Plantar Fasciitis – A pain in the Sole!
This is very well known as a difficult and painful condition to manage. For those who have unfortunately suffered with plantar heel pain know it is not something they would wish upon anyone. I for one experienced this annoying issue a couple of years ago, which really made me dread going to work. I would stand for long periods in agony, almost looking at the clock where I could finally rest my feet. Plantar heel pain made me take up further education on the most up to date research on this condition, which has now made it an area I am truly interested in. Being able to help people get over their plantar fasciitis and seriously improve their quality of life as a result, makes me excited to get to work.
Plantar heel pain from many studies has been shown to be very prevalent in both the athletic (especially runners) and general population. Plantar heel pain has been estimated to occur in 8% of all injuries related to running (Taunton et al, 2002). Plantar fasciitis should be quite easy to diagnose from your health care provider. It is characterised by first step pain (morning or periods of rest) and pain during weight-bearing tasks (Martin et al, 2014).
Plantar fasciitis is typically an overuse injury where the plantar fascia tissue is placed under repetitive loading and strain that it is unable to tolerate. Therefore, its presentation is quite like a tendon related injury. Its similarity in onset, is typically matched as well by treatment. To best get over this issue, we need to find the right balance of loading tolerance that the plantar fascia tissue can tolerate. Interestingly, individuals with a thickened plantar fascia of more than 4mm are 105 times more likely to have plantar fasciitis than those without plantar heel pain (McMillan et al, 2009). The plantar fascia thickens with fluid as a result of the overload it is placed on.
Plantar fascia thickness is an associated risk factor for plantar heel pain. Other risk factors that the evidence states are obesity (especially in the non-athletic population), flat feet in standing (due to increased strain at the origin of the plantar fascia), prolonged standing, high arched feet in those who run (due to lack of shock absorption), and a heel spur. The presence of a heel spur is a risk factor, although it is important to note that 50% of heel spurs are not painful and only two thirds of people with plantar heel pain have a heel spur.
As mentioned already, this injury is common among runners. Studies have shown that the more you run, the more likely you are to experience plantar heel pain (Van Leeuwen et al, 2016). More kilometers running per week, more days of running per week and more years as an active runner are all risk factors.
So How is Plantar fasciitis treated?
Prognosis for this debilitating injury is worse if symptoms have persisted for longer than 7 months. So it is critical to get it managed early! The good thing is there are a lot of options and as we all respond differently to different modalities, there certainly is hope for your feet and your quality of life. The evidence widely accepts a first line of treatment to manage this condition consisting of education, stretching, exercise rehabilitation, comfortable footwear and taping.
Foot orthotics are an option in pain relief, however research has found that expensive customized orthotics are no better than prefabricated insoles (Rasenberg et al, 2021). So be careful if someone is trying to sell you those customized orthotics for plantar heel pain. Taping can help very briefly in the short term as the arch is supported. (Rathleff et al, 2015) investigated and found that a heavy slow resistance training protocol was quicker and better than just plantar stretching alone from months 3-6. If we remember that plantar fasciitis is likely the result of overload, then a slow and heavy resistance training program would be very appropriate for building the loading capacity to overcome this injury.
If you are over putting up with heel/arch pain, then book in and see if The Reform Lab Osteopathy can get you back to whatever it is you want to be doing. Your feet and overall quality of life can improve, don’t push through heel pain. Remember those who wait more than 7 months have a worse prognosis.
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