Physical Therapist's Guide to Plantar Fasciitis
Plantar Fasciitis is a condition causing heel pain. Supporting the arch, the plantar fascia, a thick band of
tissue connecting the heel to the ball of the foot, can become inflamed or can tear. You experience pain when you put weight on your foot—particularly when taking your first steps in the morning. The pain can be felt at the heel, or along the arch and the ball of the foot.
Plantar fasciitis is a common foot condition. It occurs in as many as 2 million Americans per year and 10% of the population over their lifetimes.
Factors that contribute to the development of plantar fasciitis include:
- Age (over 40 years)
- A job, sport, or hobby that involves prolonged standing or other weight-bearing activity
- Rapid increases in length or levels of activity, such as beginning a new running program or changing to a job that requires a lot more standing or walking than you are accustomed to
- Decreased calf muscle flexibility
- Increased body weight (Body Mass Index greater than 30)
- Tendency to have a flat foot (pronation)
Plantar fasciitis affects people of all ages, both athletes and non-athletes. Men and women have an equal chance of developing the condition.
Treatment generally reduces pain and restores your ability to put weight on your foot again.
Signs and Symptoms
The onset of symptoms of plantar fasciitis frequently occurs with a sudden increase in activity. You might feel a stabbing pain on the underside of your heel, and a sensation of tightness and/or tenderness along your arch.
People with plantar fasciitis may experience pain:
- In the morning, when stepping out of bed and taking the first steps of the day
- With prolonged standing
- When standing up after sitting for awhile
- After an intense weight-bearing activity such as running
- When climbing stairs
- When walking barefoot or in shoes with poor support
As your body warms up, your pain may actually decrease during the day but then worsen again toward the end of the day because of extended walking. Severe symptoms may cause you to limp
How Is It Diagnosed?
The physical therapist's diagnosis is based on your health and activity history and a clinical evaluation. Your therapist also will take a medical history to make sure that you do not have other possible conditions that may be causing the pain. Sharing information about the relationship of your symptoms to your work and recreation, and reporting any lifestyle changes, will help the physical therapist diagnose your condition and tailor a treatment program for your specific needs.
To diagnose plantar fasciitis, your therapist may conduct the following physical tests to see if symptoms occur:
- Massaging and pressing on the heel area (palpation)
- Gently stretching the ankle to bend the top of the foot toward the leg (dorsiflexion)
- Gently pressing the toes toward the ankle
How Can a Physical Therapist Help?
Physical therapists are trained to evaluate and treat plantar fasciitis.
When you are diagnosed with plantar fasciitis, your physical therapist will work with you to develop a program to decrease your symptoms that may include:
- Stretching exercises to improve the flexibility of your ankle and the plantar fascia
- Use of a night splint to maintain correct ankle and toe positions
- Selection of supportive footwear and/or shoe inserts that minimize foot pronation and reduce stress to the plantar fascia
- Application of ice to decrease pain and inflammation
- Iontophoresis (a gentle way to deliver medication through the skin)
- Taping of the foot to provide short-term relief
Research shows that most cases of plantar fasciitis improve over time with these conservative treatments, and surgery is rarely required.
Dr. Patrick McCauley