What is plantar fasciitis? 

Plantar fasciitis is a particular affliction of the feet, caused by enduring strain on the tough “bowstring” Plantar fascia. It is a ligament extending from the heel directly to your toes, furnishing stability and shape to the arch of the foot. As you walk, this resilient fiber creates a coiled steadfastness.

How common is plantar fasciitis? 

Plantar fasciitis is a condition that is fairly prevalent, impacting about 1 out of every 10 adults. It can be experienced by individuals regardless of their athletic status. It is more frequently observed among individuals whose jobs require prolonged standing on unforgiving surfaces and those engaged in physical activities like long-distance running.

What are the risk factors for  developing plantar fasciitis? 

Various factors contribute to the strain experienced by your plantar fascia. Plantar fasciitis is not solely caused by excessive exercise, standing, or walking. Common risk factors encompass the following:

• Age: Plantar Fasciitis is prevalent among individuals aged 40 to 60

• Gender: Frequently observed in women compared to men

• Weight: Being overweight increases the risk

• Diabetes: Individuals with diabetes are more susceptible to developing plantar fasciitis

• Flexibility: Reduced ankle movement can heighten the peril

• Foot type: It is more common in people with high arched feet

• Footwear: Old or poor quality footwear can also escalate the risk

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What are the symptoms of plantar  fasciitis? 

The symptoms commonly associated with this condition include:

1. Variable pain: Individuals typically experience pain in the heel bone, primarily on the sole of the foot. Many people describe it as “first step” pain, occurring when they initially stand up. This pain may improve throughout the day and with physical activity, but it tends to worsen towards the end of the day or after prolonged exertion. In severe cases, the pain originating from the plantar fascia can be intense enough to hinder participation in sports and cause a noticeable limp.

2. Morning stiffness: A significant number of individuals report stiffness around the heel bone, especially upon getting out of bed. However, this stiffness usually subsides after a few minutes of walking, although it may persist for a longer duration.

3. Tenderness: The underside of the heel is often tender to the touch. While the tenderness can be diffuse in some cases, there is typically a specific area that is particularly sensitive.

X-rays and scans 

Imaging procedures such as X-rays or scans are often unnecessary for diagnosing plantar fasciitis. Your doctor or physiotherapist can usually confirm the condition by relying on your medical history and physical examination. In the event that imaging is required, an ultrasound scan is typically employed. This involves using a handheld probe that is moved over the skin above the plantar fascia, generating an image on a screen through sound waves.

This method is fast, safe, and effective in visualizing the plantar fascia. In some cases, Magnetic Resonance Imaging (MRI) may also be utilized. It’s worth noting that an X-ray might reveal a heel spur, a small bony growth beneath the heel bone near the plantar fascia. However, this finding should not be mistaken as the sole cause of plantar fasciitis, as approximately 3 in 10 individuals have a heel spur without experiencing heel pain. Similarly, many individuals with plantar fasciitis do not possess a heel spur.

Treatment options 

1. Cryotherapy:

  The application of ice, wrapped in a moist tea towel, to the affected area can effectively alleviate pain. It is recommended to apply ice for a maximum of 20 minutes, up to four times daily or after physical activity. Caution should be taken to avoid applying ice for extended periods or directly to the skin to prevent ice burns. It is not advisable to use ice or ice packs on areas with numbness, reduced sensation, or poor circulation.

2. Analgesics:

Short term intake of paracetamol or certain other anti-inflammatory drugs like ibuprofen for two or three days will soothe any irritations. It is also advised that any medication for inflammatory responses be accompanied with meals.

3. Moderate Rest:

Achieving a healthier lifestyle can be reached by doing exercise in different formats, that don’t have negative effects on the physical body. Swimming, biking, as well as aqua jogging can be alternatives. Modifying the work hours to recenter them and taking pauses when having excessively stretched periods of time standing, or being energetically walking, are advised.

4. Home-based Exercises:

  The following exercises can be performed at home:

– Stretching the plantar fascia (refer to page 7)

– Rolling the plantar fascia (refer to page 9)

5. Footwear:

  It is advised to wear supportive footwear with a rigid outer sole and a cushioned insole. Consider the following:

– Opt for footwear with arch supports and heel cushioning.

– Avoid walking barefoot or wearing flip flops.

– Keep your shoes in good condition and replace your trainers every 300 to 500 miles. If you are a runner, consider having two pairs of trainers in rotation.

