HOW TO TREAT PLANTAR FASCIITIS (HEEL PAIN)

Plantar fasciitis can be extremely frustrating for the patient experiencing its painful and insidious symptoms. Pain in the heel on getting out of bed in the morning, getting out of the car after a routine commute to work, getting up from the office chair, are common experiences of this condition. At its’ worst plantar fasciitis pain can be cruel with its sufferers literally hobbling along just trying to get by.

INCIDENCE OF PLANTAR FASCIITIS

Approximately 5-10% of the population will experience the debilitating effects of plantar fasciitis [1,2]. Within the running community it is estimated that 15% of all running injuries strike the feet, and of this 15%, plantar fasciitis comprises 8% of all running related foot injuries [3].

Changes to the plantar fascia are similar in nature to the changes that affect achilles tendons. That is the plantar fascia itself does not tend to get inflamed, despite what the Latin suffix ‘itis’ in plantar fasciitis denotes (in Latin, ‘itis’ means ‘inflammation of ’). Rather the fascia undergoes a gradual decline in its strength and tissue quality, as the runner experiences a proportionate and gradual increase in the pain on the sole of their foot.

Plantar Fasciitis can at times be very debilitating and more often than not incredibly frustrating for the sufferer.For practitioners and the physiotherapist treating plantar fasciitis can be equally frustrating. As therapists we take pride on assisting our clients to get results in a timely manner. Unfortunately plantar fasciitis treatment is rarely an overnight or short term sensation. I have had clients who have suffered for it for years and others just several months.

HOW TO TREAT PLANTAR FASCIITIS-A BREAK-THROUGH STRENGTH EXERCISE

Treatment of plantar fasciitis to date has centred around plantar fascia stretches, calf stretching, foot mobilisations, orthotic prescription when necessary, and fascial releases (e.g. with a roller or rolling pin etc).

There are generally two groups of people that as a physiotherapist I see developing plantar facsiitis. They are:

1. people who have a Body Mass Index (BMI) in excess of 30.
2. runners who ‘spike’ their training load by doing too much, too soon, too fast.

The world of rehabilitation is a-buzz as recently Scandinavian researchers have tested a new approach for the treatment of plantar fasciitis [4].  The team of researchers looked at the effect of high load strength training as a possible treatment of plantar fasciitis. They compared this intervention against plantar fasciitis sufferers who were prescribed a standard plantar fascia stretching program. High load strength training has long been used with success in the treatment of Achilles tendon and patellar tendon problems.

Both groups in the study were given an information sheet and also provided with gel inserts. There were 48 subjects in the study.  The stretch group stretched their plantar fascia with 10s holds by 10 reps, three times each day. Meanwhile the strength group performed single leg calf raises but with a towel under their toes. The exercise was specifically completed as follows:

• The towel was placed under the toes (must be bare-footed) in order to place more load on the plantar fascia and to facilitate the windlass mechanism (note one end of towel can be left unrolled -this can help reduce pressure on the metatarsal heads which in some instances can be aggravated by this exercise).
• The exercises were completed every second day for a period of three months.
• The repetitions were 3 x 12 reps initially which then progressed to 4 x 10 reps with a heavier weight, and eventually 8 sets of 5 reps with an even heavier weight.
• Each calf raise were held for a total of 8s each (3s up, 2s at top, and 3s down).

Interestingly the long term effect (at 6 and 12 month follow up) of both groups (stretch and high level strength) was similar however there was a far greater reduction in pain through-out the first 6 months for those subjects who completed the high load strength rehabilitation protocol.

Watch the below video for instruction into how to perform high load strengthening exercise to treat plantar fasciitis.

It is important to note that other contributory factors such as foot biomechanics, activity related loads (eg training, sports participation levels etc), and calf strength and tension may also need to be corrected in order to achieve a full resolution of plantar fasciitis symptoms.

For the runners when it comes to returning to running after an episode of plantar fasciitis there are several key criteria and steps involved. They are as follows:

• Aim to walk for 10km briskly as first step of recovery.
• Monitor the symptoms and any discomfort for during the activity, after the activity has ceased, and getting out of bed the next day
• I usually use an 8 week return to run program which aims to control loading and slowly increase running distance. The aim over the 8 weeks is to be able to cover 5kms running plantar fasciitis symptom free (yes this can be frustrating for the half and full marathon runners).
• Clarifying runners often very unrealistic expectations is key. I am often heard telling runners suffering from plantar fasciitis that there is no ‘magic bullet’, but rather a process involved.
• Generally after 1 month plantar fasciitis sufferers may feel a bit better and after 6 months much better.
• heel raises/gel inserts can be of use in settling symptoms.
• In general active and fit people do better with  regards to the above strength program
• The above is a guide only, programs need to be individualised to also include lower leg strength exercises-click HERE.
• Deficits in toe flexor strength often also need to be addressed for resolution of plantar facsiitis symptoms.
• If the runner has experienced an acute flare up-as opposed to a slow build up of progressively worsening plantar facsiitis symptoms there may be no need to load the runner up with the above mentioned strength program. Rather they may need only a reduction in load related to their running training program.

Get started on your journey from pain and injury into best physical performance HERE.

Brad Beer (APAM)

Physiotherapist, Author Amazon Best Seller You CAN Run Pain Free! , Founder POGO

REFERENCES

1. Hill CL, Gill TK, Menz HB, Taylor AW. Prevalence and correlates of foot pain in a population-based study: the North West Adelaide health study. J Foot Ankle Res 2008;1(1):2 doi: 10.1186/1757-1146-1-2[published Online First: Epub Date].

2. Dunn JE, Link CL, Felson DT, Crincoli MG, Keysor JJ, McKinlay JB. Prevalence of foot and ankle conditions in a multiethnic community sample of older adults. Am J Epidemiol 2004;159(5):491-8.

3. Lopes AD, Hespanhol Junior LC, Yeung SS, Pena Costa LO ‘What are the main running related musculoskelatal injuries? A systematic review. Sports Med. 2012: 42 910): 891-905.

4.  Rathleff MS, Mølgaard CM, Fredberg U, et al. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scand J Med Sci Spor 2014:n/a-n/a doi: 10.1111/sms.12313[published Online First: Epub Date]|.

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