Have you ever heard the song “Every Breath You Take” performed by The Police? If you have then you know the lyrics.… “Every move you make, every bond you break, every step you take, I’ll be watching you”. If you just replace the “I’ll be watching you” with “I’ll be HURTING YOU” it fits right in with those who have plantar fasciitis. In fact, these lyrics are belted out with pride every day if you suffer from plantar fasciitis from the very first step you take out of bed. The pain is comparable to a terrible karaoke night of drunk monotone college kids gleefully singing some Nickelback song to you ensuring that you will regretfully remember this feeling forever.
Thankfully, I am here to tell you that you do NOT have to suffer from pain associated with plantar fasciitis.
Heel and foot pain can result from many different pathological conditions ranging from minor to severe. Some common examples of reported foot/heel pain include achilles tendon tears, bruises from contact with objects, skin irritation from rubbing of shoe wear, calcaneal stress fractures, fat pad of heel irritation, and calcaneal bursitis just to name a few. One of the most common diagnoses of heel pain in outpatient physical therapy clinics is a condition called plantar fasciitis.
If you have been diagnosed with plantar fasciitis, you are very aware of the pain that ensued. For those of you that have not heard of this condition, I will put it to you in terms you may be able to relate to…. Walking with plantar fasciitis can be like stepping on a Lego block each time you walk. Typical phrases that are commonly heard from individuals with plantar fasciitis may include – OUCH, YOWZA, $*##*$$!
WHAT CAUSES PLANTAR FASCIITIS?
The onset of plantar fasciitis pain can be linked to a multitude of factors including poor ankle mechanics, poor footwear choices, limitations in ankle mobility, and tight musculature. Additionally, individuals commonly present with imaging that shows heel spurring. The condition affects middle-aged individuals mostly between the ages of 25-65 years old that lead an active lifestyle. Runners and those who are commonly wearing high-heels are most at risk of developing the pathology.
Plantar fasciitis is responsible for approximately 10-15% of all professional medical care visits involving reported foot/heel symptoms.
Micro-tearing of the plantar fascia is one of the highest contributing factors to developing symptomatic plantar fasciitis. Poor foot mechanics while performing dynamic activities such as running, high-impact gymnastics or dancing, and wearing shoes that allow the arch of the foot to cave in (pes planus) is a main contributive factor to developing plantar fasciitis. Constant repetitive stretching “never allows the plantar fascia to recover the collagen gaps created via the tears” and thus results in degenerative changes that can cause scarring and thickening of the tissue (bad news bears for foot problem). Combine all of the above with poor availability of blood supply to the plantar fascia tissue and normal inflammatory mediators cannot perform their jobs appropriately causing a DOUBLE WHAM!
If this all sounds gibberish to you, no need to fret, compare it to something like this…
One day you start to have a small nagging pain in your foot/heel region that causes you to say, “hmm that kind of sucks”, however, you proceed on with life because well… we are humans, and we keep moving forward. You go on stating “Nothing a little NSAIDs and R&R cannot fix”, right? Additionally, You have worn the same shoes for 4 years because those darn new shoes cost too much to replace.
Over the next few weeks/months your little ouch has become so chronic that it is a daily occurrence that you now say, “I just live with it”. In fact, by this time you may even develop a nickname for it (dosh garnet foot pain). Finally, you wake up one morning and realize that the pain is so unrelenting that you start to change the way you are walking to accommodate the pain relief. That night, you decide to set up an appointment to see a foot doctor (podiatrist). The podiatrist will assess your foot-related injury and provide you with a few options they think would be best to help you.
One of those options may be in the form of an injection of steroids or numbing agent (or a combination of the two)- read more about that here –https://www.footcaremd.org/conditions-treatments/injections-and-other-treatments/plantar-fascia-injection). The other option the podiatrist may provide is a referral to physical therapy. As a Doctor of Physical Therapy, I can say firsthand that we have extensive knowledge of the world of how the human body functions and operates. We are specialists in body aches and pains, muscular injuries, nerve injuries, conditioning, performance, recovery, and yes…. foot/heel OUCH pain from plantar fasciitis.
HOW CAN PHYSICAL THERAPY HELP WITH MY PLANTAR FASCIITIS?
Physical therapy sessions can last anywhere from a few sessions in length all the way up to 18 months for full relief. The initial session will be compromised of a full-body assessment to see if anything up the chain or down the body chains that may be contributing factors to your foot/heel pain. A comprehensive evaluation is performed to gather objective measures of your range of motion, strength, nervous system involvement, and functional abilities among other tests/measures. Your physical therapist will ask questions to get a better understanding of your perceived disability and the effects that your foot/heel pain is having on your quality of life at home or in the workplace.
