What is Plantar Fasciitis? The Symptoms & Treatment Options

According to the Australian Family Physician[1], approximately 3.6% of the population or over 900,000 Australians will experience heel pain. Plantar fasciitis is the leading cause of heel pain in Australia. Australians between 45-64 years of age most commonly experience this condition.[1]

Plantar fasciitis usually develops over time after repetitive stretching and loading activities in a standing position. Examples of aggravating activities include jumping, walking and running. People who overexert themselves or suddenly increase their physical activity are at a higher risk of developing this condition.

Read on to understand what you should know about plantar fasciitis; the risk factors, treatment options and expected recovery time.

What is Plantar Fasciitis?

Plantar fasciitis is a degenerative condition of the heel and the plantar fascia. The plantar fascia is a thick layer of tissue found underneath the foot to absorb impact and support the foot's arches. Injury to this area can cause heel pain, especially when weight-bearing.

What are the symptoms of plantar fasciitis?

The most common symptoms of plantar fasciitis are pain in the heel, pain in the arch of the foot and pain after exercise. People may also experience pain first thing in the morning, a swollen heel or a tight calf muscle.

Common symptoms of plantar fasciitis

• Pain in the arch of the foot

• Pain at the bottom of the heel or midfoot area

• Pain in the ball of the foot

• Usually on one foot but can affect both areas

• Pain that is worse in the morning

• Pain that is worsened by prolonged walking, running, or standing.

What causes plantar fasciitis?

Plantar fasciitis is caused by activities that stress the foot, such as running, dancing, and any sports that involve jumping. Repeated tension and stress on the arch of the foot causes plantar fasciitis.

This process of wear and tear leads to irritation or inflammation of the fascia causing pain and stiffness. However, not all cases of plantar fasciitis are caused by inflammation.

Common causes of plantar fasciitis

• Obesity

• Pregnancy

• Very active individuals

• Long-distance running

• Prolonged standing activities or jobs that require a lot of standing and walking

• Flat foot or high arch

• Tightness of Achilles tendon and calf muscle

• Wearing high heels

Sports that increase the risk of plantar fasciitis

High impact sports that require a lot of running and foot activities may increase the risk of having plantar fasciitis:

• Marathon runners or long-distance running

• Parkour or free running

• Basketball

• Baseball

• Football

• Soccer

How is plantar fasciitis diagnosed?

Plantar fasciitis can be painful and may limit your mobility. It is vital to know the root cause of your problem and address it immediately to manage your pain and restore your function.

There are several options available when it comes to diagnosing your foot pain as plantar fasciitis. One of the most common and most recommended by Australian GPs is an assessment from a physiotherapist.

Physiotherapists are highly specialised medical professionals that diagnose and deal with pain and injuries such as plantar fasciitis. A physiotherapy assessment is simple yet comprehensive.

Like visiting a GP, your assessment will start with your physiotherapist asking you vital questions about your health. This is referred to as a consultation. Your consultation will last for about 30 to 60 minutes. Take this time to discuss relevant issues relating to your ankle.

After establishing the background of your condition, your physiotherapist will perform specific physical tests to determine the best possible cause of your pain and rule out other conditions.

Following your initial assessment, your physiotherapist will provide you with a tailored treatment plan based on your condition.

From here, your physiotherapist will give you the details of your treatment program; this will include:

• Number of treatment sessions

• List of exercises you need to do at home

• Strategies to manage the pain and to prevent worsening of the condition

• Timeline of your full recovery.

How is plantar fasciitis treated?

Pain that persists for too long may start affecting other parts of your body, causing more injury and pain in the process. Medications can help relieve the symptoms, but only physical interventions can cure the root cause of your heel pain.

There are several options when it comes to treating plantar fasciitis. One of the more common, and the treatment option that is referred by Australian GPs the most, is physiotherapy.

Plantar fasciitis is an injury that physiotherapists come across regularly and the process of treating it is straightforward. Following an initial consultation, the physiotherapist will be in the best position to determine your treatment plan.

A combination of manual therapy, modalities, and specific movement exercises will be given to you by your physiotherapist. Physiotherapists are experts in dealing with pain and musculoskeletal conditions.

Depending on the severity of your plantar fasciitis, a physiotherapist may provide you with a combination of the following types of treatments:

• Education and professional advice - Speaking to a physiotherapist can be essential in gaining the correct information regarding plantar fasciitis.

• Manual therapy - Hands-on physiotherapy is used to help reduce pain and increase range of motion.

• Soft tissue mobilisation - Specific joint mobilisations are used to reduce stiffness in particular areas.

• Stretching - Stretching will help lengthen muscles and increase range of motion.

• Therapeutic exercises - Specific exercises tailored to improve your plantar fasciitis.

• Dry needling - A specific technique used by physiotherapists to reduce muscle pain.

