Plantar fasciitis
What is it?
Plantar fasciitis is a pain on the inside aspect of the heel. It is usually an overuse injury that causes inflammation of the plantar fascia at the attachment site on the heel bone.
How does it happen?
Plantar fasciitis occurs as a result of stretching or ‘pulling’ of the plantar fascia from its attachment on the heel bone. Activities such as running and dancing are commonly associated with the development of plantar fasciitis. The injury is called an overuse injury; it may happen over a long period of time before the patient decides to seek help.
How does it feel?
The pain is typically worse in the morning, with the first steps being very tender until the area warms up. Pain is worse with high impact weight bearing activities. The site of tenderness is localised to the inside aspect of the heel, and is usually described as a dull ache. Over time, combined with repetitive nature of running or walking, the inflammation can get worse and the intensity of the pain increases.
What should you do?
If you suspect you have plantar fasciitis then you should seek treatment as soon as possible. The earlier the injury is treated, the more successful the outcomes. Conservative management is indicated in the form of ice, massage, stretching, footwear modifications, heel cushioning and foot orthoses. Most importantly, the factors that have contributed to the onset of pain must be identified and modified.
What shouldn’t you do?
You shouldn’t put up with the pain in the hope it will go away. This injury is deceptive in that it warms up and you are able to walk and potentially run on the area. Unfortunately each time you run on it you are causing more problems. With time, the pain will not warm up and your injury is far harder to treat, and may take longer to respond to conservative treatment.
Could there be any long-term effects?
There could be long term problems with chronic pain in the area. A heel spur can develop secondary to the plantar fasciitis. More importantly, however, the inflammation can become chronic and may require an injection of cortisone (anti-inflammatory drug), or a surgical intervention.
Management
A Sports & Exercise Physiotherapy assessment is important in the diagnosis and management of plantar fasciitis. An accurate diagnosis is necessary to ensure successful management outcomes. This may include radiological examinations, either X-ray or ultrasound. It is important to rule out other possible differential diagnoses which affect the area of the heel. Once the extent of the injury is established, a treatment plan can be prescribed.
The treatment involves a combination of ice, massage, taping, stretching, as well as assessment and correction of biomechanical anomalies which may have caused the injury. Footwear assessment is also important in the successful treatment of plantar fasciitis. The sports and exercise physiotherapist will also be able to provide assistance in the gradual return to activities to prevent re-occurence of the injury.
Tom at Balgowlah Physio is a highly trained Sports & Exercise Physiotherapist who has had extensive experience in the treatment and management of plantarfasciitis. It is critical you have an immediate assessment if you are experiencing these symptoms to shorten the length of your rehabilitation period. To book an appointment with Tom, click here.
Brukner & Khan (2012) Clinical Sports Medicine.