What is Plantar Fasciitis?
The plantar fascia is a band of soft tissue underneath the foot which runs between the calcaneus (heel bone) and the toes. Plantar fasciitis is characterised by pain either in the heel itself, or on the bottom of your foot. Pain is often felt when bearing weight through the foot and is generally worse first thing in the morning (first-step pain), or after an increase in general activity/exercise. In plantar fasciitis, the band of soft-tissue becomes tight and thickened which results in pain when the tissue is stretched or loaded. This can be quite debilitating and often limits normal daily activities.
How does Plantar Fasciitis occur?
There are many factors that can contribute to plantar fasciitis, but there are certain attributes that significantly increase our risk of developing the condition. There are lifestyle factors such as; starting a new activity, changing your exercise routine, wearing high heels, being on your feet for several hours a day and regularly wearing unsupportive footwear. There are also physical attributes such as; being overweight, having “flat feet”, tightness in the calf complex, having an abnormal gait pattern and having a leg-length discrepancy.
The Traditional Approach to Treatment
In the past, it was thought that the most effective way to manage plantar fasciitis was to perform regular stretches to the tissue. The aim of the stretches was to provide tension in the soft-tissue which in turn would promote the healing process. This approach did have some success in the management of the condition, however, new evidence has shown that there are more effective ways to achieve tension in the plantar fascia.
The New Approach to Treatment
A study published back in 2000, showed that plantar fascia specific stretches could generate 1% of strain in the tissue. Strain is described as the change in length of the tissue compared to its original length. However, when the Achilles tendon was loaded by exercises, the strain in the plantar fascia increased to 4% - a fourfold increase compared to the stretches!
Since then, numerous studies have used this information to test new methods of treating the plantar fascia with high-load strength training. Specific sets of exercises aiming to increase the efficacy of tissue adaptation in the plantar fascia have been used and proved successful. Research is still ongoing testing different types of exercises against each other, but we now know for sure that loading the plantar fascia with strength training exercises can be used to treat plantar fasciitis.
Where can I get help for my Plantar Fasciitis?
Due to the complex nature of how plantar fasciitis can occur, a Physiotherapist will need to take a detailed history of all your daily activities, change in routines and history of symptoms. They can then advise you on how best to manage your symptoms in the short-term, and provide you with an individualised exercise programme depending on your current level of function and the goals that you would like to achieve.