Along the bottom of your feet there is an important structure called the plantar fascia. It plays an important role in helping us walk and do everyday activities. Injury to this structure can have immediate impact on us carrying out these activities and it’s the a common injury that podiatrists treat in the clinic on a daily basis. If you have suffered from plantar fasciitis or plantar fasciopathy pain, then this is a must read as you will learn more about how you can manage this injury.
What makes the structure of the plantar fascia so interesting?
The plantar fascia originates from the medial tubercle of the calcaneus and inserts onto the bases of the proximal phalanges of all 5 digits 
It is subject to large tensile forces. 1 x our bodyweight when walking and between 3-5 x our body weight when running
It is made up of a high percentage of type 1 collagen fibres which are the fibres that withstand tensile forces.
The plantar fascia also plays an important role in regards to proprioception (which is knowing where your foot is in space), stability and control the foot movements.
How does the plantar fascia work during walking?
- It stiffens the arch and reduces the arch from flattening
- It helps resupinate the foot for propulsion
- Reduces ground reaction forces
- Helps absorb and release energy during running
What is the windlass mechanism?
Tension is placed on the plantar fascia which causes compression of the midfoot, raising the arch which creates midfoot stability for effective propulsion. 
Risk factors for plantar fasciitis
Plantar fasciopathy is usually a multifactorial condition with interrelated risk factors associated in its development from one person to another.
- Advancing age due to age-related changes to the tissues within the fascia which decrease its ability to resist tensile loads
- Overuse due to prolonged weight bearing
- Increased BMI which increases tensile forces on plantar fascia and rupture
- Poor foot biomechanics which lead to mechanical overload and degeneration of the plantar fascia
- Training errors such as a sudden increase in activity or not enough time in between loading of activities
- Reduced ankle dorsiflexion range of motion and decrease 1st MTPJ range of motion may increase strain loads on the plantar fascia
- Occupation may be standing on hard surfaces all day
How does a podiatrist manage plantar fasciitis?
There are quite a few treatment options available for a podiatrist to use. Below are some treatment options and methods we may use in combination to help reduce plantar fascia pain:
- Imaging: Radiographs will show thickening or inflammation of the plantar fascia. X-ray may or may not show heel spur. It has been demonstrated that heel spurs are not the cause of the pain
- Whole-body assessment: We look beyond the foot itself, as plantar fascia pain can sometimes stem from issues further up the kinetic chain (such as the ankle, knee, hip or gait pattern), and address these contributing factors as part of treatment.
- K-Taping: To provide support, lessen pain, decrease swelling and improve function.
- Custom foot orthoses: To provide arch support and offload painful areas
- Shockwave therapy: is used in more chronic cases greater than 6 months where it creates a local inflammatory response and begins the healing process. We use both radial and focused shockwave, with focused shockwave able to target deeper, more localised areas of the plantar fascia with greater precision. It is recommended that roughly between 6-8 treatments is needed in conjunction with other interventions.
Focused Shockwave Therapy - K-Laser: Low-level laser therapy that helps reduce inflammation and pain while stimulating cellular repair in the plantar fascia.
- EMTT and Lyftogt Prolotherapy: For chronic or recalcitrant cases, these therapies stimulate the body’s natural healing response and promote tissue regeneration, often used alongside shockwave for a more comprehensive approach.
If you or someone you know experiences plantar fasciitis and would like a thorough biomechanical assessment from one of the podiatrists at The Footcare Clinic, please don’t hesitate to contact The Footcare Clinic and one of our podiatrists will assess the injury and establish a treatment plan for you. You can book an appointment online or ring our friendly admin team on (03) 9711 7562 if you have any questions.
