Plantar Fasciitis Article by our expert | Knosis Physical Therapy & Wellness | Flatiron Nomad NYC
At KNÓSIS, I frequently encounter patients grappling with the sharp, stabbing pain of plantar fasciitis, particularly when taking their first steps out of bed in the morning. The discomfort can be intense, and I understand how frustrating it is. However, treating plantar fasciitis is about more than just alleviating foot pain—it's about addressing the root cause.
With over a decade of experience and as a board-certified Orthopedic Clinical Specialist (OCS), I have developed deep expertise in treating plantar fasciitis, particularly in athletes like marathon runners and ballet dancers. My work with these high-performing individuals has equipped me with valuable insights into the specific demands their sports place on the feet, allowing me to create tailored treatment plans that effectively address pain and help prevent future issues.
Our approach to treating plantar fasciitis goes beyond merely relieving the pain in your foot. We believe true healing comes from considering the bigger picture—how your entire body moves. The function of your spine, hips, and knees plays a significant role in the health of your feet. By identifying and correcting these dysfunctions, we target the underlying causes of your pain. Our goal is not just to relieve symptoms but to prevent future issues, setting you up for long-term success.
Definition
Plantar fasciitis, often referred to as plantar heel pain, is a common and potentially debilitating condition that affects the plantar fascia, a thick band of tissue running along the bottom of your foot from the heel to the toes. This connective tissue is crucial for supporting the arch of your foot and absorbing shock during walking. Despite its name, "itis," plantar fasciitis is not considered an inflammatory condition. When the plantar fascia is overstressed, it can develop tiny tears and degeneration, leading to pain and stiffness, particularly in the heel.
Causes
Several factors can contribute to the development of plantar fasciitis:
Overuse:
Prolonged standing or intense physical activity can place excessive strain on the plantar fascia.
Foot Mechanics:
Poor foot mechanics, such as flat feet, excessive foot pronation, or high arches, can alter weight distribution across the foot, increasing the risk of degeneration.
Improper Footwear:
Shoes lacking adequate support or cushioning can exacerbate the condition.
Obesity:
Extra weight can place additional pressure on the plantar fascia, increasing the likelihood of injury.
Muscle Tightness and Weakness:
Tightness in the gastrocnemius/soleus and short foot muscles, along with increased plantar flexion range, are contributing risk factors.
Symptoms
The hallmark symptom of plantar fasciitis is heel pain, often most severe first thing in the morning or after long periods of sitting. This pain typically decreases after a few minutes of walking but may return after prolonged standing or physical activity. Other symptoms can include stiffness and discomfort along the bottom of the foot, which may worsen after exercise or at the end of the day.
Risk Factors
Plantar fasciitis accounts for approximately 15% of foot injuries in the general population. Certain factors can increase the risk of developing this condition, including:
Age:
Individuals between 40 and 60 years old are more prone to plantar fasciitis.
Occupation:
Jobs requiring prolonged standing or walking, such as teaching or factory work, can elevate the risk.
High-Impact Sports:
Participation in sports like running or basketball can place additional stress on the feet.
Diagnosis of Plantar Fasciitis
Medical History and Physical Examination
At KNÓSIS, we conduct a thorough medical history and physical examination to diagnose plantar fasciitis. We assess your symptoms, activity level, and previous injuries, as well as evaluate your foot structure, range of motion, and areas of tenderness to determine the most likely cause of your pain. Our clinical reasoning model considers the whole body to identify the root cause of your discomfort.
Imaging Tests
In some cases, imaging tests such as X-rays, ultrasound, or MRI may be recommended to rule out other conditions causing heel pain. These tests can also help confirm the diagnosis of plantar fasciitis by revealing thickening of the plantar fascia, a typical feature of the condition.
Goals of Physical Therapy
Pain Relief
One of the primary goals of physical therapy for plantar fasciitis is pain relief. At KNÓSIS, our physical therapists utilize various techniques and modalities to reduce heel pain. This includes manual therapy and instrument-assisted soft tissue mobilizations to address myofascial restrictions in the lower extremity and spine that may contribute to altered gait and foot mechanics. Our therapists are also skilled in using a technology called Shockwave or Radial Pressure Wave therapy. This unique instrument employs vibroacoustic energy to stimulate healing from within, providing immediate relief through its mechanical effect and increasing microcirculation to facilitate the body’s natural healing processes.
Restoration of Function
Physical therapy also aims to restore normal foot function by improving flexibility, strength, and alignment. Our therapists work one-on-one with patients to develop personalized exercise programs that include self-soft tissue mobilizations and targeted foot strengthening and flexibility exercises, helping you return to the activities you love.
