Plantar Fasciitis

Pain in the bottom of the foot is very common, affecting both active and sedentary people.  Some of the conditions associated with this type of pain include tarsal tunnel syndrome and various nerve entrapments, stress fracture and fat-pad syndrome.  The most common condition affecting the bottom of the foot is plantar fasciitis (fash-ee-itis).  Some authors estimate that plantar fasciitis affects 10% of adults and comprises 15% of all foot complaints that require professional care.  

The plantar fascia is a strong, thick tissue on the bottom of your foot.  It runs from your heel to your toes, and is stretched when you pull your toes up toward your shin.  As previously mentioned, plantar fasciitis causes pain in the bottom of the foot.  It usually begins with no obvious cause and is often worse in the morning or after a period of non-weightbearing. Similar to chronic tendon disorders, recent literature suggests that it is less likely to be a pure inflammatory condition but rather attributed to the degeneration of plantar tissues.  Although it is considered a self-limiting condition, recovery without treatment can take a considerable amount of time.  Perhaps this can be expected as the injured person is putting their body weight through the damaged tissue with every step that they take!

Several authors have suggested that reduced dorsiflexion (bringing your toes toward your shin) is a risk factor for the development of this condition.  Other documented risk factors include elevated body mass index, type and intensity of activity (workplace demands), micro-trauma, advanced age, abnormal foot mechanics and poor footwear.  In most instances the cause of plantar fasciitis is multifactorial.

Treatment is usually indicated for this condition and there are many different options available. Ultrasound, acupuncture, night splints and shockwave therapy are common treatments for this condition, all with varying results.  At our Chiropractic and Physiotherapy clinic in Burlington we have found great success combining active release technique, graston technique, laser therapy and supportive taping (when indicated).  We have also found great success with the use of custom foot orthotics.  Although much of the literature reviewing the treatment options for plantar fasciitis is conflicting, there is good evidence to validate the use of foot orthotics.  From our experience, the success of orthotic intervention depends on the presenting foot-type of the patient.  Not all patients require prescription orthotics and there is evidence to support the use of over-the-counter supports in some situations.

As with most of our blogs we try to offer some practical tips that you can immediately implement at home.  Some patients with plantar fasciitis benefit from rolling a tennis ball or frozen water-bottle under the affected foot.  Wearing good supportive footwear around the house can also be helpful. Given the evidence for limited dorsiflexion as a risk factor for plantar fasciitis, gentle stretching (as pictured below) or rolling of the calf muscles may assist in prevention.  If you are experiencing persistent foot pain or if you think you may be at risk for the development of plantar fasciitis, we recommend that you consult with a suitable health care practitioner (like a chiropractor) who is qualified to diagnose the various causes of foot pain. 

References

League AC. Current concepts review: planar fasciitis. Foot and Ankle International 2008; 29 (3): 358-366.

Delitto S, Dewitt J, Ferland A, Fearon H, MacDermaid J, McClure P, Shekelle P, Smith AR, Torburn L. Plantar fasciitis - APTA clinical guidelines. Journal of Orthopaedic & Sports Physical Therapy 2008; 38(4): A1-A18.

Roos E, Engstrom M, Soderberg B. Foot orthotics & night splints for plantar fasciitis. Foot and Ankle International 2006; 27: 606-611.

Disclaimer
The purpose of this blog is to educate patients and those interested in improving their health and wellbeing. We recommend that you always consult with a qualified health care professional before applying any of the topics or suggestions mentioned on this website. This information is not intended to diagnose or treat your condition. Our chiropractic clinic in Burlington, Dr. McIntyre or Dr. McDowall accept no responsibility for any complications arising from the use of any suggestions, exercises or topics of discussion on this site. Should you have any further questions about these topics please contact our chiropractic clinic in Burlington.