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Treating Plantar Fasciitis with Physical Therapy

Treating Plantar Fasciitis with Physical Therapy

If you have heel pain first thing in the morning when you try to walk, you may have plantar fasciitis. This condition can be frustrating and lead to disabling pain. A trained physical therapist can help to get your pain under control so that you can return to your normal activities without pain.

Causes of Plantar Fasciitis

Plantar fasciitis is one of the most common causes of heel pain when standing or walking. The plantar fascia is a thick fibrous tissue band that runs from your heel to the base of your toes that provides support to the arch of you foot.

Repeated strain of the plantar fascia causes tiny ligament tears, which can result in pain and inflammation. Risk factors for plantar fasciitis include:

  • Excessive pronation (feet that roll inwards when walking)
  • Flat feet or high arches
  • Increasing age (> 40 years)
  • Obesity
  • Improper footwear (high heels, incorrect fit, worn out, etc.)
  • Tight Achilles tendon (decreased ankle dorsiflexion)
  • High impact, weight-bearing activities (running, jumping, etc.)
  • Diabetes
  • Rapid changes in activity level

Physical Therapy Examination

If you’re suffering with heel pain, a physical therapist can help to determine if you are in fact suffering with this condition. They will perform a detailed medical history and thorough physical examination. They will look for the following features on examination:

  • Heel pain after prolonged periods of non-weight bearing
  • Tenderness to palpation of the anterior medial heel
  • Tight Achilles tendon that presents with limited dorsiflexion of the ankle
  • Possible limp, with a preference for walking on the toes
  • Pain that is worse when walking barefoot on hard surfaces
  • Pain that is worse when climbing stairs

Physical Therapy Treatment Options

Your physical therapist will develop a treatment program that may include:

  • Strengthening and stretching of the involved muscles
  • Joint mobilization or manipulation
  • Soft tissue massage
  • Taping
  • Modalities (iontophoresis, ultrasound)
  • Night splints
  • Orthotics

Strength training and stretching of the involved muscles have been found to be effective for the treatment of plantar fasciitis, by helping to reduce pain and improve function.

A couple of simple stretches for individuals with plantar fasciitis:

Seated toe extension:

  • begin by crossing the affected leg over the unaffected leg
  • use your fingers to apply pressure at the base of your toes to force your toes into extension until a slight stretch is felt along the bottom of the foot
  • hold for 15 to 20 seconds

Standing Achilles tendon stretch:

  • begin by placing the affected leg behind the unaffected leg
  • ensure that your toes are pointing forwards
  • bend your front knee while ensuring the your back knee remains straight and you heel remains on the ground
  • hold for 15 to 20 seconds

*If you want to engage the soleus muscle in this stretch, slightly bend your back knee during the stretch

The good news is that you won’t need many physical therapy sessions as most of the stretching and strengthening exercises can be done from the comfort of your home once you’ve mastered them.

Mobilization or manipulation of the ankle, subtalar, and midfoot, as well as soft tissue massage of the plantar fascia and surrounding muscles may help to reduce pain and improve function in patients with plantar fasciitis.

Night splints may be recommended to keep your ankle in dorsiflexion with your toes extended, which allows for a constant stretch of the plantar fascia while you sleep. Foot orthotics that provide support and minimize excessive foot pronation may help to provide short-term benefits in function and pain reduction. The benefits foot orthotics is improved when used in combination with a stretching program.

Other techniques such as taping the plantar fascia and applying ultrasound to the area may be used in some cases to help minimize pain and improve function.

If you’ve suffering with heel pain that is worse upon waking, or after being seated for a prolonged period of time, you’re likely suffering from plantar fasciitis. The physical therapists at Blue Hills Sports & Spine Rehabilitation can help to assess your condition and develop a treatment plan using a variety of techniques that will help to relieve your pain and get you back to your normal activities as quickly as possible. 

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