Plantar Fasciitis

Plantar Fasciitis

By Tyler Dyck

Do your first few steps every morning feel like you are walking on shards of broken glass? Do you have a throbbing ache in your heel towards the end of the day? If so, you may be suffering from a condition known as plantar fasciitis.
Fascia is a soft-tissue structure found throughout our bodies between our skin and our muscles. It has many functions such as compartmentalizing muscles, holding nerves and blood vessels in place, and stabilizing our internal organs. Think of it as a cling-wrap type of material, and in certain areas where some protection is desired the fascia thickens. One common area of this thickening is the bottom of the foot. Here the fascia attaches from the inside aspect of our heel bone and fans out to the five meta-carpal bones just before our toes. When this structure becomes inflamed, you have plantar fasciitis.
A few things have to happen to effectively treat plantar fasciitis. First, you have to resolve the inflammation in the area. This can be accomplished with anti-inflammatory drugs, ice, and temporarily modifying your activities (i.e.- cycling instead of walking or running). Your physiotherapist will use modalities such as ultrasound and high voltage current in an attempt to decrease the inflammation. There is also a very effective taping technique called a Low-Dye, which supports the fascia and can significantly reduce the amount of pain you are in when you have to do weight-bearing activities.
Second, the scar tissue your body is laying down to heal the affected area needs to be mobilized so that is has the appropriate length. Those first few painful steps you take in the morning are actually tearing this new tissue laid down overnight by forcing it to lengthen. This problem can be solved with appropriate stretching exercises to safely mobilize the new tissue your body has been laying down. In some cases, a night splint may be an appropriate intervention. A night splint holds your fascia in a lengthened position while you sleep. Another very useful tip at this stage is to put your most supportive shoe by your bed at night. When you get up in the morning, slip into your shoes for 5-10 minutes so you can support the fascia as it lengthens through weight-bearing.
Now that the inflammation has resolved and the scar tissue has been mobilized you should be feeling much better; however, your work isn’t over yet. To avoid having this painful condition return, you and your physiotherapist must determine the mechanical cause which led to the fascia breaking down in the first place. There are several possibilities and some of the common ones we see in the clinic are poor foot mechanics, improper footwear, and decreased calf muscle flexibility.
Poor foot mechanics means that the structures in your foot (e.g.- muscles and/or ligaments supporting the arch) are not doing an appropriate job supporting your weight and thus excessive
stress is being placed on your plantar fascia. Strengthening exercises to the muscles supporting the arch can often help prevent Plantar Fasciitis. It is important to note that custom foot orthotics may be required if poor foot mechanics are the cause and cannot be improved through exercise.
Also, if you don’t have suitable footwear for your foot type (pronator vs. supinator) then too much stress will be placed on your fascia. Flip-flops and dress shoes are often to blame. Your physiotherapist can assess your foot and help direct you into the appropriate shoes.
Another useful tip: If you have a lot of stone or tile flooring in your home, wear supportive slippers or sandals.
Lastly, lack of appropriate flexibility in the calf muscle can cause undue strain on the plantar fascia. For instance, if the calf muscle restricts motion in your ankle while walking or running, then your body will often compensate by moving excessively through the arch of the foot resulting in strain on the plantar fascia. Sitting jobs can often cause your calf muscle to be held consistently in this shortened position. Your physiotherapist will be able to help by prescribing you an appropriate stretching program.
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