What is Plantar Fasciitis?

The plantar fascia supports the arch of the foot and is responsible for shock absorption during activities such as walking or running.

Plantar fasciitis is a chronic overload injury of the plantar fascia, an important fibrous structure that connects the rearfoot to the forefoot and helps maintain the position of the arch.  The primary symptom is a tenderness in the heel area. It can also be known by other names such as plantar fasciosis, plantar fasciopathy or heel spur syndrome. 

While people with plantar fasciitis will often have a heel spur visible on X-Ray, these are considered an incidental finding, ie. not the cause of the condition. Many people will have heel spurs without experiencing any symptoms.

Causes

Plantar fasciitis is a chronic overuse injury that occurs when the load on the fascia is more than it can tolerate for an extended period of time . As this occurs, the quality of the collagen fibres is compromised,   further reducing the ability of the tissue to absorb load. This imbalance can be due to an increased load or a decrease in tissue tolerance.

There are a few risk factors that may increase your likelihood of developing plantar fasciitis. These include:

• Age: Plantar fasciitis is commonly diagnosed between the ages of 40 and 60.
• Sex: Women are more likely to develop plantar fasciitis than men.
• Weight: Being overweight can cause overloading of the plantar fascia due to increased strain on the feet from excess weight.
• Occupation: If your job requires you to be on your feet a lot or involves walking on hard surfaces such as factory floors, this will increase plantar fascia load.
• Pregnancy: Additional stress on your feet from weight gain during pregnancy or your changing centre of gravity (the body’s balance point) can result in the development of plantar fasciitis.
• Exercise habits: Changes in training over a short time period may increase your risk of developing plantar fasciitis.
• Inadequate footwear: Wearing shoes with inappropriate support may place excess strain on the soft tissue structures of the foot, which may lead to injury or degeneration over time. 
• Certain rheumatological conditions.

Symptoms

People with plantar fasciopathy will often have ‘first step pain’ or sharp, stabbing pain immediately on rising in the mornings. This will often be very severe initially and then reduce a little as the foot gets moving. This first step pain is often also present after an extended period of sitting or inactivity such as a long car ride or time spent at your desk.

Discomfort from Plantar fasciopathy may also increase through exercise. People will often feel some increased tightness at the start of a run that warms up, but as the activity progresses there will be a steady increase in discomfort. Post activity pain is also common and patients often report this as a deeper, dull ache pain compared to the morning pain.

Diagnosis

Diagnosis of plantar fasciopathy involves a combination of clinical history and physical examination.  As a part of this diagnosis, a podiatrist will palpate the heel to ensure the tenderness lines up with the origin of the plantar fascia.

Here at Spine Sport Feet clinic, we will often utilise Point-of-Care Ultrasound (POCUS) to measure the thickness of the plantar fascia.  This commonly reveal asymmetry between the sore and unaffected side.

A torn plantar fascia (partial or full thickness) is a different injury and this may be identified on ultrasound. This injury is managed differently.

Treatment

There are numerous treatment pathways for plantar fasciopathy. The individual response to different treatment options will vary from person to person, however any good treatment plan should include an element of offloading and an element of strengthening or rehabilitation.

Treatment options may include

• Prescription of home-based exercises including stretching and strength work
• Strapping
• Footwear modification or padding
• Foot orthosis or arch supports
• Extracorporeal shockwave therapy
• Low-level laser therapy
• Manual or hands-on therapy

Most patients will notice a fairly immediate reduction in symptoms, however complete rehabilitation can be a slow and gradual process.  Your treatment plan should progress as your symptoms improve, and your practitioner will provide advice on returning to full activity levels if you have had time away from sport or training etc.

Summary

Although painful, plantar fasciitis is extremely manageable with simple non-invasive treatments. Symptoms include heel/foot pain, inflammation, stiffness or pain after periods of inactivity. Plantar fasciitis can result from injury, overuse or strain of the plantar fascia from a number of causes and can be diagnosed by a Podiatrist. 

If you are suffering from the symptoms of plantar fasciitis or other foot concerns, make an appointment to see one of our podiatrists at Spine Sport Feet clinic or phone (07) 5580 5655 for more information.