The plantar fascia is a flat band of tissue that connects the heel bone to the toes. It is the most common cause of heel pain in adults, affecting both active and non-active men and women. The term fasciitis implies inflammation but research has shown that plantar fasciitis is actually a degenerative condition characterized by micro-tears and thickening of the plantar fascia. It’s almost always triggered by an overload injury which occurs due to various biomechanical and lifestyle factors. Constant overload of plantar tissues overwhelms the body’s normal repair process and results in degeneration, thickening and loss of elasticity in the tissue and a cycle of increasingly painful scar tissue.
What are the Signs & Symptoms of Plantar Fasciitis?
Insidious onset (comes on gradually).
Pain is often localized to the inner aspect of the heel (the insertion of the plantar fascia).
Direct pressure on this area will typically cause pain.
Pain may be throbbing, searing or piercing.
Pain may also be felt into the arch, along the course of the plantar fascia.
Pain is worse with the first few steps in the morning or after periods of rest.
Pain may increase with: barefoot walking, stairs, squats, running or prolonged standing.
Associated tension may be felt in the bottom of the foot or calves.
Risk factors/Common Causes:
The cause of plantar fasciitis is still not fully understood and is considered to be caused by a number of different factors. There are numerous risk factors though the overall importance of these risk factors remains unclear. Risk factors may include:
Being overweight and often during pregnancy.
Pes planus (flat foot).
Pes cavus (high arch).
Limited ankle dorsiflexion (ankle motion that occurs when you pull your toes to your shin).
Sudden increase in intensity or frequency of weight bearing activities.
Change in training surface.
Is Heel Pain Always Plantar Fasciitis?
The diagnosis of plantar fasciitis will be made based on an in-depth history and physical examination. The chiropractors at Mountain Health & Performance are skilled in the diagnosis and management of neuromusculoskeletal conditions including plantar fasciitis. We will provide a specific tissue diagnosis and develop a custom treatment plan for your plantar fasciitis or other foot-related pain. Ultrasound or MRI can also be used to confirm a clinical diagnosis of plantar fasciitis, but is typically only recommended after conservative treatments have failed and/or the condition has become very chronic. Many conditions can mimic or appear very similar to plantar fasciitis so it’s important to avoid self-diagnosis or self-treatment. The list below includes common conditions which can involve signs and symptoms similar to those associated with plantar fasciitis.
Lumbar spine disorders (radiculopathy).
Medial calcaneal nerve entrapment.
Tarsal tunnel syndrome.
Fat pad syndrome.
Heel contusion or bone bruise.
Posterior tibial tendinitis.
Calcaneal stress fracture.
Heel spurs: What are they? How do they relate to Plantar Fasciitis?
A heel spur is a calcium deposit which causes a bony protrusion on the underside of the heel bone. Heel spurs are often painless but in some cases are associated with heel pain and or plantar fasciitis. Research has found an association between heel spurs and heel pain however the presence or absence of a heel spur is not helpful in the diagnosis of plantar fasciitis and the extent to which heel spurs actually cause pain is unknown. If you are suffering from heel pain and have a known heel spur it’s worthwhile seeking opinion of a manual medical practitioner to explore conservative treatment options.
Fallen arches: Are flat feet to blame for plantar fasciitis?
Pes planus is the medical term, which describes flat feet or fallen arches. It is a common condition that may or may not lead to pain or injury. Pes planus can be structural (from birth) or functional (acquired later in life). Various conditions can lead to a functional flat foot including: posterior tibial tendon dysfunction, ligament tears, fractures, degenerative joint conditions and pregnancy. A person may also appear to have a normal arch when seated but have excessive inward rolling in a standing position. This inward rolling is called over pronation. Pes planus (flat feet) and over pronation have both been identified as risk factors for plantar fasciitis. Pes cavus (a high arch) is also a risk factor for plantar fasciitis so it is unknown exactly why both of these foot types are related to developing the condition.
Treatment for Plantar Fasciitis: How the Mountain Health and Performance team can help!
1. Active Release Technique (ART) and Functional Range Release (FR):
These myofascial release techniques are utilized to address any abnormal soft-tissue tension associated with plantar fasciitis. As indicated in the research the calf muscles are commonly tight and are thought to negatively impact ankle and foot mechanics as well as compressing nerves that provide sensation to the sole of the foot. There may be other areas of tension (foot, hamstrings, hips) that also require treatment in order to improve joint and tissue function.
Limited ankle dorsiflexion (bringing toes up to the shin) is also associated with plantar fasciitis. Ankle dorsiflexion can be limited by tight calves but may also be related to stiffness in the ankle joint. In this case manipulation and or mobilization of the ankle is the best way to improve joint range of motion and normalize ankle and foot mechanics. Research, and our experience, show that the addition of ankle mobilization to a plantar fasciitis-specific exercise plan produces faster improvements in pain and disability in patients suffering from plantar fasciitis.
3. Laser Therapy:
At Mountain Health and Performance we offer class IV laser therapy, which helps to stimulate deep tissue healing on a cellular level. When targeting the plantar fascia laser therapy can help to increase energy for cellular healing. It also improves blood flow, which increases the amount of oxygen and nutrients delivered to the damaged tissue in order to speed healing and tissue regeneration.
The Best Exercises for Plantar Fasciitis:
Unfortunately there is no best exercise(s) for any specific injury or condition. We are all unique and any good rehabilitation plan will always be specific to the individual patient and various factors including: occupation, exercise goals, age, and overall joint and tissue function. We know that flat feet and a high arches are often associated with plantar fasciitis. Both foot types can be susceptible to weakness or lack of control of the muscles in the arch (intrinsic foot muscles). These muscles are critical for stabilizing the foot and are commonly weak in patients with plantar fasciitis. Strengthening the arch is therefore an important part of rehabilitating plantar fasciitis. Stretching of the different muscles in the calves, the hamstrings and the plantar fascia has also been shown to improve pain associated with plantar fasciitis.
Since plantar fasciitis is a degenerative condition it’s also important to load the plantar fascia with specific exercises in order to strengthen and normalize the damaged tissue. Strength training exercises have been shown to produce faster improvements in pain vs. stretching alone in the short-term (after 3 months). In the long-term strengthening exercises produced equivalent results to stretching; which demonstrates the importance of including both stretching and strengthening in a plantar fasciitis rehab plan. Strengthening exercises will be done slowly and gradually as not to aggravate the injury- and will be specific to the individual patient and stage of treatment.
Though the research has found various biomechanical risk factors/potential causes of plantar fasciitis each person is unique and will require a specific treatment plan. Treatment (including rehabilitation) is based on lifestyle factors, the chronicity of the condition and on the results of an in depth history and physical examination. Doctors of Chiropractic are primary health care providers and skilled in the diagnosis and management of musculoskeletal conditions. As plantar fasciitis becomes more chronic it becomes much harder to treat/recover from so getting a quick diagnosis and on the right treatment plan is key!