Plantar Fasciitis | Plenty Physiotherapy, Bundoora

Plantar Fasciitis Document

Plantar fascia is an overuse-related  irritation and micro-tearing of the thick  fibrous band connecting the heel bone  (calcaneus) to the toes. It is often degenerative (plantar fasciopathy) rather  than purely inflammatory. - It’s the most common cause of heel  pain in adults. - Prevalence: ~10% of people at some point; higher in runners, standing workers,  and those with reduced ankle mobility.  Contributing factors: A) Overload: Having an accumulation or  sudden increase in physical  activities/high-impact activities such  as running on hard surfaces or  standing for long periods of time for  work can place an incredible amount  of increased stress through the foot,  the plantar fascia. This can irritate the structure and cause  inflammation and pain, as well as create microtraumas to the tissue.  B) Poor footwear/ mechanics: a. Overpronation (flat feet) b. Reduced Ankle Dorsiflexion (tight/reduced strength of calf muscles) c. Rigid High Arches (poor shock absorption and increased fascia tension)  

All of these can contribute to the development of plantar fasciitis due to the increase in  stress and damage accumulation potential of this structure. Therefore, footwear that  does not support the foot appropriately to counter these biomechanical deficits will  contribute negatively. 

C) Weigt and age: This condition has been illustrated to be correlated with  individuals with higher BMI, often over the age of 40. The higher the BMI the more  force and pressure will be placed through this tissue.  D) Muscle imbalances: Reduced strength in muscles such as the intrinsic foot  muscles, toe flexors, calf, and knee/hip muscles may contribute as they each alter a person’s biomechanics. They also reduce the foot's ability to absorb  impact and distribute forces optimally. Treatment/Management: 1) Load management: : Initially minimising/removing aggravating factors and  activities. These factors can include minimising running, standing for long  periods, hopping and jumping. Loa management is crucial, therefore laying out  your current exercise/sports schedule and modifying things such as frequency,  duration and intensity will aid this. This will enable the healing process.  2) Ice/medication: : Ice as well as using forms of pain killers/Anti-inflammatories  (as directed by your medical professionals) can help manage acute bouts of  pain.  3) Orthotics/footwear: Appropriate footwear or orthotics may help with not only  supporting your arch and foot mechanics to help the legs overall biomechanics,  but it may also help soften the forces through the plantar fascia region by  absorbing force more evenly. 4) Taping/other modalities: Special taping technique may be implemented by  your physiotherapy to help load and encourage optimal foot mechanics. Other  modalities such as massage, mobilisation of the ankle joint, other manual  therapy utilities, and shockwave therapy can be integrated.  5) Exercise-rehab: Exercises targeting the muscle imbalances and poor  biomechanical patterns, as described above, will aid in more optimal  movements and loading of this structure.  

6) Medical intervention/referral: In some presentations if conservative  management is not responding as expected or the presentation is severe, this  may warrant potential imaging such as an ultrasound. There may also be  considerations to refer to a specialist for a steroid injection to reduce the large  inflammatory components of the dysfunction and help promote healing.