, thigh, and hip. Important areas to strengthen in order to limit pronation and reduce impact when the foot hits the ground include the tibialis posterior and fibularis longus (directly limit midtarsal pronation via eccentric contraction), tibialis anterior (eccentrically controls ankle plantarflexion), quadriceps femoris (eccentrically limits knee flexion), gluteus medius (eccentric control of hip adduction and internal rotation). At Fox Physical Therapy all of our board certified Doctors of Physical Therapy will help to identify the true cause of your pain and teach you how to prevent it from ever coming back.
Here are a few home treatments you can start right now. Many of these techniques will treat the painful site at the heel directly. Remember that to truly rid yourself of this issue work up and down the chain is needed as well. This is where a visit to a skilled Doctor of Physical Therapy can get the help you need.
Tips for at Home Treatment
Tip #1: Calf and arch stretch with a towel. Perform 3 sets pulling back on the foot for 30 seconds before going to sleep and before first steps in the morning.
Tip #2: Stretch of the plantar fascia stretch with cross-friction massage. Stretch the big toe up and massage bottom of the foot for 1 minute, 3 times before taking first steps. This can also be done throughout the day by placing the heel on the ground and the ball of the foot on the wall and leaning forward.
Tip #3: Roll plantar fascia over a can or ball. Perform for 1 minute (3 times with 30 rest in between) before going to sleep and before first steps in the morning. You can also roll over a frozen water bottle as needed for control of pain and inflammation.
Tip 4: Use the toes of the painful foot to pick up a dry paper towel, drop and repeat for 2 minutes. Also, scrunch a towel using only your toes.
Contact us today and let us get you back on your feet!
If you or someone you know is suffering from foot pain, the board-certified Doctors of Physical Therapy at Fox Physical Therapy can provide a complete evaluation, including biomechanical screening to identify deficits and underlying causes. No two people are the same and therefore it is essential to have a plan of care that is specific to your needs. Individualized treatment programs can help to relieve plantar fasciitis and prevent it from coming back.