Dealing with plantar fasciitis

Plantar fasciitis is a painful condition of the foot and can inhibit function. Clients need to know what exactly is plantar fasciitis, what causes it to develop, and possible non-medical treatment options.

Plantar fasciitis obviously affects the plantar fascia of the foot. The plantar fascia is a specialized structure, made of connective tissue, that absorbs impact to the heel and supports the arch of the foot. It runs predominantly longitudinally and originates from the anterior calcaneal tubercle and goes distally to the five metatarsophalangeal joints and ends and the proximal phalanges of the digits (Johnson, Haas, Lindow, & Shields, 2014). Plantar fasciitis is painful combination of inflammation and degeneration of the plantar fascia, with inflammation of the medial calcaneal tubercle caused by repetitive trauma (Johnson et al., 2014).

Like most chronic conditions, plantar fasciitis is multifactorial.

The onset of plantar fasciitis is usually slow and is a result of a combination of factors that increase stress on the plantar fascia. Some possible causes of plantar fasciitis include obesity, a decrease in ankle dorsiflexion, a tight Achilles tendon, excessive running, high arches, flat feet, long periods of standing, a sudden increase in physical activity, poor footwear, and hard flooring (Johnson et al.,2014). All these conditions would increase pressure on the plantar fascia and could possibly contribute to the development of the pathology.

There are many treatment options for plantar fasciitis. Some options include surgery, corticosteroid injection, Botox injection, cryotherapy, NSAIDS, taping, and shockwave therapy (Johnson et al.,2014). Yet in most cases these treatment options are no more effective than exercise interventions and custom orthotics.

Rathleff et al. (2015) examined how strength training the Achilles tendon helps relieve the symptoms of plantar fasciitis. Using high loaded heel raises and a device called the windlass mechanism, which tightens the plantar fascia during dorsal flexion of the metatarsophalangeal joints, strengthens the Achilles tendon and strengthens the collagen fibers in the plantar fascia and increases the synthesis of new fibers. Rathleff et al’s., (2015) every other day training protocol was more effective in restoring foot function than stretching and orthotics.

Stretching protocols can be effective in reducing pain in the pathology. Unfortunately the common theory of stretching the soleus and gastrocnemius, to increase dorsiflexion of the ankle , has minimal effect in decreasing pain from plantar fasciitis, because it does not directly affect the plantar fascia (Garrett & Neibert, 2013). Direct plantar fascia stretches, like crossing the affected leg over the opposing leg ,and pulling the toes toward the shin increases tension in the plantar fascia, and was more effective than stretching the Achilles tendon (Jha, Uprety, & Shah, 2013).

Orthotics are helpful at treating plantar fasciitis by improving biomechanics, improving comfort, and helping absorb shock. Specifically, they are designed to prevent the eversion of the heel and pronation of the midfoot (Seligman & Dawson, 2003). This helps decrease pressure on the heel, and lessens the symptoms of plantar fasciitis. Strengthening, stretching, and wearing orthotics are effective strategies in treating plantar fasciitis.

References

Garrett, T. R., & Neibert, P. J. (2013). The effectiveness of a gastrocnemius-soleus stretching program as a therapeutic treatment of plantar fasciitis. Journal of Sport Rehabilitation, 22(4), 308-312.

Jha, R., Uprety, S., & Shah, L. (2013). Functional outcome in patients with chronic plantar fasciitis treated with plantar fascia stretching vs tendoachilles stretching exercises. Journal of Institute of Medicine, 35(1), 32-38.

Johnson, R. E., Haas, K., Lindow, K., & Shields, R. (2014). Plantar fasciitis: What is the diagnosis and treatment? Orthopaedic Nursing, 33(4), 198-204.

Rathleff, M. S., Fredberg, U., Kaalund, S., Andersen, K. B.,

Jensen, T. T., Aaskov, S., . . . Malgaard, C. M. (2015). High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up.Scandinavian Journal of Medicine & Science in Sports, 25(3), 292-300.

Seligman, D. A., & Dawson, D. R. (2003). Customized heel pads and soft orthotics to treat heel pain and plantar fasciitis. Archives of Physical Medicine and Rehabilitation, 84(10), 1564-1567.