Despite containing “itis”, plantar fasciitis in the foot is characterised by the absence of inflammatory cells and hence it is considered degenerative and not an inflammatory condition. Therefore, faciosis and fasciopathy are commonly used to refer to this condition.
What are the symptoms?
The condition is characterised by first step pain in the morning (due to the ligament having become over-stretched from activity the previous day) and pain during weight-bearing tasks, especially after periods of rest.² Pain is usually stabbing, a dull ache or throbbing and is non-radiating, as well as tenderness found on palpation of the plantar fascia.³ (Palpation is a method of feeling with the fingers or hands during a physical examination.)
More about the plantar fascia
The plantar fascia plays an important role in the normal biomechanics of the foot. (Biomechanics related to the structure, function and motion of your body parts.) This band of tissue connects your heel bone to your toes and acts as a kind of ‘bow string’ underneath the foot to create shock absorption by supporting the arch.¹
Factors that may cause plantar fasciitis
- Age – this most commonly occurs in people aged between 40 and 60.
- Sport – those more prone to plantar fasciitis are long-distance runners, ballistic jumpers, ballet and aerobic dancers.
- Foot biomechanics
- A flattened arch or flat feet means the fascia is continually stretched;
- High foot arches can lead to a shortened plantar fascia; and
- Incorrect walking patterns can also contribute to this.
- Obesity – excessive weight increases the load on the foot resulting in an increase in the tension of the plantar fascia.
- Occupation – any occupation where increased standing occurs may lead to a dysfunction in the plantar fascia.
Diagnosis
Diagnosis is made by a physiotherapist taking a thorough history which focuses on the onset, nature, intensity and severity of the pain. Your physiotherapist will do the following:
(a) a physical examination which will include palpation of the plantar fascia and surrounding structures;
(b) the Silfverskiöld test to assess the muscle length of the calf muscle;
(c) the Windlass test which evaluates the functioning of the plantar fascia; as well as
(d) other tests necessary to rule out a differential diagnosis.⁴
How to treat plantar fasciitis
Physiotherapy is recommended for the management of plantarfaciosis.⁵ Treatment includes education with regards to footwear, activity modification and prognosis, taping to offload the plantar fascia, stretching of the plantar fascia and surrounding musculature, manual therapy, strengthening to prevent re-occurrence of the injury and shock wave therapy as indicated.⁶
A programme of stretches helps with tight muscles, as well as correcting the foot bio-mechanics. In addition, strengthening the muscles around the pelvis, hip and knee will help patients to change poor walking habits.
Other help includes supportive taping of the plantar fascia, recommending compression socks at night time and advice on correcting footwear to allow for good arch support.
Self-treatment includes stretching the arches and wearing shoes with adequate arch support.
References
- Buchanan BK, Kushner D. Plantar fasciitis. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431073/
- Morrissey D, Cotchett M, J’Bari AS, Prior T, Griffiths IB, Rathleff MS, et al. Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. British Journal of Sports Medicine [Internet]. 2021 Mar 30;55(19):1106–18.
- Trojien T, Tucker AK. Plantar Faciitis. American Academy of Family Physicians. 2019 November 2019;99(12) 744-750
- Thompson J, Sundeep S, Reb C, Daniel J. Diagnosis and Management of Plantar Faciitis. The Journal of the American Osteopathic Association. 2014 December,14(12) 900-906.
- Rhim HC, Kwon J, Park J, Borg-Stein J, Tenforde AS. A Systematic Review of Systematic Reviews on the Epidemiology, Evaluation, and Treatment of Plantar Fasciitis. Life. 2021 Dec;11(12):1287.
- Lau M. Plantarfaciitis Exercises. Available from https://theprehabguys.com/plantar-fasciitis-exercises/ [Last accessed 11/07/2024].