A frequent condition that causes heel discomfort, usually at the bottom of the foot, is plantar fasciitis. It happens as a result of irritation or inflammation of the plantar fascia, a thick band of tissue that runs from the heel bone to the toes. This tissue supports the arch of the foot and aids in absorbing the strains and stresses that we put on our feet.

Causes of Plantar Fasciitis:

• Overuse or Strain: The issue may be exacerbated by repetitive foot-stressing activities including walking, running, or prolonged standing.
• Foot Mechanics: Poor walking habits or abnormal foot structures, such as high arches or flat feet, can put too much tension on the plantar fascia.
• Tight Muscles or Tendons: By increasing the strain on the foot’s fascia, tightness in the calf muscles or Achilles tendon can aggravate plantar fasciitis.
• Obesity: Carrying more weight can put more strain on the feet, particularly the plantar fascia.
• Improper Footwear: Plantar fasciitis is more likely to occur in shoes that are worn out, lack adequate arch support, or lack cushioning.
• Age: The illness can strike at any age, but it is more common in those between the ages of 40 and 60.

Symptoms of Plantar Fasciitis

Heel discomfort is the primary sign of plantar fasciitis, especially:

Morning discomfort: When most people walk for the first time after getting up, they usually feel a sharp, stabbing pain. Moving around may help this pain, but standing for extended periods of time or getting up from a seated position usually makes it worse.

discomfort from prolonged standing or walking, particularly on hard surfaces.

discomfort when standing on tiptoes or climbing stairs.

Risk Factors

Age:

• Middle-aged individuals (40 to 60 years old) are at higher risk, as the plantar fascia becomes less flexible and resilient with age.

Activity Level:

• Runners or individuals who engage in high-impact activities are more likely to develop plantar fasciitis due to repetitive stress and strain on the feet.
• Occupations that require prolonged standing or walking (e.g., teachers, factory workers, healthcare professionals) increase the likelihood of strain on the feet.

Foot Structure and Mechanics:

• Flat feet or fallen arches can put excess stress on the plantar fascia.
  High arches can also be problematic, as they may not provide sufficient shock absorption.
• Abnormal walking patterns (e.g., overpronation or supination) can lead to improper distribution of weight and stress on the foot.

Obesity:

• Excess weight places added stress on the feet, increasing the risk of plantar fasciitis, especially during walking or standing for long periods.

Tight Achilles Tendon or Calf Muscles:

• A tight Achilles tendon or calf muscles (gastrocnemius and soleus) can lead to increased tension on the plantar fascia, raising the risk of inflammation.

Improper Footwear:

• Worn-out shoes, shoes with inadequate arch support, or high heels can contribute to poor foot mechanics and increased strain on the plantar fascia.

Increased Physical Activity or Sudden Changes in Routine:

• A sudden increase in activity levels (e.g., starting a new workout routine or walking long distances) can strain the plantar fascia, especially if the body isn’t accustomed to the activity.

Gender:

• Women are at a higher risk, particularly due to wearing certain types of footwear, such as high heels, which can put extra pressure on the feet. Hormonal factors may also play a role.

Certain Health Conditions:

• Diabetes, arthritis, and other conditions that affect joint health or circulation can make the foot more susceptible to injury and inflammation.

Previous Foot Injuries:

• People who have experienced past foot or ankle injuries (such as sprains, fractures, or strains) may have a higher risk of developing plantar fasciitis due to altered gait patterns or weakened structures in the foot.
• By being aware of these risk factors, individuals can take steps to prevent plantar fasciitis, such as wearing proper footwear, maintaining a healthy weight, and practicing stretching and strengthening exercises.

