Plantar Fasciitis


Plantar fasciitis (PF) is a prevalent musculoskeletal condition involving the plantar fascia, usually at the proximal insertion (connection to the heel bone). The nomenclature of this condition has evolved from what many know this condition as plantar fasciitis to plantar fasciopathy. Why? We are finding in the literature, thickening and age-related changes are more common than an actual inflammatory process (-itis).1 The etiology of PF is unclear and will often have an insidious onset (unknown cause).1,2 Typically, PF presents as a sharp pain when first walking in the morning or walking after a period of rest. The pain usually becomes better after walking but may worsen toward the end of the day or during impact activities. In this blog we will discuss potential risk factors and treatment options to help with plantar fascia pain.

Looking into the research, there may be some factors that increase the risk of PF onset, but again, the evidence supporting these factors is unclear. For the purposes of this blog, I will list a few intrinsic and extrinsic risk factors, and note, this is not an exhaustive list.

Instrinsic Factors1,2:
• Most cases of PF occur between the ages of 45-60 yrs old, and the authors contribute this to age related changes that may decrease elasticity and shock absorbing capabilities, which may make this age range more susceptible.
• There has been no difference found between male and female.
• Overweight individuals have been shown to have an increased risk, potentially 1.4 fold increase.
• Tightness of the gastrocnemius muscle.

Extrinsic Factors1,2:
• Recreational running
• Military Activities
• Certain styles of dancing such as Irish dancing

The good news is, about 90% of PF cases can be treated successfully without surgical intervention.1,2,3 Regarding orthoses/inserts, one study compared over the counter vs. customized shoe inserts and found no significant difference in pain relief at a 12-month follow up.1 Night splints have been well supported in the literature to help alleviate morning stiffness and pain because of the stretch applied to the fascia throughout the night.1 There is low quality evidence supporting the use of cortisone injections for a temporary pain relief (no more than one month), and when compared to a placebo there was no significant difference.1 Note, a few potential complications from multiple cortisone injections is fat pad atrophy and rupture of the plantar fascia.1 The above treatments are not your long-term solution, as these are shown to provide temporary relief. So, what is your long-term solution?

Physical therapy is shown to facilitate recovery and reduce the persistency of this condition. Physical therapy seems to be underutilized for this condition, but is very effective, and in most cases is recommended.3 Interestingly, only ~7% of individuals with plantar fascia pain are seen by a Physical Therapist.3 Physical therapy can help guide your path on improving mobility and strength and develop a long-term management plan, which includes workload management, to help you return to the activities you enjoy. If you are somebody who is dealing with foot pain, and have had difficulties managing this on your own, Nevada Physical Therapy is now offering FREE 20 minute phone consults as well as FREE 20 minute in-person discovery visit with one of our licensed Physical Therapist. We look forward to being a part of your rehabilitation process!

Written by: Dakota Ezell, PT, DPT

References:
1. Monteagudo, M., de Albornoz, P., Gutierrez, B., Tabuenca, J., & Álvarez, I. (2018). Plantar fasciopathy: a current concepts review. EFORT Open Reviews, 3(8), 485-493. doi: 10.1302/2058-5241.3.170080
2. Goff, J., & Crawford, R. (2011). Diagnosis and treatment of plantar fasciitis. Am Fam Physician, 84(6), 676-682.
3. Plantar Fasciitis: Will Physical Therapy Help My Foot Pain?. (2017). Journal Of Orthopaedic & Sports Physical Therapy, 47(2), 56-56. doi: 10.2519/jospt.2017.0501

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