This information has been prepared to help you fully understand your condition so you will be in the best position possible to work with your physio and follow the steps to your full recovery. Understanding the goals of your treatment and having complete confidence in your physio are vital elements of your recovery plan, so if you have any questions then please feel free to ask your physio.
Plantar fasciitis is inflammation of the plantar fascia (or arch tendon) of the foot. It is an overuse condition which causes pain in the heel. There are many potential risk factors including having a job that requires a lot of walking or standing, tightness in calf muscles and poor foot mechanics (e.g. flat feet, high arches). Running on your toes, hills or very soft surfaces and a rapid increase in activity levels can also contribute.
The plantar fascia is a tough, fibrous band of tissue (fascia) connecting your heel bone (calcaneus) to the base of your toes. As the normal foot has an arch, the plantar fascia is at the base of the arch and acts like a bowstring to help maintain the arch of the foot. Repeated trauma to the tissue where the plantar fascia attaches to the heel bone can result in microscopic tearing at this attachment. The most common cause of over-stressing the plantar fascia is due to having a degree of “flat foot”, called excess pronation. As the foot drops into this flattened position the joints in the middle of the foot are “unlocked”, allowing them to move freely and therefore relying on the fascia more and more to control the foot position.
Plantar fasciitis pain typically starts as a dull, intermittent pain in the heel and may progress to very sharp, constant pain. A common complaint is piercing heel pain with the first few steps in the morning and heel pain when walking or standing for long periods.
If you don’t treat plantar fasciitis, it often becomes a chronic condition. You usually are not able to keep up activities such as running or other weight-bearing sports, and you may also develop knee, hip or back problems because of the way plantar fasciitis changes the way you walk. The microscopic tearing (“micro trauma”) in the plantar fascia will become more and more difficult to heal, and your recovery can be greatly slowed down. If you just rest from aggravating activities like running then your symptoms may settle, but because the problem is almost always caused by biomechanical problems within your foot if you don’t fix these causative factors your pain usually returns when you try and return to running and similar exercise.
This depends on how long you have had your condition before you get help and how severe the pain is. The majority of cases of plantar fasciitis respond well to physio and orthotics however the recovery time varies tremendously from client to client. Some clients will have good recovery with 6 weeks of treatment, while others may require 6 months or longer for recovery. Correcting your foot position is vital for a long-lasting recovery. Persisting cases may need immobilisation in a walker boot or referral to a sports physician for PRP injections.
Your physio has been extensively trained to thoroughly assess and diagnose your injury. They will give you a step-by-step recovery plan to make your treatment easier for you to understand. The most common phases, or steps, that you will go through during your recovery plan are outlined below. The order and timing of the phases are tailored individually for you and so may vary form this list. Please feel free to ask your physio if you have any questions about your recovery plan.
Inflammation is the redness and swelling that occurs whenever you injure yourself. Our bodies need inflammation to start the normal healing process but we also need to control it. Therefore, the first goal is to reduce the inflammation and pain in your plantar fascia.
The techniques your physio may use to manage your inflammation include specific local massage and fascial releases, ice and calf stretches. We are often able to bring you significant symptom relief rapidly with taping to unload your plantar fascia. Importantly, we will also guide you on modifying your current activity and footwear to ensure that you are not continually reaggravating your inflammation as this will significantly slow your recovery.
Your biomechanics (how you move) play a big role in causing, repairing and preventing injuries including plantar fasciitis. Faulty biomechanics can happen naturally or from an injury where your body moves differently than normal. When your foot biomechanics are poor your body doesn’t distribute strain and load correctly and this increases the strain on your plantar fascia as well as other areas of your body including your knees, hips and even your back. We will also assess and begin to correct your stability around your hips, pelvis and spine because these also play a major part in controlling the alignment of your lower limb and foot.
Techniques used to correct biomechanics include orthotics (shoe inserts that can be either off-the-shelf our custom-made using our Gaitscan Electronic foot assessment system), taping techniques and specific muscle strengthening.
Calf muscle tightness is a common predisposing factor to plantar fasciitis. A tight calf means that your heel lifts off too early when you walk or run and your foot tends to move into a flatter position. This places increased stress on your plantar fascia, causing micro-trauma and inflammation. Tight muscles can also make the job of other muscles harder and cause too much load on joints, so it is important to get your full muscle length back to stop all this from happening.
If muscle tightness is found then your physio may use techniques including hands-on muscle releases, rolling using a foam roller or trigger-point release ball or stretches to regain your length and flexibility.
Often muscles are weak because they are not being used properly, they have been damaged, or they have been inhibited by pain after an injury. In plantar fasciitis there may be weakness in the smaller muscles within the foot as well as in the leg, hip, pelvis and core muscles.
If weakness is found then your physio will show you specific exercises using bodyweight, free weights or resistance bands. You will start at low-levels to ensure your plantar fascia is not damaged as you start to put load through it to build strength and gradually progress to harder and heavier exercises. If testing shows that you have significant weakness or reduced control of your biomechanics then completing a program with one of our Clinical Pilates instructors or Exercise Physiologists is an excellent option.
This is the last phase of your journey to full recovery. When you are returning to your activity you must be able to do it at full speed and resistance before being back in the game. You need to be able to apply your speed and force with the correct technique in training first to prevent another injury. In this phase we tailor exercises specifically to your activity by doing advanced sports-specific strengthening and high speed movements combined with rapidly changing directions. This phase is essential both for getting your back to your full level of performance, and also for preventing re-injury due to persisting background weakness or reduced co-ordination of muscle contractions.
Many clients find that seeing one of our Exercise Physiologists, Strength and Conditioning coaches or Personal Trainers is a great way to build strength, ability and confidence for a smooth return to full sporting activity. If Pilates is more your style then our great Sports Pilates program is an ideal way for you to continue to build your stability and strength. As well as being an important part of your rehab program these services can help you lift your sports performance whilst staying safer and reducing your risk of future injury.