Plantar Fasciitis

Disease Process

Plantar Fasciitis (PF) is an overuse injury that affects the sole (plantar surface) of the foot. It is characterized by inflammation of the fascia, a tough fibrous band of tissue connecting the heel bone to the base of the toes.

Causes

Plantar fasciitis is most commonly found in people who are over weight, who have jobs that require standing or walking on hard surfaces, runners, people with flat feet or high arches, people with tight Achilles’ tendons (calf muscles) or who have recently increased their activity level. PF is more common in women than men.

Symptoms

The common symptom that all PF patients report is having sharp pain with the first few steps in the morning that gradually lessens to a dull ache. This pain is typically found on the bottom heel and sometimes can run all the way down the foot, along the arch. Another common complaint is pain that is worse at the beginning of an activity.

Current Treatment

PF pain is often times very difficult to get rid of completely. Many patients have trouble following the treatment guidelines as they require a significant commitment to resting, stretching, icing and sometimes bracing. All of the following may be seen in the common treatment of PF:

• Rest (decrease the activity that requires weight-bearing on the foot).
• Ice
• Stretching (especially to the Achilles' Tendon [calf muscle] and the PF itself).
• Heel Cups (to decrease the shock through the heel).
• Night splints (hold the ankle in a slight stretch. This helps decrease the initial pain felt in the morning).
• Proper shoes (ones that provide good heel and arch support).
• Cortisone Injection
• Custom Foot Orthotics
• Physical Therapy

How Can Physical Therapy Help

Physical Therapy is an excellent treatment option for people with PF. They can:

• Educate patients on proper stretching techniques of the calf muscles and the fascia.
• Instruct in a proper exercise program to help with weight loss.
• Teach activities to avoid, such as walking barefoot.
• Apply tape to the arch to help support the fascia.
• If the taping is effective, patient may be a candidate for custom foot orthotics which the physical therapist can fabricate (make).
• Fit patient with heel cups to absorb some of the shock (and help decrease the pressure from tight heel cords).
• Check leg length to see if they are uneven and provide a proper heel lift if they are.
• Fit with night splints to be worn to help gently stretch the Achilles’’ Tendon (heel cord).
• Instruct patient how to do transverse friction massage; a technique that will help break up the inflammation in the plantar fascia and make it more flexible in order increase the effectiveness of stretching.
• Provide exercises that increase the strength and flexibility of the foot and ankle muscles.
• Instruct in the use of ice.
• Apply modalities such as ultrasound and Iontophoresis to help decrease inflammation and pain.

Patient Resources
MedlinePlus
Healthlink
American Academy of Orthopedic Surgeons

Disease Process
Causes
Symptoms
Treatment
Physical Therapy
Patient Resources

Facts

A heel spur can commonly be seen on x-ray in patients with complaints of heel pain, but not always.

If an x-ray does show a heel spur, that is not always the cause of the pain. Be cautious about having the spur removed as doing so may not relieve the symptoms.