Your Doctors of Physical Therapy will then help to create an evidence-based individualized program for you to combat the problem at home. They will teach you how to mitigate the pain and improve your function by prescribing and demonstrating a personal HEP (Home Exercise Program). The HEP will be filled with useful information in the form of videos, and/or live teleconferencing with educational materials to help you in your journey to eliminating the condition. The good news is that most individuals have the supplies at home that are needed to effectively perform the HEP without any additional out-of-pocket costs for equipment.
It Is Important To Remember – Every individual is different, and every disease pathology can present in many ways. What works for one may not work for everyone. If someone tells you that they know EXACTLY how to fix your injury or problem, then you need to be suspicious of their proclamation. As a Doctor of Physical Therapy (DPT), I will attest that we are all “practicing” our learned profession. There is very little blanketing in the medical profession…. While evidence-based interventions help to provide quality care for the individuals that we see, they may not be the only answer to the problem.
There is value in seeing a movement specialist such as a DPT for movement-related disorders of the musculoskeletal and neuromuscular systems. “When in doubt, see a Doctor of Physical Therapy to help you figure it out”
WHAT KIND OF INTERVENTIONS WILL I PERFORM?
All Interventions listed below are considered High Evidential Value (Strong grade “A” evidence according to the Journal of Orthopedic & Sports Physical Therapy).
***DISCLAIMER*** PLEASE DO NOT ATTEMPT ANY OF THE INTERVENTIONS LISTED WITHOUT APPROVED MEDICAL CLEARANCE FROM A LICENSED DOCTOR OF PHYSICAL THERAPY OR OTHER HEALTHCARE PROFESSIONAL. FAILURE TO ADHERE TO THIS WARNING MAY RESULT IN SERIOUS BODILY HARM AND/OR SIGNIFICANT INJURY! THIS INFORMATION IS INTENDED FOR EDUCATIONAL PURPOSES ONLY.
To be more specific about evidence-based interventions for plantar fasciitis I have included a few examples below for you to review along with some product recommendations for use at home. We will also be doing a video series on these interventions to address this body region in more detail on our YouTube site and social media accounts. Be sure to follow along to stay up-to-date on our most current content.
- Stretching of the posterior heel cord and musculature surrounding the lower limb including the gastrocnemius/soleus complex (calves); Using a foam roller or heel pads can be utilized for additional benefits of stretching the calves
- Antipronation taping (taping to prevent the foot from rolling inward and flattening the arch); Gastroc/soleus (calves) and plantar fascia elastic taping to assist with arch support
- Prefabricated or custom foot orthoses to prevent medial arch collapse (medial longitudinal arch) and support the foot in neutral alignment for better biomechanics during functional movements in weight-bearing positions; This can be used long term if relief is provided from an anti-pronation taping regimen
4. Night Splinting
- If you have pain during the first step in the morning, you can wear splints at night to help elongate the tissues in the calves and plantar fascia to prevent adaptive shortening. This could reduce painful onset in the morning by providing static relief throughout the night
Did you know? – when you are sleeping at night your feet are naturally relaxed into a flexed position with the toes pointed (plantar flexed). The plantarflexed position can cause the calves to become shortened in the length and when you take your first step in the morning a stretch is applied to the calves which translates through the achilles to the plantar fascia. It is important to understand how we function to provide optimal relief. When in doubt see a Doctor of Physical Therapy to help sort out movement dysfunctions.
5. Manual Therapy
- Your physical therapist will apply hands-on techniques to improve joint and soft tissue mobility that may be hindered due to the status of your injury. The Doctor of Physical Therapy will implement appropriate techniques based on associated findings. Find more information on how we can help you by visiting our physical therapy page
Living with foot/heel pain SUCKS! Book an appointment with one of our Doctors of Physical Therapy. WE CAN HELP ALLEVIATE YOUR PAIN! https://drvnphysicaltherapy.janeapp.codm
1. Tahririan MA, Motififard M, Tahmasebi MN, Siavashi B. Plantar fasciitis. J Res Med Sci. 2012;17(8):799-804.
2. Martin R, Davenport T, Reischl S et al. Heel Pain—Plantar Fasciitis: Revision 2014. Journal of Orthopaedic & Sports Physical Therapy. 2014;44(11):A1-A33. doi:10.2519/jospt.2014.0303
3. Villines Z. Plantar fasciitis stretches: 6 exercises and other home remedies. Medicalnewstoday.com. https://www.medicalnewstoday.com/articles/324353#_noHeaderPrefixedContent. Published 2019. Accessed December 21, 2020.
Dr. Craig A. Muchow, PT, DPT, TPI, SFMA