Plantar Fasciitis

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Plantar Fasciitis

Physiotherapy Treatment of Plantar Fasciitis

What is Plantar Fasciitis?

Plantar fasciitis is a common condition causing pain in the heel, which can radiate into the foot. It is typically seen in people age 40-60 but can also occur in younger people who are on their feet a lot, like athletes or soldiers. Plantar fasciitis may present in one foot or both feet. The plantar fascia or arch ligament runs under the foot from the calcaneus to the metatarsal heads at the ball of the foot. It is thought to be an inflammatory condition as well as involving some degeneration of the collagen fibres close to where the plantar fascia attaches to the calcaneus. 

A variety of causes or contributing factors exist for plantar fasciitis. Some of the most common causes include:

  • excessive weight load on the foot due to obesity or prolonged standing
  • mechanical imbalances through the joints of the foot
  • sudden increase in walking or running (overuse)
  • tight calf muscles, which also insert into the calcaneus
  • wearing shoes with poor support, including flip-flops

The most common treatments for plantar fasciitis include:

* icing the affected area

* use of custom-made orthotics with your shoes

massaging the plantar fascia

* nonsteroidal anti-inflammatory drugs (NSAIDs)

* steroid injections

* strengthening the foot and lower quadrant muscles

* wearing a night splint

* wearing shoes with arch support

* stretching the calf muscles

* physiotherapy (which often includes many of the above)

Clinical Implications:

There is no single cure for plantar fasciitis. Whilst many treatments can be used to ease pain, in order to treat it effectively long-term, the cause of the condition must be addressed. A recent randomized controlled trial (2011) investigated the effects of trigger point (TrP) therapy combined with a self-stretching program for patients with heel pain. After one month, the patients receiving a combination of calf muscle and plantar fascia stretching and TrP release had significantly greater improvements in their calcaneal pressure pain thresholds, functional and pain scores as compared to those receiving only the self-stretching program.

Physiotherapy Treatment: 

For patients presenting with plantar heel pain it is important that all contributing factors be addressed. At Corona Physio-Rehab Centre, we are able to address the biomechanical factors and provide education, custom orthotics if indicated, and personalized home programs of stretching and strengthening. We also assess the gastrocs and soleus muscles for tight bands, knots, and trigger points and treat them using various deep tissue release techniques. Dry needling has also been found to be very effective in releasing these trigger points. For further information, please contact us at the clinic and ask to speak to one of our physiotherapists.


Reference:

Renan-Ordine R et al Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial. J Orthop Sports Phys Ther. 2011 Feb;41(2):43-50. Epub 2011 Jan 31

Achilles Tendinopathy

ACHILLES TENDINOPATHY

The Achilles tendon, the largest and strongest tendon in the body, connects the calf muscles (soleus and gastrocnemius) to the heel.  The Achilles lifts us up on our toes, raising the heel, and plays a critical role in walking, running and jumping.  

Pain near the heel or along the back of the leg, tenderness on palpation of the tendon and surrounding tissues indicate an issue with the Achilles tendon.  Achilles tendinopathy more often affects athletes, for example runners, dancers, and volleyball players, but also affects sedentary adults.

Tendinopathy can result from

·       Over-use such as repetitive mechanical loads or overload in training

·       Micro-tears

·      Acute and then chronic phases of inflammatory ‘‘tendinitis’’ that lead to tendon degeneration. 

Chronic inflammation was once thought to be the cause of pain. However , no inflammatory cells are found in the area once the issue becomes a chronic problem.  When there is an increase in training load a tendon may not be able to adapt fast enough for the changes. Exceeding the strength of the tendon leads to small tears. Typically a tendon will heal and remodel. However, if the increased training continues, progressive tendon changes occur which then become symptomatic.

Additional symptoms of tendinopathy include morning stiffness and thickening of the Achilles tendon, decreased function (difficulty walking), limited range of motion (particularly dorsiflexion) and localized swelling.

Diagnostic imaging is not necessary to diagnose Achilles tendinopathy, Ultrasound (US) and MRI can verify a clinical diagnosis.  US may indicate the tendon thickening, discontinuity of fibers and changes in water content.

Age, genetics, limitations or excess in ankle joint and/or foot movement, gait disturbances (lateral heel strike with compensatory pronation), ankle instability and other biomechanical factors play a role in the development of tendinopathy.  Muscle weakness/imbalance, increases in physical load, repetitive loading, excessive force, training errors, poor training, shoes and running surface can contribute as well.

Treatments for Achilles tendinopathy include, ice, rest, anti-inflammatory agents, corticosteroids, manual therapy, exercise (stretching, eccentric loading), ultrasound, taping, orthotics, heel raise inserts, needling (acupuncture, intramuscular stimulation), low level laser therapy, and extracorporeal shockwave therapy.  Physical therapy management starts with identifying the significant contributing factors and may include any of the listed treatments. Eccentric exercises have been show to improve tendon structure and increase collagen production with both short and long term effects.

For further information, please call or email us to speak to one of our physiotherapists. 

References:

U. Fredberg1, K. Stengaard-Pedersen.  Chronic tendinopathy tissue pathology, pain mechanisms, and etiology with a special focus on inflammation. Scand J Med Sci Sports 2008: 18: 3–15

J L Cook,1 C R Purdam.  Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med 2009;43:409–416.