Plantar fasciitis is a common disorder seen in physical therapy that results in pain in the heel and bottom of the foot. The pain is usually most severe with the first steps of the day or following a period of rest. Pain is also frequently brought on by bending the foot and toes up towards the shin and may be worsened by a tight Achilles tendon. The condition typically comes on slowly, in about a third of people both legs are affected.
The causes of plantar fasciitis are not entirely clear. Risk factors include overuse such as from long periods of standing, an increase in activity, and obesity. It is also associated with pronation of the ankle/foot and a lifestyle that involves little exercise. While heel spurs are frequently found it is unclear if they have a role in causing the disease.
Plantar fasciitis is a disorder of the insertion site of the ligament on the bone characterized by micro tears, breakdown of collagen, and scarring. As inflammation plays a lesser role many feel the condition should be renamed plantar fasciosis. The diagnosis is typically based on signs and symptoms with ultrasound / an MRI sometimes used to help. Other conditions with similar symptoms include osteoarthritis, ankylosing spondylitis, heel pad syndrome, and reactive arthritis.
Most cases of plantar fasciitis resolve with time and conservative methods of treatment like physical therapy. Usually for the first few weeks people are advised to rest, change their activities, take pain medications, and stretch. If this is not sufficient physical therapy, orthotics, splinting, or steroid injections may be options. If other measures do not work extracorporeal shockwave therapy or surgery may be tried.
Tight calves and a tight Achilles tendon can also pull the plantar tendon and weaken the attachment of the fascia to the bone. If the plantar tendon is stretched beyond what the fascia is capable of holding, the fascia forms micro-tears and begins to pull away from the bone, causing inflammation. When the plantar tendon is consistently over-stretched, the body begins to add calcium where the attachment between the tendon and the heel bone takes place. Over time, enough calcium is added to build more bone mass in that particular spot, creating a heel spur that can be even more painful than plantar fasciitis.
Other common causes of plantar fasciitis include: Wearing inflexible or worn out shoes, very low or high arches, being overweight, spending long hours on your feet, tight calf muscles, and walking barefoot in soft sand for long distances. Between 4% and 7% of people have heel pain at any given time and about 80% of these cases are due to plantar fasciitis. Approximately 10% of people have the disorder at some point during their life. It is unclear if one gender is more commonly affected than the other.
If you feel that you might have plantar fasciitis and would like to see how physical therapy can help, give us a call (716-836-2225) or reach us through our website to set up for a consultation. We will be happy to review your problem and present you with your treatment options.