Understanding Plantar Fasciitis
Plantar fasciitis is an inflammation of the tissue that runs across the bottom of the foot, from the heel bone to the toes. It's the most common cause of heel pain among people ages 40 to 60, athletes (especially runners), people who are overweight, and women who wear high heels without adequate heel support.
Approximately 10% of the United States population experiences bouts of heel pain, resulting in about 1 million visits per year to medical professionals for treatment of plantar fasciitis.
What Plantar Fasciitis Feels Like
Plantar fasciitis typically causes a stabbing pain in the bottom of the foot near the heel. The pain is usually worst with the first few steps after waking up, though it can also be triggered by long periods of standing or by getting up after sitting. Pain tends to be worse after exercise rather than during it.
Ignoring plantar fasciitis can lead to chronic heel pain that interferes with daily activities. Changing the way you walk to avoid the pain can also create new problems in the foot, knee, hip, or back.
How Physical Therapy Helps
A physical therapist begins with an assessment of your gait, how you walk, to evaluate how your symptoms are affecting your movement and to guide treatment.
Your therapist will teach you stretching exercises to improve the flexibility of your ankle and plantar fascia, especially first thing in the morning. Achilles tendon stretching can be performed standing, with the affected leg behind the other leg and the toes pointed forward.
Strengthening exercises improve the strength of the supporting muscles. High-load strength training has shown to be effective in treating plantar fasciitis and may aid in a quicker reduction in pain and improvement in function, this is something your PT can discuss with you further.
Additional tools your PT may use include ice application to decrease pain and inflammation, iontophoresis (a gentle, transdermal way to deliver medication through the skin), and taping of the foot for short-term relief.
Orthotics, Splints, and Gait Training
Orthotics, or shoe inserts, and supportive footwear help minimize abnormal foot motion and support the arch, reducing stress on the plantar fascia. Night splints hold the ankle and foot in a position that keeps the Achilles tendon and plantar fascia slightly stretched, helping you maintain correct ankle and toe positioning while you sleep.
Gait training involves an analysis of muscle function to understand deficits in running and walking and how to address them. Your PT will include functional exercises that directly address how your body performs as a unit during activities, helping lessen symptoms and improve your walking ability.
Fascia Mobilization and Shoe Recommendations
Fascia mobilization involves mobilizing the fascial adhesions on the plantar surface of the foot to improve pliability for weight-bearing demands. This allows the therapist to target primary restricted regions and address limitations in ankle and foot movement.
Because patients wearing either low or high heels can develop plantar fasciitis, the right choice of shoe wear can vary widely from person to person. A therapist can evaluate how your foot accommodates the ground and offer shoe recommendations to reduce pain with walking and standing.
If you're feeling something in your foot or ankle, it's worth having it checked, and if you know someone diagnosed with plantar fasciitis, it may be time to consider physical therapy for pain management.