Plantar fasciitis (PLAN-tur fas-e-I-tis) is one of the most common causes of heel pain. It involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia).

Plantar fasciitis is typically a pain that occurs in the bottom of the foot. It’s located usually close to the heel bone, and patients most often complain that it hurts first thing in the morning when they put weight on their foot. Typically the pain will slowly reduce once the patient moves around and begins walking, within about five to ten minutes usually but will return later in the day, especially if the patient has been sitting for a long period and then gets up to stand again. Often seeing your local family physician is a great place to start to get a referral to the right healthcare practitioner. 

The pain felt can quite often be fairly debilitating because one is bearing weight on a painful structure on the bottom of the foot. And so this affects up to 10 percent of the population. Now while most people have heard about plantar fasciitis, what they may not have heard about is something called plantar fasciitis, and it’s a technical term but the difference really is a difference between inflammation in the structure that’s causing the pain, versus degeneration which is occurring in the structure. In treating this condition, often seeing a local massage therapist for muscle tension, a local personal trainer for muscle strength and a physiotherapist for release and conditioning is a good option.  

And with plantar fasciitis what we see under a microscope is small degenerative tears in the fascia of the plantar structures. And so to orientate you on the foot, if this is the foot and particularly if I turn the foot underneath, what we’re talking about is the plantar fascia which attaches on the heel bone and runs up to the toes in a fan-like structure and so where things usually break down is at the point of attachment on the heel bone and we’re either talking about an inflammation or a degenerative process right at this point.

One can develop pain in a structure that gets repetitively overused. In a normal situation the plantar fascia is designed to be able to take the load put on it every day. But when things are not aligned optimally or when we have muscle imbalances or joint imbalances the plantar fascia can become twisted in a sense which is an abnormal strain placed on that structure multiple times during the day, every single time you step on your foot. You basically irritate that structure and it becomes inflamed and swollen. Or becomes degenerate which can also cause pain and dysfunction.

The way that its treated is really in multiple ways, physiotherapists would need to do an objective assessment to determine which structures might be predisposing the individual to getting this pain such as malalignment in the hip or the lumbar spine or an irritated nerve, possibly from a disc in the low back.

But typically the Local physiotherapist will use soft tissue technique such as massage or stretching, joint mobilization techniques or even some advanced techniques such as acupuncture or intramuscular stimulation. Intramuscular stimulation is especially useful if it is determined that this is a degenerative problem in which case a nerve root is functioning abnormally and IMS or intramuscular stimulation is a great way to solve this problem.

Something else that is commonly used is orthotics and while orthotics can be useful for certain individuals they’re not necessarily going to help everybody. It’s important to ascertain whether your foot needs an orthotic, and if it does, how long would that orthotic be useful for, because once you have an orthotic it doesn’t always follow that you’ll wear an orthotic forever.

So it’s really important to have good advice from a physiotherapist trained in these biomechanical issues to determine whether intramuscular stimulation or acupuncture would help or whether your problem is going to be solved more readily by joint mobilization or the possibility of rehabilitative exercise and possible an orthotic.

You might visit a physiotherapist for information on what is, conditions, side effects, symptoms and treatments related to physiotherapy for plantar fasciitis, choosing custom orthotics, rehab exercises following an injury and foot exercises.

Presenter: Gordon Bohlmann, Physiotherapist, Vancouver, BC

Now Health Network Local Practitioners: Physiotherapist