The plantar fascia is a broad sheath of tendinous tissue which wraps around and supports the arch of the foot. It extends from the calcaneus, or heel bone, forward to attach just under your toes. The purpose of the plantar fascia is to support the arch and intrinsic muscles of the foot, and to improve shock absorption during loading. The plantar fascia can become inflamed and painful. This inflammation in known as plantar fasciitis. This can occur for several reasons, but some common causes include unsupportive footwear such as thongs, sudden increase in physical activity – especially running, and prolonged standing.
In some case a heel or calcaneal spur can arise. A spur is a bony growth on the calcaneum, which occur due to excessive and prolonged pressure at the attachment of the plantar fascia. It is important to note that not all episodes of plantar fasciitis will be associated with a spur developing, and that not all heel spurs will be painful.
- Pain under the heel or on the foot just inside the heel with walking and load bearing. These points will often be very tender to touch.
- Severe morning pain which occurs on the initial steps when first weight bearing
- Pain or burning sensation under the foot
- Pain whilst walking and standing
- Tightness in the calf muscles or ankle joint
Your physiotherapist will review your footwear and the position of your foot and ankle in standing and through gait. It may be necessary to correct your foot position through the use of orthotics or inserts. In the short term it may also be beneficial to use a small wedge or ‘heel rise’ under the affected foot to reduce pressure on the plantar fascia and Achilles tendon.
In addition you will be provided with a series of stretches for the calf and foot. Stretching the calf helps to reduce tension on the Achilles tendon causing abnormal movement of the foot, which places pressure on the plantar fascia. It is important that you perform these exercises regularly to gain maximum effect. Your physiotherapist will advise you on this.
Massaging the sole of your foot using a tennis ball or golf ball is very effective and regular icing to relieve inflammation is also beneficial . A great way to combine both of these is to freeze a water bottle and roll you foot over the bottle, icing and massaging together!
Manual therapy techniques to decrease muscular tightness through the calf and deep tissue release to the plantar fascia itself can assist in recovery. Use of electrotherapeutic modalities such as ultrasound and/or electrical stimulation decrease inflammation by accelerating your body’s natural healing mechanisms are also helpful tools.