Posted on 7th October 2020 by Fiona
At goPhysio, we are seeing and hearing from an increasing number of people who are suffering with quite debilitating pain on the sole of their foot. This common complaint is often the result of a condition known as Plantar Fasciitis.
What is Plantar Fasciitis?
Fascia is connective tissue which is found all over the body in various forms for different functions. It’s most common forms are sheaths surrounding muscles and ligaments to compartmentalise and protect these tissues or thickened fascial bands or sheets in certain areas of the body.
The plantar fascia is a thickened sheet of fascia on the sole of the feet, running from the inside base of the heel bone and fanning out into the base of the toes. It’s elasticity gives us a spring in our step when walking or running.
Plantar fasciitis is an overuse injury to the fascial sheet on the sole of the foot.
Causes of Plantar Fasciitis
The main cause of plantar fasciitis is the plantar fascia being put under excessive stretch for lengthy periods of time. This can happen for example when your foot arches are too flat, so that as you walk or run, the fascia is excessively overloaded and stretched. Over time microtrauma, injury and pain result.
The foot can also be termed the “rubbish bin” of the body, where asymmetries further up the body can result in compensations in the foot. The body will compensate up to a point, but due to the excessive forces during the propulsion as you move that go through your feet, the foot may adapt by stiffening up and thickening of the plantar fascia. So sometimes, it can be something going on further up the body that may put too much stress on your foot, that will in turn cause this problem.
Plantar fasciitis is normally felt as a pain on the bottom of your foot, sometimes going into your heel.
Unfortunately plantar fasciitis is often confused with another foot problem called calcaneal bursitis heel pain). Without a thorough examination, most plantar foot problems are diagnosed as plantar fasciitis.
So a quick test you can do yourself to indicate whether your foot pain is plantar fasciitis or not is to see which is more painful; walking on your tip toes or your heels.
If it is painful to walk a few steps on your heels, you may have an element of calcanea bursitis. If it’s more painful too walk on tip toes (stretching plantar fascia), it’s likely you have plantar fasciitis.
Why is it so painful 1st thing in the morning or after I’ve been sat for a while and then get up?
Plantar fasciitis is usually painful after a period of rest. The reason being is that when you’re sat for a while or asleep in bed, the fascia is off loaded and re-tightens. When you get back up on your feet, you are re-stretching the tight, painful fascia. It may ease a little as you start to move around as it effectively ‘warms up’ and stretches.
What can affect recovery?
There are many factors that will affect the speed of recovery. Seeing an expert Physiotherapist who has a wide range of experience treating lower limb overuse injuries is vital to identify all the factors and work towards removing or modifying the triggers unique to you.
The most common triggers for foot problems such as plantar fasciitis are:
Biomechanics It’s crucial to assess whether your foot and leg biomechanics (e.g. flattened arches, knocked knees etc.) are contributing to your injury and may need correcting. Here at goPhysio, our Physio’s can do this quite easily as part of your recovery by combining their physical assessment findings with performing a computerised foot screen using our Gaitscan system.
Training Patterns and Intensity If a runner or keen walker has the condition, it’s vital to look at the historical loading of the fascia and modify their training schedule to a level that allows the condition to heal. Without breaking the cycle, the tissues won’t be able to recover. However, we like to keep people doing what they love, so rather than advise complete rest, we try wherever possible, to modify your activity or suggest alternatives in the short term that will promote recovery.
Lower Limb Stability Often muscle imbalances further up your body in your knee, hip or pelvis, will have an impact on the foot. As part of your recovery we will always address these elements too to help prevent re-occurrences.
Age Research suggests that older people experience more severe and more prolonged episodes of inflammation and pain. So, if you’re 40 years plus and enjoy an active lifestyle, your pain is unlikely to settle with just rest. It will be easily aggravated when you resume normal activities, as the cause and actual injury hasn’t been addressed.
Footwear Unsupportive, flat, old, worn out shoes or trainers can both contribute to causing plantar fasciitis and will inevitably prolong the condition.
