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.

Plantar Fasciitis

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 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

Prognosis

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.

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"Eric was an excellent physical therapist. I made tremendous improvement during my time there. Rachel & Brittany were always smiling and creating a positive environment. Highly recommend using twinboro EHT!!!"

Ella G.

"Although getting released from physical therapy is a great thing, today was bitter sweet. How often do you get to rehab with your twin daughters at a place that makes you feel important, special and at home? Twin Boro Physical Therapy in Middletown has been our home away from home for the past three months. We always looked forward to our sessions because they helped us gain back the life we had before. From the phone calls with Stephanie scheduling appointments (all three of us simultaneously) to our awesome therapists: Andrew, Chris, Sydney, Brad, Justin & Anthony, to our PT assistants: Ryan, Gerard, Julian and the girls, we can't thank you enough! We couldn't even walk on two feet when we arrived. Today, we successfully completed "Boot Camp' running, hopping and jumping! We appreciate all that you have done. We will truly miss you all, but you have taught us well. We are forever grateful."

Denise M.

"Twin Boro Piscataway/South Plainfield is great! I was treated for occipital neuralgia and posture issues. Aside from performing wonderful treatment, everybody there is super friendly and accommodating (you will always be greeted with a smile) and also very focused and helpful! Bri is a knowledgable and experienced physical therapist who is not only a great PT, but also one of the friendliest people you will ever meet. Her pacing with my various exercises was perfect, as she pushed me, but not to any point that was uncomfortable for me. I enjoyed the variety of exercises and treatments, from heat and stim to exercises with weights and stretch bands. I thoroughly enjoyed going in 3 times a week to be treated by Bri. It is clear that she cares about and wants the best for her patients, with her passion and expertise for physical therapy! My posture has gotten much better and the headaches and pain I used to experience have completely disappeared after 3 months at Twin Boro. 5/5 I would recommend Twin Boro Piscataway/South Plainfield to anyone seeking physical therapy."

Stephanie M.

"After my back surgery my doctor wanted me for physical therapy. He suggested Twin Boro Physical Therapy as one of the locations to go to. I checked out all the locations in the area and decided to go to Twin Boro. I stopped by on a Saturday but they were closed. Someone was at the desk doing paperwork and gave me all the information that i needed to fill out. She put the paperwork through and gave me a schedule to return on Monday for my first visit.The therapist ( Andrew ) examined me an put me through a series of work outs three times a week along with his daily exam. As each exercise became easier I was given something a little harder. They were slowly building up the strength in my lower back, core, legs and arms. After years of back pain I am now able to begin to get back to a normal life. I had a chance to work with other therapist there, they are all fantastic and there to help us return to a healthy life. The entire staff is was a pleasure to work with. They listen to what you have to say and and pay attention to what you said. I looked forward to going there, the staff was caring, kind and funny at times. I would highly recommend Twin Boro for physical therapy."

Victor S.

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