Top 10 Tips For Treating Plantar Fasciitis
You wake up in the morning, the sun is shining and you are about to head out for a run or to hit the tennis courts. You swing your legs out of the bed and put your feet on the ground and BAM… searing pain in your heel. And you think “Oh no! Not me. Not Plantar Fasciitis!”
Plantar fasciitis is a common and often persistent type of repetitive strain injury afflicting runners, walkers and hikers, tennis players, and nearly anyone who stands for a long period of time especially on hard surfaces. Working on concrete, running on pavement, overtraining, excessive pronation, calf tightness, and excessive load through the foot are all risk factors. Plantar fasciitis is infamously stubborn and painful and symptoms can last a long time. But have no fear. There is help!
Some people can recover from plantar fasciitis with a little rest, arch support (regular shoe inserts or just comfy shoes), and stretching, but not everyone. Severe cases can stop you in your tracks, undermine your fitness and general health, and drag on for months if not years. If you suffer with plantar fasciitis that just won't go away, read on to see if you have tried everything below. If not, there is still hope!
What is the Plantar Fascia? The plantar fascia is like a sheet of connective tissue (fascia) that runs along the bottom of your foot. It stretches from heel to toes, and travels across the arch.
What is Plantar Fasciitis? Plantar Fasciitis is an overuse injury. The “itis” suffixes in the word fasciitis mean “inflammation,” however, there is rarely inflamed tissue (maybe at the very beginning of the injury), rather a thickening and degeneration of the tissue. It’s especially common in runners, and in menopausal women. In 2003, Lemont et al looked at 50 cases and found so little inflammation that they declared that plantar fasciitis “is a degenerative fasciosis without inflammation, not a fasciitis.” So, it would be better to use a more generic suffix — like opathy (diseased) or osis (condition). The exact pathology is not entirely understood, it is likely caused by microtearing of the fascia on the bottom of the foot, which leads to degeneration of the fascia.
Why does Plantar Fasciitis happen? Plantar fasciitis is basically caused by chronic irritation of the arch of the foot due to excessive strain. If the arch of your foot is like a bow, think of the plantar fascia as the bow’s string. The plantar fascia, along with several muscles both in the foot and in the leg, supports the arch and makes it springy. Too springy, and the foot flattens out, overstretching the plantar fascia. Not springy enough, and the plantar fascia absorbs too much weight too suddenly. Either way, it starts to burn with the strain. It causes mainly foot arch pain and/or heel pain. Morning foot pain is a signature symptom as well as heel pain after prolonged sitting.
What can Physical Therapists do to help? There are many treatment options for people suffering with plantar fasciitis.
1. Dry Needling has been shown to release tight bands of muscle tissue restoring more normal joint and tissue mobility. It can be highly effective and often has immediate and lasting results. It can be uncomfortable, but the pain relief you will experience is worth the discomfort!
2. Manual Therapy such as soft tissue or deep tissue mobilization to the foot, ankle, and lower leg can be helpful to decrease pain and increase the extensibility of the muscles and connective tissue. Many of the muscles of the plantar fasciia arise from the lower leg, so don't ignore the calves (the gastrocnemius and soleus are the bigger muscles of the calf), the posterior tibialis muscles on the inside of the lower leg and the peroneals on the outside of the lower leg.
3. Stretching: Tight calves are a contributing factor to plantar fasciitis, which can put a strain on the plantar fascia. But the fascia is one continuous connective tissue throughout the body, so stretching and doing yoga to the feet and entire body can influence your feet. You can also do toe yoga, which are specific stretches to do just for your toes! Combining the manual therapy from a Physical Therapist and stretching has been shown to get a better outcome than stretching alone.
4. Icing can help alleviate some of the pain, but it won’t cure the injury. Rolling your foot on a frozen water bottle may just feel good to you, so if it does, keep it up! You can ice up to 20 minutes a few times per day.
5. Taping: There are various taping techniques that a Physical Therapist can perform to help mitigate some of the heel pain. Low dye taping has been found to be effective in unloading the plantar fascia, which helps decrease the pain you feel!
6. Strengthening the intrinsic muscles of the foot to help restore the arch if it has flattened over time, as well as strengthening the muscles of the lower leg, hamstrings, and gluteals in the hip. Some people just do calf raises to strengthen, which is ok, but you need much more than that to balance the strength of the anterior and posterior compartments of the lower leg. So, the muscles in the front of the shin bone need to be strengthened just as much as the calves. But the hamstrings and gluteals make up the rest of the kinetic chain and are just as important to strength during walking and running and can affect the way the foot hits the ground.
7. Orthotics: a good custom or semi-custom orthotic may be just what your foot needs for a little support for a more long-term solution. If you felt relief from the low dye taping, you should have a good outcome with an orthotic.
8. Shoe Wear Modifications: You may be in a shoe that is just not for you. So seeking advice from your Physical Therapist or being fit by a specialist at a running store may be worth the visit to make sure you are in the most optimal shoe for you!
9. Running Analysis: Assess your running mechanics (if you are a runner or use running as cross training). Your running form may have issues, so having your Physical Therapist who is trained in Gait Analysis may be warranted in your treatment plan. Making simple modifications to your running form, can make a huge impact on the strain in your foot.
10. Dynamic Warmups: will get your legs ready to perform. Don't just go out for your run or jump on the tennis court without being properly prepared for the sport. This will give your body a chance to war up and stretch tight muscles, decreasing your chance of being crippled once you have finished.
Dr. Baudo Marchetti is a Board Certified Sports Clinical Specialist at One on One Physical Therapy, a multidisciplinary private practice in Atlanta. For nearly five years she was a full-time sports physiotherapist for the WTA Tour and is a tennis medicine expert. She teaches a Sports Physical Therapy course and assists in teaching orthopedics within the Division of Physical Therapy at Emory University. Learn more by visiting www.onetherapy.com.