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Plantar Fasciitis: The Most Common Cause of Longstanding Heel Pain

 

Plantar fasciitis [PF] is pain in the heel of the foot characterized by stiffness and inflammation throughout the area.  PF is the most common chronic foot pain beneath the heel in adults, and makes up 11-15% of foot symptoms requiring professional care for relief to occur.3  There are many possible causes of PF evidenced as Fraser et al. states, “The etiology of this condition is multifactorial, and the condition can occur traumatically; however, most cases are from overuse stresses.”1

PF is more specifically the inflammation, weakness, and/or swelling of the flat band of fibrous tissue at the bottom of both your feet that connects from your toes and inserts into the heel in five separate bands.  PF could affect anyone from someone who leads a more sedentary lifestyle or even those who are very physically active.1  PF is commonly caused by recent changes in level of activity, frequent running, prolonged standing, leg length issues, gait abnormalities (over-pronation) and changes in body mass index (BMI) of non-athletic individuals.  A tell-tale sign of PF is when the individual notices that heel pain is most intense with initial steps after periods of inactivity or prolonged standing.2  Astoundingly, it’s estimated that 1 in 10 people will actually develop PF in a lifetime in varying degrees.

People often describe PF pain as sharp or stabbing in the heel, accompanied by an intermittent burning sensation at the sole of the foot.  In most cases, the pain may reduce gradually with light walking throughout the day.  Although, throughout daily activities a dull and/or aching pain could return with standing on unpadded surfaces for prolonged periods or with continuous walking.  If symptoms are left untreated, a heel spur could potentially develop.  Heel spurs can form as the band of tissues, making up the plantar fascia, pulls on the heel bone resulting in a more chronic issue.3  Research supports that early recognition and intervention of PF can result in a shorter course of treatment.  Ultimately, early intervention with physical therapy allows the opportunity to avoid surgery by using conservative rehab measures to provide short and long term pain relief.2

Research supports that physical therapy often provides positive outcomes in resolving PF through various interventions in order to shorten the recovery process.3  Manual therapy or hands-on techniques are used to reduce abnormal restrictions in motion that cause further inflammation of the sole of the foot.  These techniques can be coupled with specific therapeutic exercises, stretching methods, taping, shoe inserts, night splints, ultrasound, iontophoresis and footwear modifications as some options for treatment.4  In order to identify causative factors of PF, a physical therapist will thoroughly examine the patient in order to determine an appropriate plan of care.  The diagnosis of PF will typically involve:  special tests performed in clinic, observation of gait/foot/ankle mechanics, pertinent patient history (recent change in activity level or BMI), and other objective measures.

Consequently, physical therapy interventions aide in reduction of pain levels and decrease inflammation present in those with PF.1  Physical therapy treatment can also provide the individual with increased ability to tolerate weight-bearing activities while at work, at home or during recreational tasks.  Therapy can help in pain relief and possibly avoid surgery, thus reducing overall down time.

  1. John J. Fraser, Neal R. Glaviano, Jay Hertel. (2017) Utilization of Physical Therapy Intervention Among Patients With Plantar Fasciitis in the United States. Journal of Orthopaedic & Sports Physical Therapy 47:2, 49-55.
  2. Sweeting D, Parish B, Hooper L, Chester R. The effectiveness of manual stretching in the treatment of plantar heel pain: a systematic review. J Foot Ankle Res. 2011;4(1):19.
  3. Thing J, Maruthappu M, Rogers J. Diagnosis and management of plantar fasciitis in primary care. Br J Gen Pract. 2012;62(601):443-4.
  4. Digiovanni BF, Nawoczenski DA, Malay DP, et al. Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up. J Bone Joint Surg Am. 2006;88(8):1775-81.

By Justin Maurizio, DPT

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