Plantar Fasciitis and Conservative Treatment

Plantar fasciitis is the most common foot condition treated by healthcare providers today. It has been estimated that plantar fasciitis effects approximately 2 million individuals each year, and will effect over 10% of the population over one’s lifetime.

Plantar fasciitis, as it is most commonly diagnosed, is local irritation, microtears, or tensile overload with/without inflammation to the plantar aponeurosis of the foot.

The plantar aponeurosis, or better known as the plantar fascia, is one of the many passive structures within the foot that provides support to the medial longitudinal arch. It is comprised of three separate bands, a medial, central, and lateral band. The most common site of patient reported pain is usually at the medial tubercle on the plantar aspect of the heel, or calcaneus, which is the origin of the central band of the plantar fascia.

The specific cause of plantar fasciitis is poorly understood; however, there are many risk factors and impairments that have been strongly associated with plantar fasciitis. Most commonly, individuals report plantar fasciitis pain after a period of increased or unaccustomed activity, especially after a period of inactivity. This could be after partaking in more vigorous activity, increasing your running/walking mileage, or simply increasing the time spent on your feet everyday at work. Additional risk factors include a body mass index between 25-30kg/m2, limited dorsiflexion range of motion, and running.

So you think you have plantar fasciitis, now what?

The good news is that over 90% of those diagnosed with plantar fasciitis will recover in 6-12 months with conservative treatment.

There are a host of conservative treatment options available that are strongly supported in the literature for treating plantar fasciitis. The first would be to seek out your local orthopedic physical therapist! A physical therapist can perform a host of manual therapy techniques, such as joint and soft tissue mobilizations to decrease pain and improve function.

He or she might perform soft tissue mobilizations to your calf to improve dorsiflexion range of motion, or joint mobilizations to your foot and ankle to ensure that there is adequate joint motion. Inadequate joint motion means that other structures in your foot must compensate for the increased demand, and many times that structure is the plantar fascia.

A physical therapist can also deliver medications directly to your area of pain, such as dexamethasone or acetic acid via iontophoresis, to provide short-term pain relief. Additionally, a physical therapist can utilize taping techniques or design custom orthotics to complement their manual interventions to treat your plantar fasciitis. The goal of taping techniques and orthotics are to decrease abnormal foot pronation, which is thought to increase the stress placed on the medial longitudinal arch.

While direct evidence to establish an association between plantar fasciitis and abnormal foot motion is inconclusive, there is strong clinical support for the use of taping and foot orthotics for short-term reduction in pain as well as improvement in function.

If you can’t see a physical therapist, there are still plenty of things you can do at home to treat your plantar fasciitis. The first, and easiest thing to do at home, is to stretch your calf and plantar fascia. Plantar fascia-specific self-stretches and calf stretches are easy to implement and have been shown to provide short-term pain relief.

Calf stretching is important because not only do tight calves limit dorsiflexion range of motion (which is a risk factor for the development of plantar fasciitis itself), but there is also a soft tissue connection between the Achilles tendon and the plantar fascia.

Thus, calf and Achilles tendon tightness can translate into plantar fascia tightness as well.

Stretching should be implemented at least two to three times per day. Calf and plantar fascia stretches can either be held for sustained or intermittent stretching times as neither dosage demonstrates a better effect in the literature.

Furthermore, night splints should be considered for those who have had symptoms longer than 6 months. When we sleep, our feet are in a slightly plantarflexed (toes pointed down) position; thus, our calf muscles are in a shortened position. This is counterproductive to the stretching we are doing during the day! Night splints keep the foot in a neutral position, which can limit adaptive shortening of the calf muscles, as well as improve pain with the first step in the morning.

There are a host of non-operative treatment options available to decrease pain and improve function related to plantar fasciitis. As mentioned earlier, 90% of patients diagnosed with plantar fasciitis will recover in 6-12 months utilizing many of the non-operative treatment methods outlined in this article. If your pain or function doesn’t improve, see your local physical therapist (if you haven’t already) and seek a consultation.

 

 

References
Brantingham, James W., Debra Bonnefin, Stephen M. Perle, Tammy Kay Cassa, Gary Globe, Mario Pribicevic, Marian Hicks, and Charmaine Korporaal. “Manipulative Therapy for Lower Extremity Conditions: Update of a Literature Review.” Journal of Manipulative and Physiological Therapeutics 35.2 (2012): 127-66.
Irving, D.b., J.l. Cook, and H.b. Menz. “Factors Associated with Chronic Plantar Heel Pain: A Systematic Review.” Journal of Science and Medicine in Sport 9.1-2 (2006): 11-22.
Martin, Robroy L., Todd E. Davenport, Stephen F. Reischl, Thomas G. Mcpoil, James W. Matheson, Dane K. Wukich, Christine M. Mcdonough, Roy D. Altman, Paul Beattie, Mark Cornwall, Irene Davis, John Dewitt, James Elliott, James J. Irrgang, Sandra Kaplan, Stephen Paulseth, Leslie Torburn, James Zachazewski, and Joseph J. Godges. “Heel Pain—Plantar Fasciitis: Revision 2014.” J Orthop Sports Phys Ther Journal of Orthopaedic & Sports Physical Therapy 44.11 (2014): A1-A33.

 

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