What is plantar fasciitis?
Plantar fasciitis is the most common cause of heel pain and is caused by when a band of tissue in the foot, known as the plantar fascia, is damaged and thickens. The plantar fascia is a flat band of connective tissue that provides support for the arch of the foot and assists with the pushing off phase when walking. It extends along the base of the foot before inserting in to the base of your five toes.
What are the symptoms of plantar fasciitis?
- A severe, sharp pain when taking the first steps in the morning after a nights sleep or after period of rest.
- Most commonly pain is felt in the base of the heel but can also be felt in the arch of your foot as well.
- Gentle exercise can help to ease the pain but being on your feet or going for a long walk will often make the pain feel a lot worse, particularly the following day.
- The pain generally builds over time and whilst some describe it as a dull ache, for others it will feel sharp.
What are the causes of plantar fasciitis?
- A recent change in footwear.
- Being on your feet for long periods of time.
- Doing lots of walking, running and standing when this is not normal for you.
- If you have recently started exercising on a different surface.
- If you have been wearing shoes with poor cushioning or poor arch support – Click here to find out why wearing your flip flops can cause plantar fasciitis and many other problems!
- A sudden stretch to the sole of your foot.
- Tightness in your Achilles tendon and calf muscle.
- Being overweight can put extra strain on the muscles, tendons & ligaments of the heel.
HOW WILL PHYSIOTHERAPY HELP ME?
At Bradley Physio our physiotherapists are trained in the moulding and fitting of Bespoke Custom Made Orthotics – commonly plantar fasciitis occurs in people with overpronated or flat feet. The plantar fascia is placed under increased stretch by the tension caused through the arch of the foot. Orthotics moulded to your foot will reduce the strain placed on the plantar fascia and help to alleviate your symptoms. Click here for more details.
Specific manual therapy techniques including deep soft tissue massage, deep transverse friction massage and stretches may be used. Other treatments may include acupuncture, electrotherapy and the use of sports tape. As you improve your physiotherapist may recommend a programme of rehabilitation exercises in our on-site rehab gym as well as exercises and stretches to continue independently at home. We will aim to identify the cause of your injury and advise you on prevention in the future.
Corticosteroid Injection is a strong anti-inflammatory medicine that is injected directly into the plantar fascia. It is useful when other physiotherapy modalities are not working to relieve the symptoms. Following a thorough verbal and physical assessment your physiotherapist will explain and advise whether joint injections are likely to be helpful for you. In most cases a course of traditional physiotherapy will be undertaken first. If your symptoms fail to show signs of improvement within 2-3 sessions then the decision may be made to try a corticosteroid injection.The subsequent reduction in inflammation and pain will allow you to move more freely, strengthen the affected area and return to normal function.
What Can I Do To Help Myself?
Stretches for the sole of the foot and calf will help alleviate tightness in the lower leg…
- Stand facing a wall in a step standing position with your painful leg BEHIND you. Keep your toes pointing forwards and your heel on the floor. Lean forwards into the wall bending your front knee and KEEPING YOUR KNEE STRAIGHT. You should feel a stretch in the calf. Hold for 30 seconds and repeat 3 times. This is primarily stretching the part of the calf known as the Gastrocnemius muscle.
- Stand facing a wall in a step standing position with your painful leg IN FRONT of you. Keep your toes pointing forwards and your heel on the floor as your gently bend your FRONT knee pushing your kneecap towards the wall. You should feel a stretch in the lower calf towards the back of the ankle. Hold for 30 seconds and repeat 3 times. This is primarily stretching the part of the calf known as the Soleus muscle.
- Roll up a small hand towel to form a sausage shape. Stand on a step with your heel hanging over the edge and your rolled up towel under your toes. Sink you weight down into your heel and feel the stretch in the sole of your foot. Hold for 30 seconds and repeat 3 times.
Massage can help reduce scar tissue around the affected area…
- Whilst sitting on a chair place a golf ball, rolling pin or small bottle of frozen water in the arch of your foot. Gently roll the ball/bottle into the affected area using your body weight to increase the pressure of the massage depending on your level of pain. Continue for 5 minutes and repeat 3 times a day.
- Tissue grabbing -Start by placing a couple of tissues on the floor and then proceed to pick the tissues up one by one with your feet. Do this for two minutes twice a day.
- Calf & foot strengthening – Roll up a small hand towel to form a sausage shape. Stand on a step with your heel hanging over the edge and your rolled up towel under your toes. Slowly sink your weight down into your heel, stretching the ankle, the push up onto your tiptoes. Repeat 10-15 times, 3 times a day.
- No barefoot walking.
- Keep supportive shoes on as much as possible.
- Orthotic Insoles – Bespoke Custom Fit Orthotics can be made for you by your physiotherapist – Click here for more info.
- To manage your pain it is advised that you regularly take simple painkillers which can be bought cheaply over the counter from your pharmacist. If you have allergies or conditions which prevent the use of painkilling or anti-inflammatory medication, please seek advice from your GP or a pharmacist first.
Returning to running after plantar fasciitis
- To begin with you will jog in intervals of one minute ON A FLAT, EVEN SURFACE with two minutes of stretching your calf muscles in between. A treadmill is a good place to start.
- Repeat this up to five times to begin with so long as your level of pain doesn’t go above a 4 out of 10 (10 being the worst pain imaginable.)
- If this goes well, repeat it after a two-day rest (i.e. run on Monday and Thursday). If it is still too painful, stop running and do nothing until your next physio session.
- The running can be built up until you can complete three 15 minute runs with a pain score below 2 out of 10. Once this stage has been reached you can begin to gradually increase the distance you run.
- Once you are nearing your preferred distance on a flat surface you can start to introduce some hills and finally, eleven surfaces.
- CONTINUE WEARING YOUR ORTHOTICS & STRETCHING THE CALF MUSCLE TO PREVENT RECURRENCE.