By Sarah Ryerson, PT, ATC, CSCS for Athletico Physical Therapy
Plantar fasciitis is one of the most common causes of heel pain. This condition impacts the plantar fascia, which is a thick band of fibrous connective tissue on the bottom of the foot that extends from the heel to the toes. Based on its location and makeup, the plantar fascia is ideally positioned to maintain and support the arch on the bottom of the foot. However, it is not designed to be the primary stabilizing structure.
Both muscles and tendons of the foot perform a primary stabilizing role, but weakness or dysfunction of these muscles can increase demand on the plantar fascia. This may lead to the characteristic heel pain experienced by those dealing with plantar fasciitis. This heel pain results from increased tension in the plantar fascia pulling on the attachment site at the heel when the foot is loaded with weight bearing. In addition, the plantar fascia can become inflamed or tight for a number of other reasons, including prolonged standing, beginning a fitness program or activity with increased weight bearing demands, calf tightness, decreased ankle dorsiflexion range of motion, increased BMI, or a high or low arch.
Poor running mechanics, change in activities or footwear, and dysfunction in the muscles of the hip or leg may also result in gait alterations and weight bearing that can lead to increased demand on the plantar fascia. Therefore, if plantar fasciitis symptoms become chronic or fail to resolve, an evaluation by a physical therapist to determine the underlying cause(s) is recommended.
Common characteristics of plantar fasciitis include:
- Heel pain at attachment of the plantar fascia
- Heel pain associated with initial ambulation in the morning or after prolonged sitting
- Increased pain with walking, especially barefoot and standing
Plantar fasciitis is most prevalent in athletes, commonly runners, as well as sedentary, overweight individuals. The condition also commonly occurs in patients with either flat or high arches, and is frequently associated with decreased ankle range of motion, poor calf flexibility, and decreased foot and ankle strength. In addition, plantar fasciitis is commonly noted in populations with decreased hip strength and lower extremity stability, as well as those with alterations in gait or weight acceptance on the foot.
What can a physical therapist do for patients with plantar fasciitis?
Fascia mobilization – Mobilization of the fascial adhesions on the plantar surface of the foot is essential to remodel scar tissue and improve pliability for weight bearing demands. While ball rolling on the bottom of the foot to address muscle tension can assist with mobility, it usually is not deep enough to localize restrictions. Not only can a therapist more specifically target primary restricted regions, but he/she also can address limitations in ankle and foot mobility prohibiting the foot from adapting to the ground for even weight distribution with walking.
- Graston/ASTYM – Graston Technique® and ASTYM® are both methods of instrument assisted soft tissue mobilization that use uniquely crafted tools designed to target connective and soft tissue restrictions in the body. A physical therapist trained in one of these techniques can directly localize restricted regions to remodel the scar tissue causing stiffness, limited mobility and chronic pain. Improving mobility and pain will serve to restore function of the foot.
- Dry Needling – Dry needling is a form of trigger point therapy intended to release restrictions in muscles that result in pain and altered movement. While the plantar fascia is not directly treated, addressing “knots” in proximal calf and hamstring muscles provide favorable benefits.
- Evaluation of running/walking mechanics – Physical therapists are trained to not only recognize muscle weaknesses and imbalances during a typical evaluation, but also to understand how these deficits can impair the functions of walking or running. An analysis of muscle function enables a physical therapist to prescribe exercises addressing observed deficiencies. Exercises that are functional more directly treat how the body performs as a unit during activities.
- Low-Dye or Kinesiotaping – Low-Dye is a form of taping that prevents flattening of the arch, which can offer support and therefore pain relief to the plantar fascia during weight bearing activities. Kinesiotaping is a rehabilitative taping technique that uses uniquely manufactured tape to promote the natural healing process of the body by providing muscle support. This helps to improve function without limiting natural mobility. Patients who have an improvement with taping may also benefit from orthotics.
- Selection and instruction in exercises to target muscle tightness and weaknesses – As the entire lower extremity chain must control and coordinate mechanics for walking, a thorough evaluation of the hip, knee, ankle and foot is necessary. Proximal hip strength and stability deficits may result in increased weight bearing demands on the foot and restrictions in tissue mobility can alter how the foot strikes the ground and therefore adapts to weight demands. Additionally, as foot and ankle strength deficits and limited ankle range of motion may be primary contributing factors to plantar fasciitis, appropriately targeting these causes is essential to long-term management.
- Shoe wear recommendations – While individuals having either low or high arches can develop plantar fasciitis, the choice of appropriate shoe wear can differ vastly. A therapist can not only evaluate how your foot accommodates to the ground, but also offer shoe recommendations to reduce pain with walking and standing.
If you have symptoms of plantar fasciitis, schedule an appointment at a nearby Athletico clinic today so our experts can provide treatment recommendations and help you get back to doing the things you love to do.
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