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
- NSIAIDs: To control swelling and reduce pain.
- Stretching on the Achilles muscles takes tension off the plantar fascia.
- Strengthening exercises provided may reduce strain on the plantar fascia and strengthen the arch of the foot.
- K-Taping: To provide support, lessen pain, decrease swelling and improve function.
- Spikey ball to release tension within the arch and reduce pain
- 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. It is recommended that roughly between 6-8 treatments is needed in conjunction with other interventions.
- Footwear: Changing footwear to a rocker bottom shoe will provide comfort when walking, allow for a more efficient gait and may reduce pain
- Archies thongs have a nice heel cup and arch support and is a good alternative to wear around the house instead of walking barefoot which may be causing pain
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.