Sydney is a city full of people who love running. There is a lot of running events every year to make running fun and keep people motivated. Blackmore’s Sydney Running Festival is one of highlights and ready to take the city by storm this weekend. Usually right before and after these events, we see many patients with various lower limb injuries from training harder than normal or trying to push for their PB. It is not uncommon to have rear foot pain in this group of people, and plantar fasciitis is known to be the most common cause of rear foot pain. After reading this you should have a better understanding of what plantar fasciitis is, whether you are a runner or not.
The role of the plantar fascia
The plantar fascia is an important structure to provide normal foot biomechanics (Brukner & Khan 2012). It has three bands, the lateral, central and medial band, which all originate from the bottom of the heel bone. Plantar fascia plays a key role in maintaining the static foot arch and for dynamic shock absorption
How do you know if you have plantar fasciitis?
Most commonly the location of the pain is at the insertion of plantar fascia into the heel.
The pain is usually worse in the morning, eases with rest and increases with activity (Brukner & Khan 2012). One example would be an increase in pain in the first couple of steps after sitting for a while. If the condition is more irritable, there would be pain during weight-bearing activity and the person could be walking with a limp.
There are several known risk factors in the non-athletic population, including restricted dorsiflexion ankle range of motion (common after an ankle sprain) and high body mass index (Martin et al, 2014). High or low foot arches will also increase risk of developing plantar fasciitis. Activities that involve simultaneous maximal plantarflexion of the ankle and dorsiflexion of the toes for examples prolong walking, running, and dancing, tend to pose higher risk of resulting in plantar fasciitis as well.
Clinical diagnosis and investigation
There are various clinical tests that can be done by physiotherapists to confirm the diagnosis of plantar fasciitis. Imaging usually isn’t necessary, but in terms of investigation options, ultrasound is currently the gold standard for plantar fasciitis (Brukner & Khan 2012). X-ray is not particularly helpful for confirming the diagnosis but it could be used to differentiate a calcaneal stress fracture, if that was suspected (Brukner & Khan 2012). MRI is not commonly used and it was found that there could be increased signal intensity in the plantar fascia and calcaneal spurs even in asymptomatic individuals (Ehrmann et al, 2014)
Treatment and Management
Basically management can be divided in to short term and long term.
For short term pain relieve management (the first four months), there are several things can be done including; avoiding aggravating activities, ice, manual therapy, stretches for the plantar fascia, soleus and gastrocnemius muscles, therapeuetic ultrasound, cortisone injection, anti-pronation or low-dye taping, a heel pad or heel cup, and prefabricated or custom made foot orthoses (Brukner & Khan 2012 & Martin et al 2014). There is some evidence suggesting potential benefit for trigger point dry needling (Martin et al 2014). Often a combination of these strategies is used together, but stretching is a main stay in conjunction with all other options. It was suggested the dosage should be either 2-3 times per day and varies between a sustained 3 minutes or intermittent 20 seconds stretch for optimal effect (Martin et al 2014).
A good combination of ice and massage is rolling your foot on a frozen water bottle.
Long term management options
If symptoms persist over 6 months, a night splint (e.g. Strassburg sock) can be considered an option and it was recommended to wear it for 1 to 3 months (Martin et al 2014). This typically will ease the early morning symptoms.
Strengthening exercises will also be a crucial part of the rehabilitation. It was found that strengthening the intrinsic muscle of the foot (e.g. toes flexors) can improve the arch support and stress distribution on the plantar fascia. The proximal hip muscles, specifically hip abductors and external rotators, were found to have a strength deficit after lower limb overuse injuries such as plantar fasciitis, and it is critical to strengthen these impaired muscles to improve lower limb biomechanics (Brukner & Khan 2012 & Kuligh et al 2011).
Hopefully the above information gives you a better understanding of what plantar fasciitis is and for those who are participating the Sydney Running Festival this weekend, good luck and have fun!
If you would like to get an accurate diagnosis and treatment, contact a physiotherapist here at Thornleigh Performance Physiotherapy. We have an expertise in musculoskeletal physiotherapy and we are near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Wahroonga, Westleigh, West Pennant Hills, West Pymble amongst others.
Brukner, P. & Khan, K (2012) Clinical Sports Medicine. Australia: McGraw-Hill Australia.
Ehrmann, C., Maier, M., Mengiardi, B., Pfirrmann, C. W., & Sutter, R. (2014). Calcaneal attachment of the plantar fascia: MR findings in asymptomatic volunteers. Radiology, 272(3), 807-814.
Kulig, K., Popovich Jr, J. M., Noceti-Dewit, L. M., Reischl, S. F., & Kim, D. (2011). Women with posterior tibial tendon dysfunction have diminished ankle and hip muscle performance. journal of orthopaedic & sports physical therapy,41(9), 687-694.
Martin, R. L., Davenport, T. E., Reischl, S. F., McPoil, T. G., Matheson, J. W., Wukich, D. K., ... & Godges, J. J. (2014). Heel Pain—Plantar Fasciitis: Revision 2014. Journal of Orthopaedic & Sports Physical Therapy, 44(11), A1-A33.