Physiotherapy Rehabilitation of Plantar Fasciitis
Plantar fasciitis is an uncommon but disabling condition which results in pain under the inner side of the heel on weight bearing and may result from inflammation of the insertion of the plantar fascia onto the spur under the heel bone. The heel spur may be connected to the pain but many people have heel spurs on x-rays without any symptoms, while plantar fasciitis can occur in the absence of a heel spur. This condition is most often reported in athletes but can occur in people of any degree of activity. The plantar fascia is a thickened band of fibrous material which runs from the heel spur area under the heel bone forwards to the forefoot.
The plantar fascia acts like a rope support along the longitudinal arch of the foot, absorbing some of the stresses suffered as the foot hits the ground, reducing the levels of force exerted by the body weight. Symptoms are typically an intense, sharp and often sudden onset, pain under the heel on weight bearing, often worse on the first few steps of the morning. Pain and a dull ache in the area may persist throughout the day if the person has spent much time standing. Exercise and movement may improve the symptoms but they return after a period of rest or immobility.
The physiotherapist can usually elicit the pain by palpating firmly over the inside of the centre of the underside of the heel, while pulling the toes up or walking on tiptoe may also bring on the typical symptoms. Athletes who increase their sporting intensity in some way are most at risk of developing this problem, with hard surfaces, poor or worn footwear and speed work all increasing the likelihood of heel pain. Physiotherapy assessment will involve looking at the anatomical structure of the patient''s foot, looking for abnormalities such as flat foot, high arches, and overpronation of the foot in gait, all which may increases the stresses through the plantar fascia.
The calf muscles may also be tight, reducing the amount that the foot can be pulled upwards in the action known as dorsiflexion, or can be weaker than expected. The fatty padding of the heel is protective of fasciitis but thins with age, increasing the risk of pain. Physiotherapy involves stretches or strengthening to the calf, corrective insoles, frictions to the painful area and ultrasound. Severe cases may need ultrasound guided injections or surgical release of the plantar fascia.
Author: Jonathan Blood-Smyth