Plantar Fasciitis is one of the most common foot injuries that is seen by health providers. It can be described as an inflammation of fibrous tissue that runs on the bottom part of your foot; it is a vital connection from the base of your heel all the way to your toes.
It can affect all types of individuals such as athletes but also can occur in the non-athletic population. People have described their symptoms as “intense heel pain” and it is common to feel this type of pain in the morning or when taking your first steps after prolonged inactivity. Plantar fasciitis is a frequent overuse injury for runners. This condition can also affect individuals who are overweight and who wear shoes without proper support. Other common risk factors for plantar fasciitis are prolonged standing and limited range of motion in the ankle joint; specifically, in dorsiflexion (bringing toes towards the sky). The plantar fascia at the base of your foot is a thick band of fibers shaped like a bowstring. It has an important role in supporting your inner arch and acts as a shock absorber when you walk or run. Just like a bowstring, it can take stress and tension but when it becomes too much it can lead to tiny tears in the fascia. If repetitive movement continues it can cause irritation or inflammation.
How can you diagnose Plantar Fasciitis, you can sit down with your physical therapist and they can do an examination. They will take down the history of when the symptoms started and how they started. After that, the therapist will palpate tenderness at the base of your heel that can reproduce the “stabbing” pain. Special tests can be performed to rule in and rule out other secondary conditions such as the Windglass Test and Tarsal Tunnel Syndrome Test. Imaging such as diagnostic ultrasound can be used to assess the thickness of the plantar fascia.
Plantar Fasciitis is commonly treated conservatively with physical therapy. Based on literature stretching, manual therapy, taping, foot orthotics, and night splints5 have shown positive results when treating Plantar Fasciitis. Here are some examples of things you can do at home to treat your symptoms:
Manual therapy: soft tissue massage of the plantar fascia (bottom part of the foot).
Stretching: Stretching of the calves and plantar fascia
Taping: Use athletic tape to prevent excessive pronation (collapsing of the arch). You can also use Kinesiotape to help with pain relief.
Foot orthotics: Can be purchased over the counter, can help support the inner arch
Night Splints: Should wear for up to 1-3 months every night. Can purchase online or over the counter.
Incorporating these types of exercises into your daily routine can help with your recovery. Approximately 70% of PF cases can be resolved through conservative treatment but some cases fail and result in non-surgical and surgical treatments.
Nonsurgical treatments are common and are used to prolong the wait for surgery. People have looked into corticosteroid injections6 and it has shown improvement with short-term relief. These injections can be provided by your primary care physician and may be covered by insurance. Another popular treatment that individuals have used is shockwave therapy, studies have shown minor to moderate improvement with pain. There are many options but these two are the most commonly inquired.
When all else fails individuals turn to surgery. There are few options but the most popular surgery is Endoscopic Release of the plantar fascia. It is a minimally invasive procedure where they make very small incisions on both aspects of the heel and cut the plantar fascia. Studies have shown that the majority of individuals have found immediate relief. The advantage of endoscopic plantar fascia release offers individuals a quicker recovery and reduction of surgical complications. Here is a link to see more about this surgery: .
Postoperative care includes:
1: Casted and partial weight-bearing until 3 weeks
2. Gentle stretching and range of motion exercises
3. Begin more progressive weight-bearing activities, quadriceps and hamstring strengthening exercise by week 6.
4. Can return to recreational activities by weeks 6-8
Finally, Plantar Fasciitis is a common foot injury and there are many options for conservative treatments. The prognosis for conservative treatments of PF is unfortunately long, at least 10 months, but as said before at least 70% of conservative cases recovery.
- Boyle, R.A., Slater, G.L. Endoscopic plantar fascia release: a case series. Foot Ankle Int. 2003.24(2).
- Buchbinder, R. Plantar Fasciitis. N Engl J Med. 2004. 351(8).
- Hui, L., Yuan, X., Wu, Z., et al. Shock-wave therapy improved outcome with plantar fasciitis: a meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg. 2019. 139(12).
- Malahias, M.-A., Cantiller, E. B., Kadu, V. V., et al. The clinical outcome of endoscopic plantar fascia release: a current concept review. J Foot Ankle Surg. 2020. 26(1).
- Martin, R.L., Davenport, T. E., Reischil, S. F., et al. Heel pain-plantar fasciitis: revision 2014-.J Orthop Sports Phys Ther. 2014.44(11).
- McMillan, A. M., Landorf, K. B., Gilheany, M. F., et al. Ultrasound guided corticosteroid injection for plantar fasciitis: randomized controlled trial. BMJ. 2011.4(S1)