Plantar fasciitis is a painful condition involving a thick band of tissue known as the plantar fascia. It runs along the bottom of the foot from the heel to the toes and supports the arch while also acting as a shock absorber during walking.
Every year, approximately two million people are affected by plantar fasciitis, making it the most common foot condition treated by healthcare professionals. While there is a range of treatment options for plantar fasciitis, physical therapy remains the most common.
Most people with plantar fasciitis can begin to see improvements within a few weeks or months using in-person physical therapy, night splints, arch supports, and other conservative treatments. And most people will fully recover in 7-9 months. If you are suffering from persistent pain on the bottom of your foot, you can find relief with exercises and interventions prescribed by a physical therapist.
UT physical therapy specialists at RPT work on an individual basis to develop a regimen that relieves pain and restores function of the foot, ultimately helping you get back to the activities you need and want to do. To better understand the nuances of plantar fasciitis, our orthopedic physical therapy specialists put together a guide.
What is Plantar Fasciitis?
First, the plantar fascia is a web-like band of tissue located on the bottom of the foot. It runs from the heel to the toes connecting the entire foot structure as one. The design of the plantar fascia helps to absorb the high stresses and strains placed on the feet, while also helping to maintain the arch height.
Plantar fasciitis is often an overuse injury where repetitive strain causes micro-tears of the plantar fascia. However, it can also occur as a result of trauma or other multifactorial causes, although not common.
Although the term plantar fasciitis often implies inflammation, this condition is notably characterized by an absence of inflammatory cells.
Symptoms of Plantar Fasciitis
Patients with plantar fasciitis usually report pain at the bottom of the heel or midfoot area and often describe the pain as sharp. While it is common to affect a single foot, this condition can present on both feet.
Pain is typically the worst in the morning with the first few steps out of bed. However, the pain can gradually decrease throughout the day. Difficulty with walking after sitting or standing for too long and difficulty walking on an incline or climbing stairs are other common complaints. Although prolonged inactivity has been shown to increase pain, prolonged activity can also escalate plantar fasciitis pain.
Plantar Fasciitis Causes and Risk Factors
Usually, plantar fasciitis develops with no identifiable cause. Even though there might not be an obvious cause of plantar fasciitis, there are many risk factors that predispose you to developing the condition. Some of these include:
- Tight Calf Muscles: Tight calf muscles can put more strain on the plantar fascia by altering the way the foot and ankle move while walking.
- Foot Posture: Having too high or too low of an arch can place increased stress on the plantar fascia by reducing the ability of the foot to absorb shock while standing and walking.
- Occupations with Prolonged Standing: People who work on assembly lines or who are standing on hard surfaces for long periods of time are predisposed to developing plantar fasciitis.
- Obesity: There is a strong association between greater body mass index and chronic heel pain in a nonathletic population.
- Repetitive Impact Activity: Running was found to be a risk factor for developing plantar fasciitis, especially if they are running on hard surfaces or in flat/spiked shoes. Dancers have also shown a higher prevalence of heel pain, possibly associated with repetitive jumping and landing.
- Heel Spurs: Although heel spurs are not a direct cause of plantar fasciitis, the two conditions often coincide.
Plantar Fasciitis Treatment
Most patients with plantar fasciitis will get better with physical therapy! A physical therapist will work with you to develop an exercise program that targets the specific structures involved in plantar fasciitis. Some of these exercises will include stretching your calf muscles and the plantar fascia itself, as well as strengthening the muscles of the lower extremity to improve the way you move, further preventing the onset of pain in the future. A well-formulated pain-relieving plan may involve a series of specialized treatments, such as regular icing, massages, exercise, stretching, orthotics, and more.
Your physical therapist may suggest starting with resting and icing the affected area. Relative rest from the aggravating activity as guided by the level of pain can be very effective in reducing irritability early on.
Ice can also help to initially reduce your heel pain. When ice contacts the skin, it transmits a sensory input to the brain that blocks the pain input coming from the heel, much like the effect of rubbing an injured body part. Icing for 10-15 minutes twice a day is a safe relatively safe and effective regimen.
Icing immediately following activity may also help to reduce longer lasting pain. An effective way to ice the planar fascia is freezing a single-serve water bottle and rolling the bottom of the foot over it.
Tight muscles in your feet and calves may aggravate the plantar fascia leading to pain. Working with a physical therapist at RPT, you will create a custom exercise routine that stretches your calves and plantar fascia.
After a thorough examination of the affected area, your orthopedic physical therapist might recommend wearing night splints. These splints help stretch your calf and the arch of your foot while you sleep by holding the heel in a lengthened position through the night. Although night splints can make sleeping difficult at first, it is a very effective treatment. Over time, as the pain reduces, the night splints may be removed.
As previously mentioned, having a higher or lower arch can alter the way in which the foot absorbs shock while walking and running. This places more stress on the plantar fascia, making it more prone to injury. An orthotic can help to accommodate these different foot postures and reduce the stress placed on the plantar fascia.
Your therapist may start by simply taping your foot in various ways in an attempt to change the arch height or facilitate muscles responsible for maintaining the arch height. If effective, they may then instruct you to try an over-the-counter or prefabricated orthotic to either support the arch, cushion the heel, or both. If necessary, your therapist may have a custom orthotic designed for your specific foot posture.
Outside of orthotics however, wearing a shoe with a thicker sole or more cushion can be fairly effective in reducing heel pain, especially in occupations where you may be standing for longer periods of time.
Find Plantar Fasciitis Pain Relief at RPT
Although recovering from plantar fasciitis can seem like a slow and painful process, our physical therapists will work hard with you to achieve the relief you desire, and help you return to doing the things you enjoy.
While RPT specializes in orthopedic physical therapy for plantar fasciitis pain, our full range of physical therapy services includes treating injuries associated with bones, joints, ligaments, tendons, muscles, and cartilage. Contact our qualified physical therapists to establish an effective treatment plan that helps improve the way you move, so that you can get back to doing what you love. Schedule an appointment with an RPT specialist today.