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)
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.
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.
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