My feet hurt…is it Plantar Fasciitis? | Total Performance Physical Therapy

My feet hurt…is it Plantar Fasciitis?

June 6, 2019

If you are a runner, someone who stands a lot throughout the day, or someone whose activities include a lot of jumping and you have foot/heel pain, you may have plantar fasciitis.  Plantar fasciitis is irritation of the plantar fascia, which is a thick tendon-like tissue that runs from your heel to your toes along the bottom of your feet.  The plantar fascia provides the foot with increased shock absorption and also acts as increased support for the arch of the foot.  Repetitive stress, overworking the tissue, and microtrauma from running, jumping, and prolonged standing can cause irritation of this tissue.  It can also occur in older, sedentary individuals who suddenly increase their activity level when the plantar fascia is not used to the stress.  With plantar fasciitis, an individual’s pain will most commonly be at the front (more towards your toes) and inside of the heel, which is where the plantar fascia attaches.

This is the Achilles tendon as it goes into the plantar fascia.  The plantar fascia will run the whole bottom of the foot
This is the Achilles tendon as it goes into the plantar fascia. The plantar fascia will run the whole bottom of the foot

If you have plantar fasciitis, there are certain signs and symptoms that you will present with to allow you to distinguish from other foot injuries such as a muscle strain or ligament sprain.  A hallmark sign in individuals who have plantar fasciitis is “first step pain”.   This literally means that the first step that you take out of bed in the morning is painful.  This occurs because while sleeping over night the plantar fascia stiffens up and then your bodyweight on your feet first thing in the morning stretches, irritates, and stresses the tightened tissue causing significant pain.  In addition, plantar fasciitis pain is either brought on out of nowhere in individuals with occupations that involve a lot of standing or with an increase in activity in individuals who run or jump a lot.  The pain will get worse throughout the course of the day because with each step you take you are stressing and irritating the tissue even more.  Also, the pain is alleviated when off your feet and worse when on your feet.  Another thing to consider is recent weight gain.  With increased body weight there is increased force and stress through your foot and therefore your plantar fascia.

What are contributing factors to plantar fasciitis?

Factors that contribute to individuals getting plantar fasciitis include strength, ROM, and a person’s foot type.  Individuals who have plantar fasciitis commonly have a very tight heel cord/Achilles tendon limiting their ability to bring their foot toward their shin.  Another motion these individuals are limited in is the ability to bring their big toes toward their shin.  The combination of these two motions stretches the plantar fascia and lack of these two motions is why the plantar fascia becomes so tight and stiff.  The tight and stiff plantar fascia is then put through greater stress in weight bearing positions and is how pain originates.  In addition, the strength of one’s foot is a key contributor to developing plantar fasciitis.  As stated earlier, the plantar fascia provides shock absorption and supports the arch of the foot.  The muscles in our feet serve these two functions as well.  If our feet muscles are simply weak or fatigued from being overworked from an increase in activity, then the brunt of the burden is put on the plantar fascia.  The plantar fascia will be overworked and irritated more easily and one will develop plantar fasciitis.  Another contributing factor, which has been debated recently, is foot type.  People have flat feet with no arch, highly arched feet, in between feet, and flexibly arched feet.  Any foot type can develop plantar fasciitis, but individuals with more flexible feet have a higher likelihood.  How do you tell if you have a flexible arch in your feet?  If in a seated position without your feet on the ground you have large or easily visible arches and then in a standing position your arches collapse or disappear significantly your arches are flexible.  This contributes since when not on your feet the plantar fascia is in a shortened position and then when on your feet the plantar fascia is forcibly put into a more lengthened position.  The quick change in length irritates the plantar fascia.

Night Splints

Night splints are a trend that has been used to treat plantar fasciitis.  Let me start by saying these night splints are large, uncomfortable, disturb your sleep, and are proven to be ineffective in the literature.  In addition, patients I’ve seen who have tried to use these agree that they do not work and make sleeping difficult.  Since these trendy quick fixes (not that quick though since night splints are usually wore anywhere from 4-12 weeks in the research) do not work it is important to go to a physical therapist to address your plantar fasciitis.

Treatment

Treatment is all individually based and no two people with plantar fasciitis present exactly the same and this is why you need to be evaluated by a physical therapist for proper treatment.  However, strengthening of weak muscles and stretching of tight structures mentioned above as well as evaluation of foot wear to make sure that your feet have the proper arch support are all integral in treatment.  A key stretching exercise is the stretching of the plantar fascia by simultaneously bringing your foot and big toe toward your shin.  A physical therapist can provide you with an exact exercise prescription for strengthening and stretching exercises.  One way to provide arch support without the need for an orthotic insert is by taping.  A physical therapist can specifically tape your foot to provide arch support through a technique called a navicular sling.  The taping will provide the arch support needed to prevent the plantar fascia from becoming irritated.  As taping is utilized, manual therapy (hands-on therapy), strengthening, stretching, modalities (ultrasound, electrical stimulation, heat and cold) will all be used during therapy.  In addition a physical therapist can provide you with the knowledge of your condition and a safe and effective training prescription for when physical therapy is completed so that plantar fasciitis will not develop again.  Healing the plantar fasciitis and providing the support needed from the surrounding structures of the foot and ankle while in physical therapy will prevent further episodes as well as prevent the need for a long-term orthotic insert.

If you have any foot pain, whether it related to this post or not, come to Total Performance Physical Therapy and get checked out.