What is Plantar Fasciitis (Heel Pain)?
Plantar fasciitis is a very common cause of inferior heel pain that can be triggered and aggravated by prolonged standing, walking, running and obesity, among other factors. Treatments are largely noninvasive and efficacious. Supportive treatments, including the plantar fascia-specific stretch, calf stretching, appropriate orthotics and night dorsiflexion splinting, can alleviate plantar fascia pain.
Females are more commonly affected compared to males. The patient usually presents with gradual onset of pain over the medial side of the plantar heel that is most noticeable when taking the first few steps in the morning. The pain may get better after a short period of walking, but returns when performing activities that involve prolonged weight-bearing, such as standing, walking or running. The patient may also complain that heel pain worsens after repeat weight-bearing following a period of rest, such as standing after a period of sitting at a desk.
What are the Symptoms of Plantar Fasciitis?
The patient usually presents with gradual onset of pain over the medial side of the plantar heel that is most noticeable when taking the first few steps in the morning. The pain may get better after a short period of walking, but returns when performing activities that involve prolonged weight-bearing, such as standing, walking or running. The patient may also complain that heel pain worsens after repeat weight-bearing following a period of rest, such as standing after a period of sitting at a desk.
Diagnosis of Plantar Fasciitis (Heel Pain)
Plain film x-rays of the foot are of little benefit in typical cases of plantar fasciitis, although they may be helpful in ruling out other pathology.
Physical examination in a patient with plantar fasciitis shows localized tenderness on the anteromedial aspect of the heel; firm finger pressure is often necessary to localize the point of maximum tenderness. Slight swelling in the area is common. Tightness of the Achilles tendon (dorsiflexion at the ankle limited by 5 degrees or more) is found in 78% of patients.
Who gets Plantar Fasciitis?
Risk Factors
Any factor that mechanically loads the plantar fascia can be considered a risk factor for plantar fasciitis. Risk factors can be divided into intrinsic and extrinsic factors. Intrinsic factors relating to the patient include obesity, pes planus, pes cavus, reduced range of ankle dorsiflexion and tight calf muscles. Extrinsic factors, relating to the environment and training, include running on hard surfaces, walking barefoot, a sudden increase in running intensity and/or volume, and prolonged walking/standing.
Principal risk factors associated with Plantar fasciitis.
| Principal risk factors | Causes | |
|---|---|---|
| Intrinsic | Anatomic risk | Pes planus |
| Pes cavus | ||
| Overpronation | ||
| Leg-length discrepancy | ||
| Excessive lateral tibial torsion | ||
| Excessive femoral anteversion | ||
| Overweight | ||
| Functional risk | Gastrocnemius and soleus muscles tightness | |
| Achilles tendon tightness | ||
| Gastrocnemius, soleus and intrinsic foot muscles weakness | ||
| Degenerative risk | Aging of the heel fat pad | |
| Atrophy of the heel fat pad | ||
| Plantar fascia stiffness | ||
| Extrinsic | Overuse | Mechanical stresses and microtearing |
| Incorrect training | A too-fast increase in the distance, intensity, duration or frequency of activities that involve repetitive impact loading of the feet. | |
| Inadequate footwear | Poorly cushioned surface | |
| Inappropriate replacement of shoes | ||
Physical Therapy Management of Plantar Fasciitis
Treatment is largely nonoperative, with 90%–95% of patients experiencing resolution of symptoms within 12–18 months.
Ice Massage
Ice massage can also help to reduce plantar fascia pain. One method involves rolling a frozen can under the foot with moderate pressure for five to ten minutes at the end of each day
Plantar fascia and Calf Stretch
Plantar fascia and calf stretches are inexpensive and easy to learn. The plantar fascia-specific stretch is performed by dorsiflexing the toes with one hand (taking advantage of the windlass mechanism) and palpating the plantar fascia with the other hand to ensure that it is taut. The stretch is held for a count of 30 seconds and repeated at least three times in each session. This should be done daily, especially before taking the first step in the morning and before standing following a period of prolonged sitting.
ESWT
This treatment has been shown to be efficacious for patients with chronic plantar fasciitis that did not respond well to conservative treatment. ESWT is a noninvasive procedure that takes about ten minutes per treatment; the patient usually requires two treatments spaced one week apart for optimal efficacy
Taping
Taping is purported to facilitate and inhibit muscle activity. It corrects muscle function, causes lifting of the skin, provides space for lymphatic fluid movement, and relieves abnormal muscle tension. Taping is effective to reduce the pressure and stress on the plantar fascia.
Physiotherapist
Nerve Mobilization Technique
Soft-Tissue Mobilization Technique
Cardiac Rehabilitation Physiotherapy
Sports Taping Technique
Proprioceptive Neuromuscular Facilitation (PNF) Therapy
Registered Physiotherapist (DHCC, UAE)
Registered Physiotherapist (South Korea)
References
- Management of plantar fasciitis in the outpatient setting
Singapore Med J. 2016 Apr; 57(4): 168–171 Ang Tee Lim, MSpMed, MMed,1 Choon How How, MMed, FCFP,2 and Benedict Tan, MSpMed, FAMS1 - Evaluation of plantar fascia using high-resolution ultrasonography in clinically diagnosed cases of plantar fasciitis
Purnima Aggarwal, Vivek Jirankali, and Sudhir K. Garg - Plantar fasciitis in athletes: diagnostic and treatment strategies. A systematic review Muscles Ligaments Tendons J. 2017 Jan-Mar; 7(1): 107–118. Federica Petraglia,1 Ileana Ramazzina,2 and Cosimo Costantino3
- Ultrasonography and clinical outcome comparison of extracorporeal shock wave therapy and corticosteroid injections for chronic plantar fasciitis: A randomized controlled trial
Ta-Wei Lai,1 Hsiao-Li Ma,3 Meng-Shiunn Lee,4 Po-Ming Chen,5 and Ming-Chou Ku6 - Talagia: plantar fasciitis
Ricardo Cardenuto Ferreira - Pain on the Plantar Surface of the Foot Dtsch Arztebl Int. 2019 Feb; 116(6): 83–88. Natalia Gutteck*, PD Dr.,1,2,* Sebastian Schilde*, ,1,2 and Karl-Stefan Delank, Prof.2
- Early-Application Extracorporeal Shockwave Therapy for Plantar Fasciitis in a Chiropractic Clinic: A Case Report
Kily Tracy, DC and Jonathan B. Slater, DC, CCSP, EMT - Short-Term Efficacy of Kinesiotaping versus Extracorporeal Shockwave Therapy for Plantar Fasciitis: A Randomized Study
Nihal Tezel, Ebru Umay, Musa Bulut, and Aytul Cakci - Clinical review Plantar fasciitis BMJ 1997;315:172–175
Dishan Singh, John Angel, George Bentley, Saul G Trevino
