Plantar fasciitis

Plantar fasciitis is an extremely common condition, accounting for almost 15% of all foot related problems.

The main function of the plantar fascia is to absorb impact as you walk, acting as a kind of shock absorber. As a result, plantar fasciitis can make walking, standing, and most daily activities difficult. 

What are the symptoms of plantar fasciitis?

  • Pain, usually on the bottom of the foot around the heel. It may extend further down the foot, towards the toes, in more severe cases. It is the worst when waking up in the morning, and goes down after taking a few steps. There is a dull ache and stiffness in the foot at the end of the day, and in severe cases there may be pain after sitting for a long time.
  • Swelling around the heel.
  • Stiffness in the foot, and difficulty especially while pulling the toes towards you.

What causes plantar fasciitis?

 The pain is typically very severe while taking the first few steps in the morning, and may dissipate as you walk. It is a result of inflammation of the plantar aponeurosis, a thick band of tissue on the bottom of the foot, running from the heel to the base of the toes.

In some cases, it occurs when a small spur of bone develops on the heel, irritating the aponeurosis. However, it can occur in the absence of a spur. Some other causes can be

  • Obesity.
  • Prolonged standing, running and walking.
  • Improper shoes that do not support the foot while playing sports, etc.
  • Biomechanical abnormalities of the foot; excessively high/low arches, pronated feet (heel turned outwards).
  • Thinning of the fat pad that cushions the heel (occurs as we age).
  • Tight muscles in the back of the thighs and calves.
  • Weak muscles in the front of the leg and foot.

What are the treatments for plantar fasciitis? 

 Most patients gain relief from conservative treatments, and surgical options are reserved for cases that fail to resolve with conservative treatment for a long period of time.

Physiotherapy modalities such as Extracorporeal Shock Wave Therapy (ESWT) can be used in cases where a heel spur is the cause of the plantar fasciitis.

What does physiotherapy do for plantar fasciitis?

  • Pain Relief: Modalities like ultrasound or laser may be used. Icing the area after exercise and activity is also helpful.
  • Stretch: The muscles behind the ankle and the plantar fascia itself. Deep friction massage and self-release techniques are taught to you to perform on the arch of the foot.
  • Strengthen: The muscles that support and stabilise the ankle and arch of the foot.
  • Correct: The biomechanical factors that could be the cause of the irritation to the fascia.
  • Devices: Your physiotherapist may ask you to wear a splint at night, place insoles or silicon heel pads in your shoes, or apply tape to the leg and heel. These are intended to protect the tissues.

Complete relief can be obtained, although it may take weeks to several months. Adhering to the home program is extremely important, along with consistently using the orthotics prescribed.

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