Derik Elmore, PT, DPT, OCS, COMT
Plantar fasciitis is an orthopedic condition that affects the foot. The condition is the result of degenerative irritation and primarily starts at the heel and can progress towards the front of the foot. The fascia also blends with the Achilles tendon, intrinsic foot musculature, and subcutaneous tissue.
How Does It Function:
The plantar fascia has many important roles: arch support, shock absorption during standing, walking, and running, and contribution to normal biomechanics of the foot. We create tension through the plantar fascia when we are in a standing or weight bearing position. The tension created in the plantar fascia adds stability to the loaded foot.
This condition is often caused by overuse and repetitive strain that causes micro-tears in the tissue. There are several risk factors that contribute to plantar heel pain that we should be on the lookout for as clinicians.
- Loss of ankle dorsiflexion – bring the top of your foot towards your shin bone. Prolonged standing, running, other weight bearing activities
- Improper footwear
- Elevated BMI
- Excessive high or low arch conditions
Signs and Symptoms of Plantar Fasciitis:
Plantar fasciitis is a clinical diagnosis that is based on patient history and physical exam. A comprehensive exam of bilateral lower extremities should be performed by your physical therapist. It should include assessment of the feet/ankles, knees, and hips.
Symptoms May Include:
- Point tenderness to the sole of the foot at inner part of the heel
- Pain on first steps in the morning
- Pain with forced passive dorsiflexion and toe extension
- Increased pain following barefoot walking, climbing stairs, and toe walking Limited dorsiflexion and tight gastrocnemius/soleus muscle
This condition can be managed conservatively which can serve to be very beneficial in treating plantar fasciitis. Medical treatment should include: rest from activities that aggravate, ice, NSAIDs, shoe inserts, proper stretching with a home exercise program of the gastrocnemius, soleus, and plantar fascia.
Role of Physical Therapy
- Strength training – Your physical therapist will provide graded exercise prescription that includes high-load strength training can be effective in the treatment of plantar fasciitis. Strengthening of the gastrocnemius/soleus, foot intrinsics, quadriceps, and gluteal muscles all aid in reduction of pain.
- Stretching – Stretching of the gastrocnemius/soleus complex and stretching the toes into extension to apply stretch to plantar fascia.
- Joint mobilizations – Talocrural joint mobilizations and subtalar joint distraction manipulation can be used in hypomobile joint instances. Also subtalar and midfoot joint mobilizations.
- Night Splints – These can be worn overnight and provide constant stretch to plantar fascia as foot is held in dorsiflexion and toe extension.
- Custom foot orthotics – Foot orthotics produce short-term benefits when implemented with stretching program.
- Patient education – Patient education is perhaps the most important aspect of your rehab process. Your physical therapist can help you understand your condition more for the best course of action.
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