Prevention of Recurrence
Preventing future episodes of plantar fasciitis is another critical goal of our therapy. At KNÓSIS, we focus on identifying the root causes of the problem, educating patients on proper foot care, recommending appropriate footwear, and developing strategies to avoid overuse and excessive strain on the plantar fascia. Our physical therapists collaborate closely with functional podiatrists, including Dr. Emily Splichal, founder of NABOSO, to provide excellent tools for foot treatment and prevention.
Physical Therapy Treatment
Stretching Exercises
Stretching exercises are fundamental in treating plantar fasciitis. Specific stretches targeting the plantar fascia, Achilles tendon, and calf muscles can enhance flexibility and reduce heel pain. One effective stretch involves sitting with your legs extended and using a towel to gently pull your toes toward you, stretching the bottom of your foot. Weight-bearing stretches are also beneficial. It's crucial to monitor ankle range of motion over time to ensure full mobility is achieved in closed-chain positions.
Strengthening Exercises
Strengthening exercises target the muscles of the foot and lower leg to improve support and stability. Patient-specific exercises, such as the “short foot exercise” and heel raises, can strengthen these muscles and reduce strain on the plantar fascia.
Manual Therapy
Our physical therapists employ manual therapy techniques, including soft tissue and specific joint mobilizations, to alleviate pain and improve joint mobility. These techniques are often used in conjunction with other treatments to enhance overall effectiveness.
Taping and Orthotics
Taping techniques and custom orthotics can provide additional support and alleviate pain. Taping, often using low-dye tape to prevent pronation, can stabilize the foot and offer short-term pain relief, while orthotics can correct foot mechanics and provide cushioning.
Activity Modification
Modifying daily activities to reduce stress on the plantar fascia is crucial for recovery. This may involve avoiding high-impact activities, taking breaks to rest your feet, and using supportive footwear.
Home Exercise Program
Daily Routine
A sample daily routine for managing plantar fasciitis might include stretching exercises for the plantar fascia and calf muscles in the morning and evening, strengthening and neuromuscular re-education exercises, and daily self-release for the feet using a ball.
Footwear Recommendations
Wearing supportive shoes with good arch support, cushioning, and appropriate orthotic inserts is essential for managing plantar fasciitis. Shoes with shock-absorbing soles and a stable heel counter provide necessary support, and footwear options may include rocker-bottom shoes.
Self-Care Tips
Additional self-care tips include avoiding walking barefoot on hard surfaces, maintaining a healthy weight to reduce pressure on the feet, and using a night splint to keep the plantar fascia stretched while sleeping—beneficial for patients who experience pain with their first steps in the morning.
Limit High-Impact Activities: Reduce or avoid activities that put excessive strain on the feet, such as running or jumping.
Low-Impact Exercises: Opt for low-impact activities like swimming or cycling to maintain fitness without aggravating the condition.
Self-Massage: Use your thumbs to apply gentle pressure to the calf and plantar fascia, starting from the heel and moving toward the toes.
Prognosis and Long-Term Management
Expected Outcomes
The prognosis for plantar fasciitis is generally favorable, particularly with early intervention and appropriate self-care strategies. Most individuals experience significant improvement within several months of consistent treatment, including stretching exercises, proper footwear, orthotic inserts, and activity modification. Long-term management focuses on preventing recurrence by maintaining flexibility and strength in the foot and ankle, continuing with supportive footwear, and avoiding high-impact activities that place excessive strain on the plantar fascia. Regular follow-ups with a physical therapist can help monitor progress and adjust treatment plans as needed.
Conclusion
Plantar fasciitis, a prevalent cause of heel pain, can be debilitating if not properly addressed. At KNÓSIS, we prioritize a comprehensive approach to treatment, delving into the intricate dynamics of your entire body's movement. As seasoned physical therapists, we understand that dysfunction in joints above the ankle, such as the tibio-fibular joint or hip, can significantly exacerbate heel pain.
Our movement diagnosis involves a thorough assessment to pinpoint areas of restriction in your joints or myofascial tissues and identify uncontrolled movements that may lead to excessive wear and tear. For example, limited dorsiflexion in the ankle can cause compensatory patterns higher up the kinetic chain, affecting the knee, hip, and even lower back. These compensations can place additional stress on the plantar fascia, perpetuating pain and discomfort.
At KNÓSIS, we believe that no one should suffer from foot pain, especially not those who love to move. If you're struggling with plantar fasciitis or heel pain, please reach out to us today. Together, we can develop a personalized treatment plan to help you get back on your feet and enjoy the activities you love.