At goPhysio, with a condition like plantar fasciitis, we always treat the condition as part of the bigger picture. Not only will we treat your foot itself, but we will look from the foot upwards and from the hip downwards, ensuring we leave you with no issues that will contribute to a re-occurrence.
Having identified all the factors unique to your condition, we will then address and correct them in parallel with hands-on physiotherapy treatments and education. It’s crucial to manually release the tight thickened plantar fascia with a variety of release techniques. You will also be provided with a bespoke home exercise programme for you to self treat at home and speed up your recovery in-between physio sessions.
We can also asses you to find out if you’d benefit from orthotics. In most cases of plantar fasciitis there is a biomechanics component that needs addressing. This can be achieved with orthotics. As outlined above, fattened arches will lower your body’s ability to cope with loading either from day-to-day actives or sport. At goPhysio we use a technologically advanced system called Gaitscan, which uses computer scanning to analyse your moving foot Combined with a physical assessment, the physio can identify if you’d benefit from wearing orthotics and subsequently discuss the range of options available to you to get you back on your feet a quickly.
What about Shockwave Therapy?
If you’ve already had a diagnosis of Plantar Fasciitis and had treatment and/or tried everything you can, Shockwave Therapy should be a serious consideration. There is strong evidence to support the use of Shockwave Therapy in the effective treatment of stubborn, long term Plantar Fasciitis.
If you think you may be suffering with plantar fasciitis or you have foot pain and aren’t sure what exactly it is, just give us a call on 023 8025 3317 or book an initial physiotherapy appointment online. If we think Shockwave is the best treatment for you, we can discuss the options and get started there and then!
At goPhysio, we’d always take an approach where alongside tackling the pain, we’d also analyse and address what’s caused your Plantar Fasciitis in the first place. Without doing this, you risk getting it again. So, with our expert guidance and holistic care, we give you the best possible chance of long term, recovery.
Read more about achilles tendon injuries here.
There are many treatment options when it comes to resolving achilles tendinopathies. These include:
- A wait & see approach (can just leave it and hope it will get better in time, which many will do within 8 – 12 months, it just depends whether you can live with it).
- Physiotherapy – including strengthening exercises, stretches, manual treatment techniques and taping.
- Acupuncture (which many Physio’s will do as part of their treatment).
- Activity modification – a crucial part of successful treatment.
- Medication, including pain killers and anti-inflammatories.
These forms of treatment can all be very effective for a mild or fairly recent onset of achilles tendinopathies. .
More invasive treatment options for more long standing or severe cases can include:
- Corticio-steroid injection.
Shockwave Therapy for Achilles Tendinopathies
However, steroid injections and surgery really are a last resort, there is no guarantee of success with either of these treatment options. A very worthwhile alternative for more severe, long-standing cases that may have failed to get better with other treatments is Shockwave Therapy.
With Shockwave Therapy, ‘shock waves’ are passed through the skin to the affected area using a special device. It’s a non-invasive and relatively pain-free treatment. The medical name for this procedure is ‘extracorporeal shockwave therapy for refractory tennis elbow’. ‘Extracorporeal’ means outside the body and ‘refractory’ means that the condition does not respond to conventional treatments. The ‘shock waves’ are inaudible, high-energy sound waves. How many sessions you will need depends on the severity of your pain and how long you’ve had the problem for. However, 4 – 6 are normally recommend.
The National Institute for Health and Care Excellence (NICE) states that shockwave therapy is safe, although it can cause minor side effects, including bruising and reddening of skin in the area being treated.
Research shows that shockwave therapy can help improve the pain of achilles tendinopathies in some cases. However, it may not work in all cases, and further research is needed.
If you’ve been suffering with achilles tendinopathy and want help, get in touch. You can have a free no obligation phone call to see whether it may help you.
Alternatively, book straight in to see one of our Physiotherapists. They will carry out a full assessment of your elbow and put together a recovery plan for you. If they think shockwave treatment is going to help you, they can get started straight away. Unlike many clinics. we include shockwave therapy in the cost of your appointments, with no additional charges.