Top 12 Tips for Plantar Fasciitis / Heel Pain
Heel pain is a common condition. Pain in the arch of the foot, where it meets the heel, is most commonly diagnosed as plantar fasciitis. Typically the pain is worse with the first few steps in the morning, or the first few steps after inactivity. The pain maybe worsened while running or prolonged walking and standing The pain can be, but is not always, reduced with light activity. The heel pain typically comes on gradually and progressively. On examination there is local tenderness on the bottom of the heel bone towards the arch. The tenderness may extend into the arch itself.
A manual physical therapy examination will identify the root causes of the heel pain. Typically the heel pain is brought on by a sudden increase in the amount or intensity of weight bearing activities i.e. a large increase in running distance or standing longer than usual at work. The strain on the plantar fascia can be exaggerated by the bony alignment of the lower limb as well as muscle weakness and tightness of the foot, ankle, lower limb and spine. Commonly there is a lack of mobility in the joints of the ankle and muscle tightness around the ankle. It is also common that an increase in pronation, which flattens the arch, can put extra strain on the plantar fasciitis. It is very common for the plantar fasciitis to be increased in the fall after a change to less supportive summer footwear.
Manual physical therapy treatment of plantar fasciitis is multifactorial:
Manual Therapy techniques are used to improve joint mobility and improve soft tissue flexibility around the foot and ankle. This is done through hands-on joint and soft tissue mobilization/manipulation. The soft tissue techniques typically include trigger point release which have been proven to help reduce plantar fascia pain.
Check the rest of the leg and lower back:
A manual therapist will check the rest of the spine for other underlying biomechanical faults and muscle imbalances in the leg and lower back, pelvis and hip. A manual therapist will also check for altered mobility of the nerves and soft tissue in the leg and spine.
Tape to unload:
It is very helpful to unload the plantar fasciitis with sports tape. This type of taping is termed ‘low dye’ taping. Typically the pain relief felt is significant and immediate. Taping the plantar fasciitis is also helpful in determining if orthotics will be beneficial. With low-dye taping a 50% improvement in pain is expected before recommending custom or non-custom orthotics.
Custom or non-custom orthotics:
Both custom and non-custom (over the counter) orthotics have been proven to be helpful. Some individuals will do well with over the counter orthotics while others, due to the shape and biomechanics of their foot, will need a custom made orthotic.
Assist healing with physiotherapy modalities:
A manual therapist may assist the plantar fascia in healing through use of physiotherapeutic modalities such as ice, electrical stimulation and ultrasound.
Exercises for mobility:
A manual physical therapist will provide an individualized exercise program to improve mobility. An exercise program would also address any other muscle tightness and/or lack of mobility in the low back, pelvis, hip and leg. Stretching of both the calf muscles and plantar fascia has been proven to reduce plantar fascia pain.
Strengthen the plantar fascia:
There is evidence that a specific plantar fascia ‘high load’ strengthening program can be beneficial in reducing pain and improving the health of the plantar fascia tissue. In the research study individuals who undertook the specific strengthening program along with stretching and arch supports had better outcomes than only stretching and arch supports.
Strengthen the rest of the leg:
Quite often limping to avoid heel pain creates muscle imbalances through the lower limb. Through examination of your walking pattern and manual muscle testing the changes can be addressed by specific therapeutic exercise. Recent research has demonstrated strength deficits in the toe, arch and ankle muscles in individuals with plantar fasciitis.
Education is provided to reduce strain on the plantar fascia through changes in footwear, work habits, activities and training factors. It is important to gradually resume weight bearing activities in a systematic manner appropriate for the stage of healing.
IMS dry needling:
Another treatment option with more ‘stubborn’ cases is IMS dry needling of the foot, calf and lower back muscles.
A night splint, which keeps the foot held at a 90° angle all night can be used. The night splint allows the plantar fascia and calf muscles to be positioned under slight tension, to improve mobility and make the first few steps in the morning less painful.
Another option is to see your family doctor to discuss the use of medication or a referral for further investigation and treatment if you are not improving as expected with manual physical therapy treatment.