One of the most common sources of heel pain that we encounter in physical therapy is plantar fasciitis. The word itself implies inflammation of the plantar fascia, the thick connective tissue that supports the arch of the foot during weight bearing activities. In the PT clinic, we see both acute micro-tearing of the plantar fascia as well as chronic build up of scar tissue from repetitive injury. When the plantar fascia becomes irritated, inflamed, or weakened by injury, every step can be painful.
Causes of Plantar Fasciitis
There are a number of risk factors that can lead to plantar fasciitis including limitations in dorsiflexion range of motion (ROM) in the ankle, obesity, diabetes, improper shoe wear, and inordinately high or low arches. Studies have shown that limited dorsiflexion and high body-mass index (BMI)1 in particular are the two biggest risk factors in the development of plantar fasciitis.
Plantar fasciitis is most often seen in middle age and affects females more than males primarily because of women’s tendency to wear narrow fitting shoes and high heels. It is also a very common injury seen in runners, accounting for 8-10% of all running related injuries.
• 83% of plantar fasciitis patients are active working adults between the ages of 25 and 65 years old2
• Patients who are overweight or obese have a 1.4-fold increased probability of plantar fasciitis³
• Heel striking while running causes compression of the heel pad up to 200% of body weight.4 Runners without adequate muscle strength or flexibility can overload their plantar fascia.
When To Seek Help
Early assessment and conservative intervention, like physical therapy, is key to avoiding a long term injury and more aggressive treatments like injections or surgery. Some common early indicators of plantar fasciitis include pain with the first step in the morning, discomfort in the heel or arch with walking after prolonged sitting, or the sensation of a lump or rock in the shoe. Patients often ignore these symptoms because it is not unusual for the pain to quickly go away after the first few steps in the morning or after the first minute or two of a run. Physical therapists are experts in assessing and treating all musculoskeletal dysfunctions that cause plantar fasciitis. PTs can help to quickly alleviate the primary symptoms in the foot as well as educate patients on any compensatory movement patterns that may lead to secondary complications like knee, hip, or back pain.
What To Expect During Physical Therapy
Physical therapy should be an integral part of the treatment plan for podiatrists, orthopedists, and family medicine doctors that encounter a patient with plantar fasciitis. Physicians often treat plantar fasciitis with orthotics, NSAIDs, and/or corticosteroid injections. These treatments can certainly be helpful for patients but do not directly treat the two biggest risk factors of plantar fasciitis, limited ankle dorsiflexion ROM and a high BMI.
Physical therapists are experts in the use of manual therapy techniques to improve ROM. These include joint mobilization of the talocrural and subtalar joints, hands-on soft tissue massage of the gastroc and soleus, and other hands-on techniques for rapid improvement in heel cord and calf mobility. PTs also use their knowledge of exercise science to prescribe patient specific home programs that may address issues like high BMI, gait and movement pattern dysfunctions, muscle weaknesses, and limited flexibility.
1Irving DM, Cook JL, Young MA, Menz HB. Obesity and pronated foot type may increase the risk of chronic heel pain: a matched case-control
study. BMC Musculoskelet Disord 2007;8:41.
2Frey C, Zamora J. The effects of obesity on orthopaedic foot and ankle pathology. Foot Ankle Int 2007;28(9):996-999.
3Crawford F, Atkins D, Edwards J. Interventions for treating plantar heel pain. Cochrane Database Syst Rev 2000;(3):CD000416.
4Bencardino J, Rosenberg ZS, Delfaut E. MR imaging in sports injuries of the foot and ankle. Magn Reson Imaging Clin N Am 1999;7(1):131-149.