Recovering from Plantar Fasciitis: What to Expect and How Long It Takes

Plantar fasciitis is a painful condition that affects the plantar fascia, a thick band of tissue that runs along the bottom of the foot, connecting the heel bone to the toes. The plantar fascia plays a crucial role in supporting the arch of the foot and absorbing shock during activities like walking, running, or standing. When this band of tissue becomes inflamed or irritated, it leads to a condition known as plantar fasciitis.

Distinguishing between Plantar Fasciitis, Heel Spur and Achilles Tendinitis

As a physiotherapist it is essential for accurate diagnosis and appropriate treatment to distinguish between these three conditions. It can be done by considering three factors:

1. Location of Pain
2. Morning Pain
3. Activity-Related

 

Symptoms

• Heel Pain
• Morning Pain
• Pain after Activity
• Tenderness
• Discomfort in the arch of the foot
• Pain Relief with Rest
• Gait Abnormalities such as limping

 

Causes

• Repetitive Strain
• Poor Foot Mechanics - alter the way the foot absorbs and distributes shock, putting extra strain on the plantar fascia.
• Inadequate Footwear
• Obesity
• Age - common in individuals between the ages of 40 and 60,
• Occupational Factors – like prolonged periods of standing or walking on hard surfaces
• Tightness in Calf Muscles
• Abnormalities in gait or walking patterns
• Certain medical conditions such as rheumatoid arthritis, lupus, and diabetes

Why can’t a patient walk with plantar fasciitis?

Some patients with plantar fasciitis may find it difficult to walk comfortably. Here's why walking can be challenging for individuals with plantar fasciitis:

Physiotherapy Management of Plantar Fasciitis

Stretching Exercises

Calf stretches:

Stretching the calf muscles helps reduce tension on the Achilles tendon and the plantar fascia.

Plantar fascia stretches:

Stretching the plantar fascia itself can alleviate pain and improve flexibility. In the plantar fascia stretch, the foot to be stretched is placed on top of the opposite knee, the ankle is maximally dorsiflexed, and then the toes are extended, creating tension in the plantar fascia. The plantar fascia is then gently massaged along its length.

Towel stretches:

Using a towel to stretch the arch of the foot can be effective in relieving discomfort. 

Rolling Massage:

1. This exercise can help reduce tension in the plantar fascia.
2. Use a tennis ball, golf ball, or a specialized foot roller.
3. While sitting or standing, roll the ball or roller under your foot from the heel to the ball, focusing on areas that feel tense.
4. Apply gentle pressure and repeat for a few minutes on each foot.

 

Strengthening Exercises

These exercises targets the intrinsic foot muscles and the muscles of the lower leg which in turn help improve stability and support the arch of the foot.

Arch Strengthening:

1. Sit with your feet flat on the ground.
2. Place a small towel or cloth under the arch of your foot.
3. Use your toes to scrunch up the towel, creating a wrinkled effect.
4. Relax and repeat for 10-15 reps for 2-3 sets.

 

Intrinsic Foot Muscle Strengthening:

1. Sit down and place your feet flat on the ground.
2. Spread your toes as wide as possible, holding for a few seconds.
3. Then, bring your toes back together.
4. Repeat this toe spreading and squeezing for 10-15 reps for 2-3 sets.

 

Manual Therapy

Myofascial release can be used to address muscle tightness and reduce tension in the foot and calf.

Frozen Water Bottle Massage:

1. Freeze a plastic water bottle.
2. Sit in a chair and place the frozen water bottle on the floor.
3. Roll the bottle under your foot, from the heel to the ball of the foot.
4. Apply gentle pressure as you roll and focus on areas of tension.
5. Continue for 2-3 minutes or until the ice begins to melt.

Manual Myofascial Release:

1. A trained physiotherapist may perform manual myofascial release techniques on your foot.
2. You would typically lie down, and the therapist would use their hands to apply controlled pressure to the affected areas of your plantar fascia and surrounding tissues.
3. The therapist will maintain the pressure for a sustained period to encourage the release of tension in the fascia.

Instrument-Assisted Myofascial Release:

1. Some physiotherapists use specialized instruments, such as Graston or ASTYM tools, to perform myofascial release.
2. These tools are used to gently scrape or massage the affected area, breaking up fascial adhesions and promoting healing.

 

Electrotherapy

• Cryotherapy: Applying ice to the affected area can help reduce inflammation and relieve pain.
• Ultrasound Therapy: Therapeutic ultrasound can promote healing and reduce pain. 

 

Footwear Recommendations

Proper footwear with adequate arch support and cushioning is crucial. A physiotherapist can offer guidance on choosing appropriate shoes.

Patients with plantar fasciitis experiences maximal peak stress located near the medial calcaneal tubercle during the late-stance phase of gait. The stress within the Plantar Fascia is proportional to the Achilles tendon force, which is proportional to the magnitude of heel rise during gait. Orthotics decrease heel rise and Achilles tendon force during gait, leading to pain reduction.

Choosing the right shoes is crucial when managing plantar fasciitis. Here are some key features to look for in shoes recommended for plantar fasciitis:

• Arch Support - Look for shoes that have built-in arch support or removable insoles so you can use custom orthotic inserts if needed.
• Cushioning - Opt for shoes with ample cushioning in the heel and forefoot areas. This cushioning helps absorb shock and reduces the impact on the plantar fascia while walking.
• Heel Support - Choose shoes with a firm heel counter (the back part of the shoe that wraps around the heel). A sturdy heel counter helps stabilize the foot and reduces excessive pronation or supination.
• Rigid Sole - Shoes with a slightly rigid sole can help distribute pressure more evenly across the foot and reduce strain on the plantar fascia.
• Wide Toe Box - A roomy toe box allows the toes to spread naturally and can help alleviate pressure on the front of the foot. This can be particularly beneficial for individuals with bunions or toe deformities.
• Low Heel - Avoid high-heeled shoes or shoes with a significant heel drop, as they can exacerbate plantar fasciitis by increasing strain on the Achilles tendon and calf muscles.
• Removable Insoles - Shoes with removable insoles provide the flexibility to use custom orthotic inserts.
• Supportive Material - Leather or synthetic materials that provide structure and support tend to be better choices than flimsy, flexible materials.

 

Kinesio Taping and Bracing

Techniques such as arch kinesio taping or the use of night splints may be recommended to maintain a stretched position of the plantar fascia overnight.

Immobilization: Night splints

The night splint is an orthosis that prevents plantar fascia contracture by maintaining a neutral position of the ankle during sleep. Night splinting is most effective in patients whose chief complaint is morning pain.