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Foot Pain : Plantar fasciitis

by Jane Hodgson 5 October 2009


Summary:

Plantar fasciitis is the commonest overuse injury causing foot pain in middle aged to older adults. Affecting the sole of the foot it often causes heel pain, but sometimes pain is also felt on the middle or outside of the foot.

The plantar fascia is a multi layered band of fibre that runs along the sole of the foot from the heel bone to the toes. Plantar fasciitis is a painful irritation of the plantar fascia.

What are the Symptoms of Plantar Fasciitis?

  • Foot pain: Usually heel pain in the middle or on the inside of the heel, but can affect the middle of the sole of the foot as well.
  • Gradual onset: the foot pain comes on gradually over time, there usually won't be one incident that can be identified as having caused it.
  • Pain worst for the first few steps each morning or the first few steps after sitting for a prolonged period.

What Causes Plantar Fasciitis?

It is thought that plantar fasciitis is a result of repeated microtears in the tissue that occur over a prolonged period of time eventually setting up a chronic inflammation and associated pain.

Why me?- What Makes it More Likely that you will get Plantar Fasciitis

  • Excessive pronation. On every step the foot hits the floor towards the outside border of the heel, as weight is transferred onto the foot it flattens to the floor, then rolls over to the inside of the foot ready to push off through the big toe to push you forwards. People who overpronate roll further onto the inside of the foot; this increases the stress on the plantar fascia
  • Spending lots of time stood on tip toes, for instance wearing high heels. This is something know as the windlass effect whereby the plantar fascia is tightened.
  • Tightness in the achilles tendon. Attachment of the plantar fascia means that tightness in the achilles tendon adds tension to the plantar fascia. Tightness in the achilles tendon also contributes to overpronation of the foot.
  • Obesity or rapid weight gain, for instance during pregnancy, increases the strain on the plantar fascia
  • Weak peronei. These are the muscles that control the upwards and outwards movement of the foot. Weakness in them leads the foot to flatten more quickly and with less control on each step increasing the tension on the plantar fascia.
  • Underlying rheumatoid arthritis or ankylosing spondylitis increases the likelihood of getting plantar fasciitis. If you have plantar fasciitis in both feet it is worth having some blood tests to eliminate these and other rheumatic diseases as the underlying cause for the plantar fasciitis.

What's the treatment for Plantar Fasciitis?

  • Stretching exercises- often the plantar fascia and the achilles tendon require stretching
  • Strengthening exercises including ones for the peronei and muscles higher up the leg to control its rotation. We can provide an exercise programme tailored to treat your foot pain
  • Reduce the chronic inflammation - ice or a contrast of ice and heat can be helpful. Try filling an empty plastic pop bottle with water, freeze it. Place a damp tea cloth over it to prevent yourself from getting a freezer burn then roll it backwards and forwards under your foot. A corticosteroid injection can be considered, but with caution as a known risk of these is rupture of the plantar fascia.
  • Correct any underlying mechanical problems - for instance any overpronation at the foot
  • Taping- this can be useful to take the pressure off the plantart fascia and give it time to heal
  • Night splint - the first few steps each morning can often be the most painful of the day. At night the foot rests in a relaxed position with the toes pointing downwards, in this position the plantar fascia is shortened. The theory is that healing occurs overnight, when the foot is put to the floor in the morning the plantar fascia is stretched out and the new healing tears. A night splint holds the foot with the ankle at about 90 degrees so the fascia is not in a shortened position overnight.
  • Shock absorbing insoles, reduce the force transmission through each footfall.
  • Orthotics provided by a specialist podiatrist change the relationship of the foot to the floor and can take the tension off the plantar fascia.


Products

Night splints, strapping, reusable ice packs and shock absorbing innersoles are available from:

PhysioRoom

physiosupplies


 


Disclaimer: The information on this page is written to help you understand your injury. There are many possible causes for for pain and should you have any concerns you should always seek advice from a qualified health professional such as a Chartered Physiotherapist or your GP.

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About the author

Jane Hodgson - Chartered Physiotherapist Jane Hodgson Jane specialises in lower body injuries and has raced competitively in running, orienteering and adventure racing.

Did you know

Plantar fasciitis accounts for 10% of all running injuries in middle aged athletes


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