Plantar Fasciitis

November 13, 2020
Plantar Fasciitis
Plantar Fasciitis is the name given to pain presenting in the heel. Often
causing discomfort and tenderness in the inner region of the heel and
sometimes into the arch of the foot. Pain in this area can be very
uncomfortable and stubborn, a common complaint from people is that the
pain can be felt from the first step out of bed. This condition can cause
discomfort during walking and prolonged periods of standing.
What is the plantar Fascia?
The Plantar Fascia is a thick band of connective tissue that runs under the
foot from the heel bone (calcaneus) to metatarsal bones.
The plantar fascia serves an important role of supporting the arch of the
foot. During walking and running it acts as a spring which assists in
making the foot and ankle more efficient.
What Plantar Fasciitis is NOT?
Traditionally Plantar Fasciitis was thought of as an inflammatory condition,
hence -itis the suffix for inflammatory disease. Current literature shows
this process is instead caused by tissue degeneration as opposed to
inflammation. Studies that look at people with this condition show the
plantar fascia becomes disorganised affecting its ability to transmit force.
Why do I have Plantar Fasciitis?
Plantar Fasciitis is extremely common and is estimated to affect 1 in 10
people in their lifetime. It can affect anyone from office workers to high
level endurance runners. Overload is the main factor for the onset of
Plantar Fasciitis. An increase in load that occurs too quickly causing a
protective response from the Central Nervous system to prevent further
movement. This manifests as pain and will often stop your activity in its
tracks. Over time the amount of load required to bring on pain will often
drop, until the point where even a small amount of walking can bring on
severe pain. This factor can make managing this condition tricky as often
it feels that anything you do can make it worse. These processes related
to reduction in load limited by pain contribute to the degeneration of the
plantar fascia.
What do we do about it?
The key to effective management of this condition is correct loading.
Initially there may be a short period of unloading to help cool down
symptoms. During this period it’s really important to keep active through
cross training to prevent other areas of the body from deconditioning. This
period is very quickly followed by loading of the plantar fascia through
strength based exercises. Once the plantar fascia has begun to tolerate
load it’s very important to restart normal activities in a structured
progressive manner. Training load should be progressively increased
towards your previous level of activity and then hopefully beyond.
How do I stop it from happening again?
The best strategy for preventing the return of this pain is to ensure you
manage your load effectively. Managing training loads could be an entire
blog on its own but we can start with a few basic tips. Ensuring that each
time you increase your training load it is only a small step up in difficulty.
Choosing to increase either distance or intensity one at a time. Another
great safe guard for preventing heel pain recurrence is to supplement
your usual training with strength based training to ensure your capacity to
manage load remains high. If you are less active a good way to prevent
heel pain is to ensure more frequent exposure to activity so your body is
more ready to handle any potential increase in activity you may
What not to do.
Rest: As discussed above the pain caused by plantar fasciitis will
cause activity to drop overtime. If progressive loading doesn’t occur
the ability of the structure to meet its demand won’t improve. Rest
will only keep capacity low and will mean less and less stimuli is
required to bring on pain.
Cortisone injections: Cortisone is used to reduce inflammation, as
discussed in the ‘What Plantar Fasciitis is not’ section plantar
fasciitis is not due to inflammation instead it is caused by
degenerative changes. Cortisone injections to the plantar fascia
have been shown to have a degenerative effect on the protective
fatty pads of the bottom of the foot and the fascia.
Orthotics: when compared to usual care people who received
custom made orthotics had more pain during activity, worse
function and lower rates of recovery. Orthotics do not lead to better
outcomes when compared to usual exercise based treatment.