Plantar fasciitis, a pain or discomfort to the mid foot and heel, will affect 1 in 10 people across the UK. It is most common in those aged between 40-60 years and is twice as common in women as it is men. Our Senior Physiotherapist, Jenny Wilson, looks into the common symptoms, risk factors and the best ways to overcome Plantar Fasciitis.
- Plantar fasciitis means inflammation of your plantar fascia.
- Your plantar fascia is a strong band of collagen tissue that stretches from a bony point in the bottom of your heel to the middle of your foot.
- It supports the arch of your foot and also acts as a shock-absorber when we walk, run, stand, play sport etc.
- The plantar fascia can become irritated when we overuse it with repetitive over-stretching. This can lead to possible inflammation and thickening and the attachment of the plantar fascia (that bony point in the heel). This in turn can cause us pain and discomfort, especially when standing.
- Plantar fasciitis is also influenced by the mechanics of the foot.
- Having conditions such as flat feet, high arches, pronation, or having an abnormal gait (the way in which the foot hits the ground), the fascia can become overworked or stretched abnormally, resulting in pain.
Risk factors of Plantar Fasciitis:
- If you are on your feet for a lot of the time, or if you do lots of walking, running, standing, etc.
- People with a sedentary lifestyle are more prone to plantar fasciitis.
- If you have recently started exercising on a different surface – for example, running on the road instead of a track.
- If you have been wearing shoes with poor cushioning or reduced arch support.
- If you are overweight – this will put extra strain on your heel.
- If there is overuse or sudden stretching of your sole. For example: athletes who increase running intensity or distance or have poor technique.
- If you have a tight Achilles tendon (the big tendon at the bottom of your calf muscles above your heel). This can affect your ability to flex your ankle and make you more likely to damage your plantar fascia.
Pain is the main symptom of plantar fasciitis and this can be anywhere on the underside of your foot. However, commonly, one spot is found as the main source of pain and this is often about 4 cm forward from your heel, and may be tender to touch. The pain is often worst when you take your first steps on getting up in the morning, or after long periods of rest where no weight is placed on your foot. Gentle exercise may ease symptoms a little as the day goes by, but a long walk or being on your feet for a long time often makes the pain worse.
Top Tips to Self Manage Plantar Faciitis:
With plantar fasciitis being an inflammatory condition it is important that we allow for the fascia to settle and reach a baseline level of irritation. This will allow for the body to naturally address the injury and attempt to repair the tissue at a bodily level without being further irritated.
It would be great if we could all jet off on holiday whenever we experience any pain or discomfort, rest up and return once symptoms have resolved. However, for many of us this is extremely unrealistic. As a result, we have to introduce pacing. By this we mean managing our day to day activities. Where possible it would be good to take breaks from sitting/standing/walking, perhaps do tasks sitting down where able and break daily activities up with periods of rest in order not to overload the fascia.
Ice is a great way to naturally settle down the inflammatory process. The best way to utilise ice therapy for plantar fasciitis is to get a small bottle of water with a rounded edge, freeze the water and use this to roll over the foot and heel. Please ensure when you do this that you have the ice wrapped in a cloth or tea towel to prevent ice burn. Doing this for 10 minutes 3-4 times per day can really help to alleviate symptoms. Your physiotherapist will guide you further.
Anti-inflammatory medication or gels are useful with plantar fasciitis to reduce the level of inflammation in the area. However, there are precautions we must take when using this medication. People who are susceptible to stomach ulcers, are asthmatic or are on other medication that may interfere with the effectiveness of anti-inflammatory must consult their GP before taking them. Physiotherapists are not permitted to prescribe medication.
With Christmas being the prime time of year for work functions and family gatherings sometimes our footwear can change from what we are used to wearing every day. This change in footwear can irritate our plantar fascia and cause inflammation. It is important that we wear footwear that is supportive to our arches and stabilise our foot, especially at the ankle joint.
With the temperatures dropping some of us might be reaching for our thicker winter socks to keep our feet warm this winter! However, they are also great for cushioning the heel and mid foot in our shoes. They will act as a medium between the hard sole of the shoe and our foot to protect and cushion our fascia on weight bearing activity.
Heel cups are a great tool to use in our shoes for both me and women. With the festive season upon us we are more likely to be wearing different footwear for all our events and festivities. Heel cups are a great way to reduce the shock absorption on the heel and reduce the risk of irritation the plantar fascia insertion.
If you are experiencing plantar fasciitis as a result of altered bio-mechanics, including excess over pronation (reduced arches) or leg length discrepancies then it would be useful to use orthotics in your everyday footwear. These can be individually fitted to assist in placing your foot in a neutral position in order to offload the fascia when weight bearing. It is important that you acclimatise to your orthotics correctly. Your physiotherapist will guide you accordingly if these are appropriate for you.
Soft Tissue Release
A Sport Therapist or physiotherapist would be best to treat and guide you on soft tissue release and is a great treatment tool for relieving plantar fascia symptoms. However, using a golf ball can be a great way to improve the soft tissue quality of the fascia in the area where you feel most symptoms. By rolling your heel over the golf ball on a hard surface can help improve the soft tissue quality in that area. This is suggested to do with socks on in order to prevent skin irritation but your physiotherapist will guide you further.
Avoid hard surfaces
Hard surfaces increase the amount of pressure going through specific sites on the heel which in turn can irritate the plantar fascia. As a result softer surfaces, e.g. grass would be better to exercise on if possible.
Stretching out your calf (the muscle at the back of our leg) is a useful tool to assist in the prevention and treatment of plantar fasciitis. By giving us more muscle length we can reduce the strain on the muscles and fascia in the foot making our whole lower limb chain more effective with mobility and less susceptible to injury.
It is important when managing plantar fasciitis that we take a holistic management approach in order to combat symptoms. With our feet being the foundations that hold us up it is difficult to allow them to rest and as a result the body may be less successful with its natural healing process. Therefore, we must tick as many boxes as we can with treatment and self-management. By just using a single intervention we are unlikely to fully resolve plantar fascia symptoms. If you are experiencing any foot or heel pain and require treatment , please call 033 0333 0435 to request a call back from one of our clinical team.
Camden and Cambridge Clinics