The plantar fascia is a tight band of fibrous connective tissue that originates at the heel and splits into five bands to insert at the toes. The plantar fascia is a shock absorber and helps create stability in the foot with walking and running activities. The ankle has two primary motions: plantar flexion and dorsiflexion, shown in Figure 1. During walking, the trailing foot must achieve dorsiflexion. Dorsiflexion causes tension on the plantar fascia, creating increased stability in the foot, shown in Figure 2. This allows the plantar fascia to assist in sturdiness of the foot to advance each leg with walking.
Figure 1 Shown above is an example of ankle dorsiflexion and ankle plantar flexion
Figure 2: Shown above is the impact of big toe dorsiflexion on the tension of the plantar fascia.
Plantar fasciitis (commonly misdiagnosed as heel spurs) is a condition of micro-tears in the plantar fascia due to repetitive strain, or can occur as a result of trauma. Approximately one million patient visits per year are due to plantar fasciitis2. Symptoms are often described as stabbing pain with the first steps of the morning, or after a long period of sitting. Plantar fasciitis is largely common in runners, basketball players, tennis players, dancers, overweight and diabetic patients, manual labor workers, those that wear shoes with inadequate support, and others1,3,7. Athletes and non-athletes are both affected at the same percentage.
A podiatrist may refer a patient for imaging such as MRI, x-ray, and/or ultrasound for diagnosis. Podiatric treatment includes referral to physical therapy, using an orthotic and/or night splint, medication, or steroid injection. According to research, corticosteroid injections should be re-evaluated as they are associated with increased risk of plantar fascia rupture4.
Physical therapy evaluation consists of a detailed subjective history, range of motion, strength, palpation, and special tests. Conservative management, such as physical therapy, is the initial step to treating plantar fasciitis. This includes stretching, endurance and strengthening exercises, joint mobilizations to improve ankle and great toe range of motion, dry needling, taping, heel inserts, night splints, relative rest, and patient education. Luckily, non-surgical treatment is successful in 90% of patients5. Patients who received dry needling for treatment of plantar fasciitis had lower pain levels after one year compared to patients who received a corticosteroid injection7. Surgery is the last resort in the case of failed conservative therapies2.
If you have foot pain and/or symptoms of plantar fasciitis, be sure to visit your local podiatrist and ask for a referral for physical therapy.
1. "Analysis of Data on the Prevalence and Pharmacologic Treatment of Plantar Fasciitis Pain." National Center for Complimentary and Integrative Health, 27 Mar. 2018, www.nccih.nih.gov/research/research-results/analysis-of-data-on-the-prevalence-and-pharmacologic-treatment-of-plantar-fasciitis-pain#:~:text=Approximately%20one%20percent%20of%20U.S.,with%20pa.
3. DeMaio M, Paine R, Mangine R, Drez D. PLANTAR FASCIITIS. ORTHOPEDICS. 1993; 16: 1153-1163. doi: 10.3928/0147-7447-19931001-13 [link]
4. Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. Journal of the American Podiatric Medical Association. 2003 May;93(3):234-7.
5. Neufeld, Steven K. MD; Cerrato, Rebecca MD Plantar Fasciitis: Evaluation and Treatment, Journal of the American Academy of Orthopaedic Surgeons: June 2008 - Volume 16 - Issue 6 - p 338-346
6. "Plantar fasciitis.", Mayo Clinic, 11 Dec. 2019, www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846.
7. Rastegar, S., Baradaran Mahdavi, S., Hoseinzadeh, B. et al. Comparison of dry needling and steroid injection in the treatment of plantar fasciitis: a single-blind randomized clinical trial. International Orthopaedics (SICOT) 42, 109–116 (2018). https://doi-org.proxy.lib.wayne.edu/10.1007/s00264-017-3681-1