Plantar fasciitis or fasciopathy is one of the most common causes of chronic foot pain. Research suggests that 10% of us will develop plantar fasciitis at some stage in our life. Conservative management, such as physiotherapy, has been shown to be effective, first-line treatment (Hasegawa et al, 2020).
The plantar fascia is a band of connective tissue that runs from the heel to the ball of the foot. Its main role is to support the arch and joints in position, act as a shock absorber and allow us to push off with our big toe. Plantar fasciitis or fasciopathy is now considered to be a degenerative condition of the plantar fascia due to repetitive microtears. Initially there can be an inflammatory reaction, but it is now understood that it is not an ongoing inflammatory process. There is usually not one specific cause of plantar fasciitis but is usually due to multiple factors. Some of these factors include spikes in load, age, suboptimal biomechanics, delayed healing and obesity (Luffy, 2018).
Pain is usually felt on the underside of the heel, and is often most intense with the first steps of the day or after rest. It is commonly associated with long periods of weight bearing or sudden changes in weight bearing, load or activity.
Prevention
• Start activity slowly and increase load slowly with a new exercise or program.
• Choosing the right shoe, both supportive and minimalist shoes can be helpful. Large heels should be avoided. Replace shoes when they are worn out.
• Allow adequate recovery time between workouts or training sessions. Stretch your calves regularly and strengthen your foot and toe muscles.
• Maintaining a healthy weight to minimise the stress on the plantar fascia.
Management
• Physiotherapy treatment includes soft tissue treatment of the plantar fascia, stretching and strengthening program for the calf muscles and small muscles of the foot, footwear advice.
References:
Hasegawa, M., Urits, I., Orhurhu, V. et al. Current Concepts of Minimally Invasive Treatment Options for Plantar Fasciitis: a Comprehensive Review. Curr Pain Headache Rep 24, 55 (2020). https://doi.org/10.1007/s11916-020-00883-7
Luffy, Lindsey MSPAS, PA-C; Grosel, John MD; Thomas, Randall DPM; So, Eric DPM Plantar fasciitis, Journal of the American Academy of Physician Assistants: January 2018 – Volume 31 – Issue 1 – p 20-24 doi: 10.1097/01.JAA.0000527695.76041.99