Complications

1. Chronic Pain
2. Altered Walking Patterns (Gait Changes)
3. Plantar Fascia Rupture
4. Heel Spurs
5. Tendonitis in Other Foot Areas
6. Limited Foot Mobility
7. Psychological Impact
8. Post-Surgical Risks
9. Recurrence of Pain
10. Foot Deformities

Preventions of Plantar Fasciitis

1. Wear Proper Footwear
2. Stretching and Strengthening Exercises
3. Maintain a Healthy Weight
4. Gradual Increase in Activity
5. Foot Rest and Avoid Overuse
6. Use Orthotic Inserts
7. Foot Care for Athletes
8. Avoid Walking Barefoot on Hard Surfaces
9. Massage and Foam Rolling
10. Manage Medical Conditions

Physiotherapy Treatment of Plantar Fasciitis

Stretching Exercises

• Plantar fascia stretch: Sit with one leg over the other, grab your toes and pull them toward your shin to stretch the bottom of your foot. Hold for 20-30 seconds and repeat several times, especially in the morning.
• Calf stretch: Place one foot behind the other and press the back heel into the ground while keeping the knee straight. This stretches the calf muscles and Achilles tendon, reducing tension on the plantar fascia.
• Achilles tendon stretch: Stand facing a wall, place one foot in front of the other, and gently lean forward while keeping your back heel on the ground. This stretches the Achilles tendon, which, if tight, can contribute to plantar fasciitis.

Strengthening Exercises

Strengthening the muscles of the foot and lower leg can provide better support for the plantar fascia and improve overall foot mechanics. Common exercises include:

• Towel curls: Place a towel on the floor and use your toes to pull it toward you, which strengthens the intrinsic muscles of the foot.
• Marble pick-ups: Place marbles on the floor and use your toes to pick them up, helping to improve foot strength and coordination.
• Toe raises: Stand with feet flat on the floor, then slowly raise your heels, so you’re standing on your toes. This helps to strengthen the calf muscles and the muscles that support the foot arch.

Manual Therapy

• Soft tissue mobilization: The physiotherapist may use massage techniques to reduce tension in the plantar fascia, calves, and surrounding muscles. This can help relieve pain and improve flexibility.
• Myofascial release: A technique where pressure is applied to specific points on the fascia or muscle tissue to release tension and reduce pain.

Taping Techniques

• Kinesiology taping: The physiotherapist may apply special tape (often called kinesiology tape) to the bottom of the foot or around the arch to support the plantar fascia, reduce strain, and relieve pain during movement. This tape can also help correct abnormal foot mechanics.
• Rigid taping: A more supportive taping technique might be used to limit excessive foot movement and provide extra support to the plantar fascia while it heals.

Ice Therapy

• Physiotherapists may recommend ice massage or cold packs applied to the heel and arch of the foot to reduce inflammation and swelling. Ice can be especially useful after exercises or activities that provoke pain.
• Frozen water bottle roll: Rolling the foot over a frozen water bottle provides both a massage effect and ice therapy to relieve tension in the plantar fascia.

Orthotics and Footwear Advice

• A physiotherapist may recommend custom or over-the-counter orthotics (shoe inserts) to improve foot alignment and provide better arch support. These can help redistribute pressure away from the plantar fascia.
• Physiotherapists will also advise on selecting appropriate footwear, with a focus on shoes that provide proper arch support, cushioning, and stability.

Gait Analysis and Correction

• A physiotherapist will assess how you walk (gait analysis) to identify any abnormal movement patterns, such as overpronation (excessive inward foot rolling) or supination (outward rolling). These can contribute to plantar fasciitis by placing extra strain on the foot.
• Based on this assessment, the physiotherapist may suggest exercises to correct these issues, such as foot positioning or strengthening exercises to improve overall foot mechanics.

Dry Needling or Acupuncture

• Dry needling is a technique in which a thin needle is inserted into trigger points in the muscles or fascia. This can help relieve muscle tightness, reduce pain, and improve mobility.
• Acupuncture may also be used in some cases, as it helps promote healing and reduces inflammation in affected areas.

Electrical Stimulation

• In certain cases, transcutaneous electrical nerve stimulation (TENS) or neuromuscular electrical stimulation (NMES) may be used to reduce pain and promote muscle recovery.
• These methods involve small electrical currents that stimulate nerves or muscles.

Education and Lifestyle Modifications

• A physiotherapist will educate you on posture, foot positioning, and strategies to reduce stress on the plantar fascia. They may provide advice on weight management, activity modification, and avoiding activities that exacerbate pain (e.g., excessive walking or running on hard surfaces).

Night Splints

• Physiotherapists may recommend night splints to keep the foot in a dorsiflexed position overnight. This helps to maintain a stretch in the plantar fascia and Achilles tendon while you sleep, promoting healing and reducing morning pain.

How can senOcare help?

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