Understanding and Recovering From Plantar Fasciitis

As a Physio in the Sutherland Shire plantar fasciitis is something we see a lot. It’s common in runners and generally people that are spending prolonged periods on their feet, on hard surfaces such as nurses or individuals that work in supermarkets etc. However, it can also be linked to people wearing unsuitable footwear. I am going to single out two guilty parties here, one being women’s “flats” I believe they are called and the other is your year-round thong guy! In this article we discuss the condition and management to demystify plantar fasciitis and give suffers hope of a full recovery. We have provided an initial exercise program at the end, but please keep in mind that it’s not as simple as follow this program and it will fix your plantar fasciitis. We’re not that kind of Physio, we’re the better kind :).

Many people suffer from plantar fasciitis. It’s been reported about 3.6% of the Australian population present to a GP complaining of heel pain every year, thats over 9 million people annually. Tt can be one of those conditions that just keeps coming back until you address the true cause of the condition. At Aevum we would have patients coming in every month reporting an extensive history of plantar fasciitis. They have usually seen several clinicians in the past without much luck, which has not helped their confidence of living without this pain

Let’s start with What is the Plantar Fascia?

Plantar fasciitis is a broad band-like structure running the length under your foot from your heel to the base of your toes. Its job is to form a springy load absorbing trampoline-like structure. Plantar fasciitis is when that trampoline-like structure begins to slightly microtear away from its attachment on your heel and it can be very painful. It’s one of the area’s of your body that get’s considerable load placed through it day after day after day.

Are heel spurs the cause?

No. not at all. A common misconception. Having heel spurs doesn’t mean you have pain and also isnt the cause of that pain. Although someone with plantar fasciitis may be referred for an x-ray, and that x-ray came back with “heel spurs” this does not account for why you have heel pain or plantar fasciitis. Most people with heel spurs are asymptomatic, meaning they have no pain. However, what heel spurs do show, is that there has been excessive tensile load on you plantar fascia for an extended period of time.

Plantar fasciitis highlighted in green.

How does plantar fasciitis present?

The usual presentation to your Physio is one of an insidious onset over time that has gradually become worse. The first few steps in the morning are usually the most painful and then the injury appears to warm up and ease off - giving you the misguided sense that it’s actually not that bad, as it gradually plots to ruin all your weekend plans and idealistic dreams of running that next marathon or Sutherland 2 surf. Although this is the most common presentation, it’s by no means the only presentation. Treating plantar fasciitis for almost 20 years I know the injury can present in many ways but pain around the arch of the foot or heel is usually the most common site of the pain.

What can your Physiotherapy knight in shinning armour do?

There are 3-main phases to conquering this little bugger, and your Physio will help guide you through them all. Working with so many runners in the Sutherland Shire over the years, it’s not too much to say… we have it down to an art.

Phase 1

Settle the acute symptoms - this just basically means reducing the pain. We do this initially, by applying rigid sports tape to unload the tissue and allow it to start to mend, naturally reducing your pain - over the years we have adapted this taping technique to get the best outcome. With this in mind, not everyone’s skin tolerates sports tape. In these instances, alternatives need to be discussed to achieve the same result. Additionally, recommending a short term of anti-inflammatories (if necessary) and providing you with a home based exercise program to encourage recovery and healing in the early stages. Next we start to examine the underlying causes, i.e. footwear, total weekly running load/time on feet or any biomechanical issue that need to be addressed.

Phase 2

Augment recovery and healing - As a continuation of the above, your Physio will apply hands-on techniques directly to the plantar fascia and surrounding tissue to assist recovery and address the aforementioned biomechanical issues if needed. This may include orthotic prescription or a referral to a Podiatrist. Mobilising and loosening specific ankle and foot joints, as we’ll as progressing you home exercises accordingly. During this stage we usually like to start loading the area as soon as possible. This may be through exercises or by returning you to an early appropriate level of running or alternativly using our AlterG treadmill. During this Phase we anticipate that the small microtears in the tissue, usually around the heal, will reform and heal. The next Phase aims to strengthen this newly formed tissue.

Phase 3

Strengthen the tissue - This is to establish a long-term solution to this injury, making the tissue more resilient and also enable you to get back to doing what you love without the thought in the back of your mind as to when it's going to flare up again. This involves a tailored program that is specific to the demands you plan to place on the area i.e. ultra marathon running or walking the dog around the block after they have sufficiently made you feel guilty enough for not doing it in a while. It’s never a simple one size fits all model and never should be. There are some excellent ways to specifically load the plantar fascia increasing it’s ability and tolerance to conditioning, this is often the part that has been mismanaged in the past and a key ingredient to long term success.

While all this sounds simple enough, it comes down to the details. How long should we tape the area before progressing to phase 2? What footwear is best? What strengthening best suits the individual needs and what does the research indicate gains the best results? This is the nuance that your Physiotherapist will help with, while simultaneously convincing you someone needs to place a statue to all Physiotherapists in the middle of the Sutherland Shire for conquering the horrendous humanitarian issue that is PLANTAR FASCIITIS once and for all.

If this condition rings a bell with you. Contact our team so we can help fix it and get you back out there.