Plantar fasciitis: What is it?
Plantar fasciitis may be referred to as plantar fasciitis, plantar heel pain, plantar fascial fibromatosis, among others. This is confirmed through both clinical presentation and histological analysis which demonstrates plantar fascia fibrosis, collagen cell death, vascular hyperplasia, random and disorganised collagen, and avascular zones.
The Cause of Plantar fasciitis?
There are different causes such as:
- Neurological – abductor digiti quinti nerve entrapment, lumbar spine disorders, problems with the medial calcaneal branch of the posterior tibial nerve, tarsal tunnel syndrome.
- Soft tissue – Achilles Tendinopathy, fat pad atrophy, heel contusion, plantar fascia rupture, posterior tibial tendonitis, retrocalcaneal bursitis
- Skeletal – Sever’s disease, calcaneal stress fracture, infections, inflammatory arthropathies, subtalar arthritis.
- Miscellaneous – metabolic disorders, osteomalacia, Paget’s disease, sickle cell disease, tumors (rare), vascular insufficiency, Rheumatoid arthritis
How can physiotherapy help treat Plantar fasciitis?
The most common treatments include stretching of the gastro/soleus/plantar fascia, orthotics, ultrasound, acupuncture, iontophoresis, night splints, and joint mobilisation/ manipulation.
Strength training: high-load strength training appears to be effective in the treatment of plantar fasciitis. High-load strength training may aid in a quicker reduction in pain and improvements in function.
Stretchingconsists of the patient crossing the affected leg over the contralateral leg and using the fingers across to the base of the toes to apply pressure into toe extension until a stretch can be felt along the plantar fascia.
Mobilisations and manipulationshave also been shown to decrease pain and relieve symptoms in some cases. Posterior talocrural joint mobs and subtalar joint distraction manipulation have been performed with the hypomobile talocrural joint.
Posterior-night splintsmaintain ankle dorsiflexion and toe extension, allowing for a constant stretch on the plantar fascia.
Foot orthoses produce small short-term benefits in function and may also produce small reductions in pain for people with plantar fasciitis, but they do not have long-term beneficial effects compared with a sham device whether they are custom made or prefabricated.
Recommended exercise programme:
To discuss with physiotherapist at appointment:
- Prone hip extension: Patient should lie on the stomach with legs straight out behind the patient. Then, will fold the arms under the head and rest the head on the arms. Then should draw the belly button in towards the spine and tighten the abdominal muscles. Tighten the buttocks and thigh muscles of the leg on the injured side and lift the leg off the floor about 8 inches. Keep the leg straight. Hold for 5 seconds.
- Side-lying leg lift: Patient should lie on the uninjured side. Tighten the front thigh muscles on the injured leg and lift that leg 8 to 10 inches (20 to 25 centimeters) away from the other leg. Keep the leg straight and lower it slowly.
- Frozen bottle roll: Roll bare injured foot back and forth from the heel to the mid-arch over a frozen water bottle.
- Standing calf stretch: Stand to face a wall with hands on the wall at about eye level. Keep injured leg back with the heel on the floor. Keep the other leg forward with the knee bent. Turn the back foot slightly inward. Slowly lean into the wall until feeling a stretch in the back of the calf. Hold the stretch for 15 to 30 seconds.
- Seated plantar fascia stretch: Sit in a chair and cross the injured foot over the knee of the other leg. Place fingers over the base of toes and pull them back toward the shin until feeling a comfortable stretch in the arch of the foot.
- Plantar fascia massage:Sit in a chair and cross the injured foot over the knee of the other leg. Place the fingers over the base of the toes of the injured foot and pull the toes toward your shin until you feel a stretch in the arch of the foot. With the other hand, massage the bottom of the foot, moving from the heel toward the toes.
- Achilles stretch:Stand with the ball of one foot on a stair. Reach for the step below with the heel until feeling a stretch in the arch of the foot. Hold this position for 15 to 30 seconds and then relax.