Updated: Nov 18, 2019
Plantar fasciitis is one of the most common conditions we see in our office. In this article, we highlight some of the risk factors for the conditions and the most up to date treatment options for it.
Plantar fasciitis is acute or chronic pain in the inferior heel at the attachment of the medial band of the plantar fascia to the medial calcaneal tubercle. It has been described as a chronic inflammatory process and maybe an overuse injury. Pain is worst when taking the first few steps out of bed in the morning and after periods of rest. Although an aggravating condition, pain is self-limiting and usually resolves between 6 to 18 months without treatment.
Often times individuals don't like to "wait and pray" for 6 to 18 months. Our job at All Systems is to provide our patients with the best treatment for their particular case to get them out of pain faster. More on treatment later.
Risk factors are a characteristic that increases a person’s chances of developing the condition
Strong Risk Factors for Plantar Fasciitis
Obesity: several studies have found that being overweight or obese to be a significant risk factor for developing plantar fasciitis. Also, overweight individuals tend to get more severe plantar fasciitis symptoms.
Equinus: Equinus is a lack of ankle flexibility. Specifically the inability to dorsiflex (the movement of bringing your toes to your knee). This is usually caused by calf tightness which puts excessive strain on the plantar fascia as you walk. This is why stretching and increasing calf flexibility is a great treatment for plantar fasciitis.
Weak Risk Factors
Pes Planus: Pes planus is excessive pronation of the arch of the foot causing a flat foot appearance. Some studies have shown there is an association between flat feet and plantar fasciitis. That being said it is considered a weak risk factor as many people that have flat feet never develop the condition.
Age great than 40: Plantar fasciitis most commonly occurs in the 40- to 60-year-old age range. Increasing age has also been suggested as a risk factor
History of prolonged standing: Commonly seen in people who work in a standing position, especially those who are standing on a hard, unforgiving surface such as concrete
Runners: Although a weak risk factor studies show about 10% of people you run regularly will get plantar fasciitis.
Conservative (NON-surgical) treatment for plantar fasciitis is 90% effective at reducing patient's pain symptoms. Only about 10% of cases do not respond well to conservative therapy. Treatment may take months before full recovery. A combination of therapies is recommended to not only calm down the inflammation and pain associated with the condition but also stretch and strengthen the area and fix any biomechanical or lifestyle factors that may have contributed to the plantar fasciitis in the first place. Here are some of the most common treatments that have been shown to help with plantar fasciitis.
Rest: One study demonstrated that up to 25% of plantar fasciitis patients recovered with rest from the exacerbating activities. This is most likely due to the body’s ability to deal with the inflammation on its own without intervention. That being said if there is an underlying weakness, biomechanical, or lifestyle/occupational cause then simply rest may not prevent another recurrence.
Taping: specific taping protocols have been successful in decreasing pain. Further improvements are seen when taping is combined with exercise and stretching. Taping is beneficial in the early stages before arch support devices are used and help with the stiffness and pain that is most noticeable in the morning.
Foot orthotics: Insoles, prefabricated devices, custom-made orthotics, and heel cushions are all frequently used for treating plantar fasciitis, but long-term benefits are not proven. In the initial stages, this may help with symptoms but like the other therapies, they are most useful when combined with strengthening and stretching of the foot and leg muscles.
Night splints: These are effective for those with both acute and recalcitrant pain. The idea is they help prevent the tightening of the foot and calf muscles at night. This will help with the morning pain and stiffness.
Stretching: Stretching is aimed at the tendoachilles and the plantar fascia. It is recommended 3 times daily with 10 repetitions of each stretch. The key component has been aimed at stretching first thing in the morning or after prolonged sitting or inactivity so as to limit microtrauma and associated chronic inflammation. Stay tuned for future posts on stretching and strengthening exercises to help with plantar fasciitis.
What to expect from the staff at All Systems?
At All Systems, our doctors thoroughly examine not only the foot but also walking mechanics and other areas that may be contributing to the heel pain. This allows us to identify what may be the underlying cause of the inflammation in the heel. Once we reach our diagnosis we create a custom plan that may include many options that were discussed above. We have custom made plans that blend the right amount of rehabilitation and manual therapy to help keep our patients doing the things they love to do with as little pain as possible.