Background & Etiology
The foot has over 30 joints, which are held together by connective tissues. Ligaments are one type of connective tissue, which is made of collagen and attaches bone to bone. On the outside (lateral) side of the ankle there are three major ligaments, there are several more ligaments on the inside (medial) side of the ankle joint. These ligaments extend into the foot and play a critical role in the range of motion of the foot. Ligaments in the foot include the plantar calcaneonavicular ligament, the deltoid ligament, the long plantar ligament, and the plantar calcaneocuboid.
The plantar fascia is a thick connective tissue in the foot that runs from the calcaneus or heel bone to the metatarsal heads at the base of the toes. The plantar fascia is found in the sole of the foot, and helps to support the arch of the foot. The plantar fascia can become inflamed, causing a condition known as plantar fasciitis, a common cause of foot pain.
Plantar Fasciitis typically occurs when the plantar fascia becomes overstretched or overused. This condition most often effects men ages 40-70, and is a common cause of foot pain. Common causes of plantar fasciitis include:
- Underlying problems with the arch of the foot (like flat feet or high arches)
- Obesity or sudden weight gain that stresses the structures of the foot
- Injuries to or tightness of the Achilles tendon
- Inadequate footwear with poor arch support
- Overuse injuries, particularly in long distance runners or athletes who participate in other activities that stress and strain the foot
- Pain and stiffness in the heel and bottom of the foot
- An aching or burning sensation in the bottom of the foot
- Pain that gradually gets worse when transitioning from standing to sitting after some time
- Pain in the morning, particularly upon taking the first steps of the day
- Difficulty with activities like climbing stairs
- Mild swelling or redness
The first line of treatment for Plantar Fasciitis is to avoid the activities and positions that cause the pain. A physician can evaluate your foot with a physical exam to diagnose Plantar Fasciitis and determine a course of treatment. This condition can often be treated by non-surgical means, however in severe cases surgery may be necessary to release the tissue if it becomes too tight.
Physical Therapy Interventions
Physical Therapists are professionals, educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and goal of the patient or client. Common interventions in the treatment of Plantar Fasciitis include:
- Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, deep friction massage, manual stretching and joint mobilization by a physical therapist to regain mobility and range of motion of the foot and ligaments.
- Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen the foot and effected muscle.
- Neuromuscular Reeducation (NMR) to restore stability, retrain the lower extremity, and improve movement technique and mechanics (for example, running, jumping, kicking, or stepping) in daily use of the involved lower extremity.
- Modalities that can include the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation at the foot and ligaments.
- Home program that includes strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.
Procedures that your physician may recommend and perform in addition to physical therapy may include:
- REST and ICE
- Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises
- NSAIDS (Non-steroidal Anti Inflammatory Drugs)
- Steroid shots or injections into the heel
- Surgery to correct underlying pathology or the cause of the Plantar Fasciitis in extreme cases
- Orthotic devices or special shoes
- Wearing a boot-like cast to support the foot and immobilize the injured area
- Night splints to stretch the injured tissue and allow it to heal
Most people recover full function following a course of conservative care that includes physical therapy, and pain relief. It is important that once the pain is reduced, and motion and strength are restored, the patient gradually returns to full activities.
Instruction in daily activities or sport performance is helpful for reducing a reoccurrence of Plantar Fasciitis. Non-surgical methods are typically effective and reduce the pain associated with this condition. Treatment can take several months until symptoms improve.