What Is It?
The plantar fascia is an extension of the Achilles tendon that arises from the heel bone and connects with the bases of the toes. It is composed of three segments, a strong thick central portion and two weaker and thinner outer portions.
The role of the central portion is to support the arch of the foot when stationary, and provide shock absorption when moving, to take the load off the bones and joints of the foot
Plantar fasciitis is caused when the plantar fascia is exposed to too much force and starts to break down, it becomes inflamed and irritated.
How Does It Happen?
There are a number of issues which can predispose someone to developing plantar fasciitis. Stiffness through the joints in the feet and through the ankles will increase the amount of shock absorption required by the plantar fascia, which may become too great. Likewise, excessive weakness through the ankle muscles means that the plantar fascia is again required to provide more support than it can handle.
Furthermore altered foot types, (high arches and flat feet) also alter the load on the plantar fascia. A high arch foot is a poor shock absorber and transfers more load onto the heel and plantar fascia. A flat foot has less bony support, so the plantar fascia is constantly stretched as it tries to support the arches during standing, walking and running.
Other factors contributing to plantar fasciitis can be high loads of heavy impact activities i.e. running or dancing, poor footwear, and obesity.
Signs and Symptoms of Plantar Fasciitis
Usually there will be a gradual progression of pain, which is most often felt at the tip of the heel. Initially it may be worse in the morning and gradually improve with activity.
As the condition becomes worse, pain will begin to surface whenever one is weight-bearing and become worse with activity.
Diagnosis & Investigations
A thorough assessment by an experienced MD Health Physiotherapist or Exercise Physiologist should be sufficient to diagnose plantar fasciitis. Other investigations may be performed to confirm the diagnosis. Ultrasound is the most accurate means of investigation, which will identify swelling, damage and tearing in the plantar fascia.
Treatment for Plantar Fasciitis
The goal of treatment is to reduce the amount of stress being placed on the plantar fascia. An MD Health practitioner will identify any areas of deficiency in your biomechanics and draw an appropriate exercise program to remedy these issues. This may include strengthening the calf and ankle muscles, calf stretching as well as hamstring and gluteal stretches if necessary, and joint mobilisation at the foot and ankle to try and improve flexibility.
To help manage the condition early on, you may be required to rest from any activity with is directly irritating the condition.
Written by Michael Dermansky
Senior Physiotherapist and Founder of MD Health Pilates