Plantar Fasciitis is a common source of heel pain that occurs when the plantar fascia becomes inflamed where it attaches to the heel.
The plantar plantar fascia is a very firm and strong layer of tissue that helps to provide stability, rigidity and elasticity to the foot.
Plantar Fasciitis usually presents with:
Localised heel pain most commonly on the inside of the heel
Pain that is aggravated by prolonged standing/ walking/ running or other weight bearing activities
Noticeable pain during the first few steps in the morning
The causes of plantar fasciitis are complex and usually involve numerous contributing factors:
Sudden increase in weight bearing activity or exercise.
Follow a prolonged period of lack of weight bearing such as illness or fracture.
Increase in carrying loads (common in military or intense manual labour jobs)
Change in footwear
Change in work/ exercise surfaces for e.g. running on concrete vs running on grass
In the vast majority of cases; weakness in the small muscles of the feet contributes greatly toward plantar fasciitis. As the muscles in the feet become weaker, the plantar fascia has to bear more load and compensate for this weakness which results in an overload leading to inflammation/ degeneration.
What about my flat feet?
About 1 in 3 people have flat feet without any issues. Therefore flat feet should be considered a variation of normal. The notion that flat feet are inherently pathological/ weak/ abnormal is very outdated and has no scientific basis. Flat feet in isolation do not cause plantar fasciitis. However flat feet as a result of an injury or paralysis may contribute to plantar fasciitis as the foot as gone through a big change in a short period of time. If you have had flat feet all your life then they are likely nothing to worry about.
What about the heel spur seen on Xray?
We used to think that heel spurs were a cause of plantar fasciitis. We now know that heel spurs are a form of soft tissue calcification that is due to either a prolonged period of inflammation or as a result of repetitive loads through the soft tissues. Therefore heel spurs are thought to be a symptom NOT a cause of plantar fasciitis. Furthermore, heel spurs are very common in the asymptomatic population (people without pain).
This is important to distinguish because many people who have difficulty recovering from plantar fasciitis blame the presence of a heel spur. Not to worry, with proper management there is a very high chance that plantar fasciitis will resolve even with a heel spur present long after recovery.
How can physio help with plantar fasciitis?
A thorough history taking and assessment to establish contributing factors.
Developing strategies to address contributing factors such as footwear, training surfaces, optimising rest between exercise and specific physiotherapy treatment (see below).
Feet strengthening exercises that are specific to the patient’s presentation.
Hands on therapy and dry needling for symptom relief.
Foot strapping in the short term to help ease pressure on the plantar fascia.
As always, if you think you have plantar fasciitis or if you are struggling to recover feel free to give us a call or message on WhatsApp for further info.
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