An Athlete’s Guide to Plantar Fasciitis

They say, things happen in 3’s.  Well recently at Omega Project, things seemed to be happening in 13’s – specifically the number of individuals coming in with plantar fascia pain.  So, we thought it was time to talk a bit more about this stubborn injury.

Plantar fasciitis is an injury characterized by microtears and degeneration of the plantar fascia, a fibrous connective tissue structure that spans the bottom (plantar) surface of the foot. The plantar fascia originates at the medial tubercle of the heel bone (calcaneus) and spreads towards the toes. It’s integral in stabilizing the foot’s arch and absorbing shock during weight-bearing activities.

Plantar fasciitis is often attributed to a combination of mechanical overload, chronic degenerative changes and, less commonly, inflammatory processes.

PREVALENCE

Plantar fasciitis affects approximately 10% of the population, with a high incidence seen in runners and athletes engaging in high-impact sports and occupations requiring prolonged weight bearing (nurses, teachers, etc).

CAUSES

The onset of plantar fasciitis can be due to quite an array of factors, including:

1. Mechanical Overuse: Repetitive loading during activities such as running or prolonged standing can lead to excessive strain on the plantar fascia.
2. Biomechanical Factors:
   • Abnormal hip mechanics: often related to hip strength and activation can lead to collapsing mechanics, which place additional stress on the plantar fascia along with various other structures.
   • Abnormal Foot Mechanics: Limitations in foot and ankle mobility, limitations in calf strength, tibialis posterior strength and intrinsic foot strength (small muscles within the foot) can place additional strain on the plantar fascia, contributing to pain and injury.
   • Foot Structure: pes planus (flat feet) or pes cavus (high arches), can alter loading patterns while walking and running and predispose individuals to plantar fascia pain..
3. Footwear: Inadequate footwear can contribute to the development of symptoms. Finding a shoe that best supports the specific foot structure and function of an individual is imperative. Some may need a shoe with more stability or cushion, while others need a more neutral shoe or a shoe with a wider toe box (free the toes). It’s important to discuss this with your physical therapist to determine what is best for you!

CLINICAL PRESENTATION

Patients typically present with a complaint of sharp, localized heel pain that is most pronounced with initial weight-bearing activities after rest. This pain often diminishes with movement but may recur with prolonged activity. Physical examination may reveal tenderness to touch at the medial heel and pain as the big toe is extended.

TREATMENT APPROACHES

As physical therapists, we have many tools and interventions to address plantar fasciitis:

1. Mobility Protocols: Emphasis on maximizing dorsiflexion, ankle mobility and great toe mobility can enhance flexibility and reduce tension.
2. Strengthening Regimens: Targeted strengthening of intrinsic foot muscles, calf muscles (don’t forget the soleus!) and lower extremity stabilizers (especially the hip musculature) can improve foot mechanics and support.
3. Manual Therapy Techniques: Joint mobilizations of the foot and ankle and soft tissue mobilization techniques as well as functional dry needling can help to alleviate pain and restore mobility. Functional dry needling is often targeted at the musculature in the calf and extrinsic/intrinsic muscles of the foot and can be extremely helpful in managing symptoms.
4. Orthotic Intervention: Orthotics can facilitate proper foot mechanics and additional arch support to distribute load more evenly across the foot.
5. Activity Modification: Educating individuals on lower-impact alternatives when needed and gradual return-to-sport protocols is vital for preventing recurrence.
6. Extracorporeal Shockwave Therapy (ESWT): Recent studies have shown that ESWT can help to reduce pain and improve function in patients with chronic plantar fasciitis.
7. Platelet-Rich Plasma (PRP) Injections: A growing amount of literature compares the effectiveness of corticosteroid injections with PRP injections for plantar fasciitis. While corticosteroids, which have been a popular treatment choice in the past, provide rapid pain relief, PRP injections have been associated with longer-term benefits and less risk of recurrence due to their regenerative properties.
8. Laser Therapy and TECAR Therapy: Both of these modalities are very effective in reducing pain and facilitating the healing process with slightly different mechanisms of doing so.
9. 3D Walking and Running Gait Analysis:  Evaluating and optimizing both walking and running gait mechanics can be extremely valuable in treating plantar fascia pain. Doing so will allow assessment of movement patterns, that when performed repetitively, can lead to overuse injuries, such as plantar fascia pain.

CONCLUSION

Plantar fasciitis is a complex condition that requires a multifaceted approach for effective management. As with many injuries, there is no “one size fits all” approach to plantar fasciitis. By integrating clinical knowledge with evidence-based practices, we can optimize recovery outcomes for our patients. Early intervention and a comprehensive rehabilitation strategy are crucial to restoring function and preventing future episodes.