6. Managing your weight: 

If you are overweight, see your GP to discuss strategies to help you lose weight. This can make a big difference to your plantar fasciitis and general health. 

7. Cross training: 

Engage in various forms of exercise to target different areas of your body. This practice, known as “cross-training,” is a beneficial approach to minimize injuries and maintain fitness. Consider the following examples of cross-training activities that can be helpful:

– Swimming

– Rowing

– Trying out different sports

– Attending spin classes

– Incorporating weight training

– Cycling

– Pilates

– Aerobics

– Utilizing gym equipment

– Participating in circuit training

8. Physiotherapy: 

This may involve several different treatment options including: • manual techniques • specific exercises

Other treatments: 

If the initial therapies do not alleviate your symptoms, your physiotherapist or doctor will explore alternative treatments with you.

These may include:

• Podiatry referral for assessment of shoe inserts

• Night splints to stop your plantar fascia from tightening up overnight 

• Capsaicin cream, dry needling (with or without autologous blood injection), 

• Extracorporeal shockwave therapy, and surgery are the various therapeutic options available.

According to recent findings, steroid injections are not recommended due to potential risks such as plantar fascia rupture and wasting of the fat pad cushion under the heel. These complications can result in long-term issues, which is why steroid injections are not commonly employed as a treatment choice.

STRETCHES 

Stretching the plantar fascia on a regular basis is a critical component of treatment. Perform these stretches at least twice a day with your affected foot. 

Stretch 1:  

Plantar Fascia – Standing

Place the front of your foot and toes against a wall and lean forwards from the ankle.

Hold for 1 minute. 

Stretch 2:  

Plantar Fascia – Sitting

Sit in a chair with your affected leg crossed over your good one. Grab hold of your toes and bend them backwards until you can feel the stretch in the sole of your foot.

Hold for 1 minute.

Stretch 3:  

Soleus muscle

Using a wall for support, plant your feet flat on the floor, one behind the other. With your front knee bent, lean forwards, reducing the angle between your foot and your shin, until you feel the stretch in the back of your calf muscle in the front leg. Hold the stretch for 30 seconds to 1 minute.

Do not let your heel come off the ground. 

Stretch 4: 

Gastrocnemius muscle

Using a wall for support, plant your foot flat on the floor behind you.

With your leg straight, lean forwards, reducing the angle between your foot and your shin, until you feel the stretch in the back of your calf muscle in the leg you have planted behind you.

Maintain the stretch for 30 to 1 minute. Do not let your heel leave the ground.

Rolling/Tissue Release 

Plantar fascia soft tissue release with golf ball

Place your bare foot on a golf ball. Put some pressure through your foot and roll the golf ball backwards and forwards for approximately 1 minute.

This aids in the relaxation of the plantar fascia. Do this 2–4 times per day. 

Frozen bottle rolling 

Take off your footwear and place your foot on a frozen bottle of water.

Roll the bottle backwards and forwards underneath the arch of your foot. Continue rolling for 5 minutes. Repeat 2–4 times each day.

Frequently asked questions 

Q. Will I always be required to follow my exercise program? A. Typically, once your pain subsides, there is no ongoing necessity to maintain the daily exercises. Nevertheless, if you experience a recurrence of symptoms, it is advisable to resume your exercise regimen.

Q. Is there a possibility of my plantar fascia tearing while I’m performing my exercises?

A. There is no indication that the plantar fascia is prone to rupturing during the exercises outlined in this booklet.

Q. When will I be able to resume my sports activities?

A. The duration of getting back to your sport relies on your symptoms. We advise taking baby steps with reintroducing it again. Your conditioning may reduce during injury and convalescence, consequently, it’s central to have constant aerobic health via activities like swimming and biking. Once you can take part without any pain, that’s the time to bring your sport back into the picture.

Q. Can I continue running while I am in the rehabilitation phase? 

A. Running does not appear to pose additional harm if you resume it, as there is no evidence supporting that claim. However, if you experience minimal discomfort, you can continue running. It’s important to note that running may prolong your rehabilitation process as it could worsen your symptoms. To maintain your fitness, you might want to consider alternative exercises like swimming or cycling. 

Q. Is there a surgical solution available for plantar fasciitis? A. Surgical intervention is typically considered as a last resort when all other treatments have been ineffective. Even in such cases, there is no guarantee that surgery will alleviate your symptoms.