In this post, we will talk about a common injury to the body that can be very self-limiting if not treated appropriately. According to the Journal of Orthopedic Sports Physical Therapy (JOSPT), plantar fasciitis is the most common foot injury treated by clinicians. Estimates show that it affects 2 million Americans each year, and up to 10% of the population over the course of a lifetime. Long term data from JOSPT supports a positive clinical course for plantar fasciitis when treated appropriately; with 80% of patients reporting full resolution within a 12- month period. Symptoms tend to be chronic in nature, with first presentation usually 1 year prior to seeking first treatment. Risk factors for plantar fasciitis and heel pain include high BMI in non-athletic population, runners, limited ankle dorsi flexion, and work- related weight bearing activities.
Your physical therapist can help you by making an accurate diagnosis during the examination phase of your appointment. Diagnosis can be made with the following findings: plantar medial heel pain, worse with initial steps after inactivity but also worse with activities of prolonged weight bearing. Heel pain precipitated by and increase in weight bearing activity. Pain with palpation about the proximal insertion of the plantar fascia. Positive windlass test and negative tarsal tunnel test. Limited active and passive ankle dorsi flexion range of motion. Abnormal foot posture index. High body mass index in non-athletic population.
They will also run tests and measures to help rule out other possible causative factors so that treatment can focus on the accurate diagnosis and treatment of plantar fasciitis and heel pain. Common differential diagnoses include, low back pain referring pain to the heel, fat-pad atrophy, and irritation to the plantar nerves.
Following examination, your therapist will prescribe interventions and exercises to help alleviate your pain. Common interventions include manual therapy, self- stretching, taping, foot orthoses, night splints, physical agents, footwear, education and counseling for weight loss, therapeutic exercise and neuromuscular re-education to help treat plantar fascia. In this blog we will talk and provide video demonstrations specifically about stretching and therapeutic exercise with neuromuscular re-education; however, we will briefly cover the other interventions so you can be aware.
To help better understand the importance of stretching and strengthening the plantar fascia and the muscles supporting it, it is important to understand the purpose of a muscle. Besides providing us the strength needed to perform movements and activities; the biggest skill a muscle has is force absorption. Newton describes in one of his laws, for every action there is an equal and opposite reaction. When we take a step, we apply a force into the ground that is reciprocated back into our body from the ground (ground reaction forces). If our muscles are not strong enough to absorb these forces, they go into the bone and joints and can cause increased wear and tear (arthritis). Stretching and strengthening the plantar fascia and supporting muscles can help us better accept those ground reactions forces when we take a step and avoid injury. Stretching to the calf muscle and plantar fascia can be used for short term pain relief (2 weeks-4 months) and prescribed up to 2-3 times per day. Duration of the stretch can be 20 seconds or sustained at 3 minutes; neither has shown any greater benefit. Addition of a heel pad or big toe pad can enhance the benefit of the stretch. These stretches will be provided below in our video demonstrations as well as posted on our YouTube channel: ARC THERAPY. In addition to stretching, your therapist may prescribe therapeutic and neuromuscular re-education exercises to help train the small intrinsic muscles of your foot that provide your arch support and limit excessive pronation of the foot. Exercises to strengthen the hip abductors and external rotators can help improve lower extremity loading response during weight bearing activities, such as walking and running. We will review these exercises in detail in the video demonstrations provided on this blog post as well as our YouTube channel.
With the help of a physical therapist, manual therapy can help to alleviate fascial restrictions and improve soft tissue mobility. It can also help to stretch the calf muscle to improve ankle dorsiflexion motion. Stretches to joint can also be provided by your therapist to improve motion. There are some over the counter measures you can take such as foot orthoses to reduce ankle pronation as well as night splints to help improve positioning of the foot and ankle while you sleep. Anti-pronation taping can also be applied to the foot and ankle. All three of these interventions are recommended for short term relief of pain, such as 2 weeks up to 3 months. Consult your therapist regarding the best practice for recommendation here. Lastly, recommendations for proper shoe wear can be made for rocker bottom shoes as well as a shoe rotation to minimize weight bearing pain for those who stand long periods of time at work.
Exercises discussed in video:
Stretches: standing or long sitting calf stretch with towel. Can enhance the stretch by placing a wedge under the big toe. To stretch the soleus, slightly bend the knee. Seated plantar fascia stretch by passively dorsiflexing the ankle in combination with passive big toe extension. Seated tennis ball massage to plantar fascia.
Therapeutic and neuromuscular re-education exercises: seated arch lifts, progressing to standing and then dynamic. Standing calf raises, progressing to eccentric off a step. Standing hip extension/abduction and tippy twists.