plantarfasciitis - what can we do?
Rest, ice & protection – One of the first lines of treatment for Plantar Fasciitis is to give the structure relative rest and protect the area. Specifically this means reducing aggravating activity but not stopping all activity completely. Ice is also thought to help as there is often some swelling around the Plantar Fascia in the acute (early) stages of injury.
Non Steroidal Anti Inflammatories (NSAIDS) – NSAIDS such as Ibuprofen or Neurofen are commonly used in the acute stages of this injury to assist with any associated inflammation. PhysioACTION advises all patients to seek medical advice before starting NSAIDS and to make sure they eat prior to taking them.
Soft Tissue Massage – Massage of the Plantar fascia itself as well as surrounding structures such as the calf muscles and Achilles tendon can ease some of the pain symptoms in the short term.
Acupuncture / Dry needling – Acupuncture or dry needling of the Plantar Fascia can be a good adjunct to other modalities when treating Plantar Fasciitis. The main benefits are thought to be:
An anti inflammatory response - the needles pierce the Plantar Fascia and cause micro tears of its structure. This tearing causes the brain to release extra blood flow to the area to assist with the healing process. Excess blood picks up the waste products of inflammation and carries it away from the area of injury.
Production of endorphins - locally around the needles has been shown to offer pain relief. Endorphins are thought of as “feel good factors” released over the whole body when we exercise but they do also have pain killing properties.
Footwear Advice – Footwear can be an integral part of the recovery process with Plantar fasciitis. At PhysioACTION, the first thing we do is look at what our patients are wearing on their feet. Jandals and Sandals are a bit of a “No” as they generally lack any kind of arch support. If there is no strap around the heel on these sandals or jandals, the toes are likely to be gripping the shoes as they walk. This aggravates the Plantar fascia. Secondly, hard inner sole shoes such as formal shoes or hard orthotics should be avoided as they cause compression of the Plantar Fascia - soft inner soles or orthotics are much better. Thirdly, prescribed orthotics by a Podiatrist can make a big difference in putting the foot in a better biomechanical position and therefore reduce the load on the Plantar fascia.
Foot taping- rigid / kinesiotape – Similar to orthotics, foot taping with rigid tape using a low dye tape technique or kinesiotape can offload the Plantar fascia by putting the foot in a better biomechanical position.
Foot Intrinsic exercises – Pain tends to inhibit muscle activity with most areas of the body and Plantar Fascia is no different. Traditionally, as Physios we have strengthened the deep intrinsic muscles of the foot - think of these as the core stability muscles for the foot, in order to support the bony and arch structures of the foot to prevent over pronation (foot excessively rolling in) and reduce the load on the Plantar fascia. This approach works well for the majority of Plantar Fasciitis patients alongside a combination of treatment options
Lower limb strength & mobility work– As well as looking at the overall strength and mobility of the foot itself for plantar fascia injuries, it is important to look further up the leg, as far as the pelvis and lower back. Muscle imbalances or joint stiffness higher up the limb can lead to the foot and ankle having to take extra load which can exceed this structure's capacity. This can be when injury of the Plantar Fascia occurs.
Activity Specific Advice – As Physio’s, we must always look at what our patient is doing on a regular basis that could potentially be slowing their recovery down. For example, if a runner is continuously landing on their heel rather than on their mid foot or ball of their foot, then there will be increased compression of the Plantar Fascia origin. This will in turn lead to an increased risk of Plantar Fasciitis.
Cortisone Injections – Cortisone (steroid) injection for Plantar Fasciitis is not a first line treatment and should only be considered if more conservative treatment options are not effective. A cortisone injection is where a dose of strong anti inflammatories are delivered specifically to the area of injury. This can assist with settling any inflammation in the area.
Extra Corporeal Shockwave Treatment (ESWT) – If ESWT is necessary, the patient first requires an ultrasound scan to confirm there are no tears in the plantar fascia. ESWT is a treatment modality whereby a hand held probe is used to administer a dose of very high energy sound waves to the affected area. In the case of Plantar Fasciitis, the treatment is delivered to the sole of the foot, particularly the heel and the arch of the foot. These sound waves increase blood flow to the affected area and stimulate tissue regeneration which in turn speeds up the healing process.