• Heating modalities and electrotherapy - Used to reduce tension and pain in acute situations.

• Shockwave therapy - A high-intensity treatment option that can break down scar tissue and improve muscle tension.

• Prescription shoe inserts - Specific to plantar fasciitis, orthotics can help reduce tension on the arch of the foot.

• Kinesio taping - Like orthotics, taping can provide arch support.

A typical physiotherapy session with your local physiotherapist will last anywhere between 30-60 minutes. It is not uncommon for patients to feel the benefits in just one session.

Next step - Creating a treatment plan made for you

Following your initial appointment, your physiotherapist will craft a tailored treatment plan that will highlight the course of action required, including what exercises you need to do at home and provide you with a timeline for how long it should take for a full recovery.

Self-care for plantar fasciitis

Physiotherapists are the obvious choice when it comes to getting professional help; however, there are several things you can do to help reduce pain and aid your recovery.

If you think you have plantar fasciitis, here are the best things you can do and avoid.

Things to do:

• Rest

Plantar fasciitis is a wear and tear condition. You need to give your body enough time to heal without strenuous activities for a few weeks.

• Use hot or cold compress

Heat will promote blood flow towards the area. This will also relieve stiffness and will facilitate natural tissue repair.

Alternatively, if your heel has signs of inflammation such as swelling and tenderness, you may use a cold compress instead to control the swelling. Consult your physiotherapist for appropriate use of modality with regards to your condition.

• Gentle stretching

Stretching of your calves can help relieve some tension in your leg muscles. This can also prevent plantar fasciitis from flaring up. Your physiotherapist will provide you with effective stretching techniques for your calves and Achilles tendons.

• Relaxation / Massage

Gentle massage on your plantar fascia and foot muscles can help relieve tension in the area, thus reducing pain and inflammation. Limiting your mobility can be pretty stressful, relaxing and knowing you are still in control can help you manage the pain and work progressively towards recovery.

• Keep moving

Lower body exercises should still be done without putting extra load on your foot. Staying active and maintaining your overall physical well-being should be prioritised.

Your physiotherapist may provide exercises that target the specific muscles of your lower body, which you can also do at home (Open Kinetic Chain Exercises).

Things to avoid:

• Avoid activities that worsen the pain

Take rest and consult a physiotherapist as soon as possible. Avoid walking and running for a prolonged time.

Do I need a specialist or even surgery?

Although surgery is rarely needed, and almost 95% of the cases respond to physical therapy, some people may have persistent symptoms.

Long-term plantar fasciitis may limit your ability to work and enjoy exercises or play sports. In addition, people who do not respond to conservative treatments and those who develop secondary complications such as severe difficulty walking are candidates for surgery.

It is best to communicate with your physiotherapist to discuss other options and re-evaluate your condition if it persists after exhausting other options.

An MRI or X-ray can be done to get diagnostic imaging of your condition and rule out other possible causes of your symptoms, such as heel spurs and stress fractures.

Your surgeon will coordinate with your physical therapist the best possible solution to treat your condition. Should you decide to have surgery, your physiotherapist will work with you to help you recover quickly and regain your normal function.

What is the recovery time / prognosis for plantar fasciitis?

Ultimately, recovery time is dependent on your proactiveness to seek professional treatment and the severity of your foot pain and injury.

Most cases of plantar fasciitis will completely recover within 6 months. However, symptoms may persist if left untreated. Physiotherapy can effectively help you treat the symptoms and improve the quality of your life.

Important factors in recovery include:

• Sticking to your treatment program and regularly exercising

• Resuming your sports activity gradually

• Paying attention to pain, and resting as necessary.

Can plantar fasciitis be prevented?

The following tips are helpful for prevention of plantar fasciitis, but can also help reduce symptoms if you are already injured.

• Manage your weight: Maintaining a healthy weight will help your plantar fascia manage the pressure you are putting on it.

• Modify your exercise: Incorporate low impact exercises in your routine. Try mixing your cardio routine with swimming and cycling to minimise the stress on your foot.

• Choose supportive footwear: Choose shoes with low to moderate heel, thick soles, and good arch support with extra cushion.

• Avoid wearing heels: Wearing high heels alters your feet’s natural biomechanics, which causes tightness of the Achilles tendon and may injure the plantar fascia.

Outlook and the main takeaways

If there is one thing to take away from this article, it is that there are multiple causes, symptoms and severities of plantar fasciitis. The most important thing for you to do is take action now. Early treatment results in better outcomes more often than not! See a physiotherapist today.

Anatomy of the plantar fascia

The plantar fascia is a long, thin ligament that runs directly beneath the skin of your foot. It connects the heel to the front part of your foot. It functions as a support for the arch of the foot.

Repeated stress and pressure along the plantar fascia creates micro tears and injury, resulting in inflammation around the heel where the plantar fascia is connected with your heel bone (calcaneus).