Physical Therapy Advice: Plantar Fasciitis 101

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• Plantar Fasciitis Can Be A Real Pain In The Heel

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  When someone gets out of bed and is hit with a stabbing pain in the foot, it might be because of plantar fasciitis. It can be a real problem for people that spend a lot of time on their feet and can be hard to get rid of.

  The plantar fascia is the thick connective tissue on the bottom of the foot. Lori Thein Brody, a physical therapist and athletic trainer with the University of Wisconsin Sports Medicine and Spine Center, said that “mechanically, it was probably not the most well-designed structure. It starts at a fairly small, single point at the back of your heel, and then it fans out to attach to your five toes.”

  Brody explained that while the load is spread out at the front of the foot, at the heel it’s focused in a very small area. Bill Boissonnault, a professor at the UW School of Medicine and Public Health and senior physical therapist at the Spine Center Physical Therapy Clinic of the UW Hospital and Clinics, said it “can cause big problems.”

  Boissonnault said that plantar fasciitis is consistently among the top 10 or 15 reasons that patients contact physical therapists. The worse time is usually first thing in the morning.

  “And then it gets a little better as the day goes on. But the more you’re on your feet, the more it hurts,” he said.

  The key to managing plantar fasciitis, according to Boissonnault, is early treatment and addressing the symptoms, but figuring out what the underlying cause is as well.

  “Rarely is this associated with a traumatic injury,” he said, “so it’s difficult for many people to say ‘this is what caused it.’”

  Boissonnault shared that possible causes of plantar fasciitis include “muscle imbalances, foot and ankle mechanics, footwear, training regimen.”

  So, after the acute symptoms are taken care of, these are the areas to consider for real resolution of the problem. The load that the feet are bearing is what it boils down to.

  “It’s a pretty mechanically-based issue,” Thein Brody said.

  One aspect to look at is the frequency of load. That is how long someone is on their feet, but it’s also important to look at what types of activities are causing it.

  Thein Brody said it’s important to consider questions like “what’s the intensity of being on my feet? Am I just standing, am I walking, am I running? Do I have extra body weight contributing to the intensity of the load?”

  In addition, she said, pay attention to duration of all of those load-bearing situations.

  Health officials said it can be a challenging condition to treat because the situations that can cause it might be necessary parts of people’s everyday life — at home and at work. But ignoring the symptoms won’t help, they said, and can exacerbate the problem. Boissonnault said that when a patient has been experiencing pain for a year or more, it can progress and become more serious.

  Thein Brody said that when the name of an ailment ends in “-itis,” it means that there is an inflammation. Sometimes, what is thought to be plantar fasciitis is actually plantar fasciosis. The latter, she said, “is more of a degenerative condition, which is why sometime anti-inflammatory measures don’t work for ‘plantar fasciitis.’” The plantar fasciosis is what can result from not treating the fasciitis early enough.

  If the condition progresses, it isn’t necessarily permanent, Boissonnault said, but the recovery will be longer and harder.

  Treatment options focus on correcting the mechanical issues at the root of the problem. Addressing weakness at the hip is a common approach, as is preventing the foot from rolling during walking. Sometimes, the issue is an error in training techniques.

  Thein Brody said that when a patient comes in with plantar fasciitis in only one foot, that should signal the physical therapist to investigate why, when both feet should be experiencing similar load from similar use. One possibility is a difference in leg length, or something as unexpected as a result of always running the same direction on a track, and there being something irregular about the surface.

  Orthotic inserts in footwear can provide relief for many people who are suffering from plantar fasciitis. To reduce symptoms, steroid injections can help, but Boissonnault emphasized that those do nothing to address whatever the underlying cause may be.

  In treating this condition, Thein Brody said that “a good physical therapist will sit down with the person and look at them from head to toe, examine their gait, examine their posture, look at their flexibility, look at their strength, talk to them about training, and figure out where the problems are. Oftentimes, it’s a combination of factors.”

  Boissonnault added that since the acute pain is usually in the heel area, that’s where a lot of the attention at the start should go. “But then after the acute phase, the (physical) therapist should be looking from stem to stern … to try and figure out ‘so why did this start, and what can we do to prevent this from coming back again.’”

  The Mayo Clinic has a useful resource page about plantar fasciitis diagnosis and treatment.