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Aug 08

Plantar Fasciitis

 

“Ouch. My feet hurt” A common phrase that often seems to become a long and lasting problem.

Plantar Fasciitis is a strain or overuse of the ligament that supports your arch. Often this presents as pain with early morning steps, pain with prolonged walking or standing, and noted tenderness at the bottom of the foot because of the swelling that occurs.

How does the ligament get strained? Often it starts with tightness in the calf muscles (gastrocnemius and soleus). The tight calves lead to excessive pulling on the Achilles tendon thus pulling on your heel bone. With prolonged tightness the heel bone rotates causing the plantar fascia tendon to become tight. This can eventually result in plantar fasciitis and sometimes bone spurs. Ouch!

How do your calves get tight? This can be a result of poor sitting posture, weight gain, shoe choices, incorrect gait pattern with walking or running, or simply not stretching. At that point most patient are looking at several possible treatment options.

1.)  Stretching:  Treatment should focus on recovery of adaptive shortening tissue (progressive stretching!). We typically start stretching with a low load stretch, this may give some relief, but it’s also where treatment may fail. If stretches are not progressed correctly the tightness will return and the fascia will never fully recover. This is accomplished through the guidance of a physical therapist.

2.)  Orthotics: These force your foot into a more restricted position. However, don’t we want to become flexible?  Why if you were pain-free for decades do you now need orthotics to tolerate walking?  Have you gained weight recently? Orthotics may be necessary for excessive weight gain.  With regards to flexibility, the orthotics may only provide temporary relief because they restrict your foot’s ability to move.

The firmness of the orthotic often limits foot mobility.  Yes, sometimes they are required and medically necessary, but for plantar fasciitis I recommend trying a supervised stretch program first.

 

3.) Injections may be helpful to reduce swelling that occurs from an abnormal tightness, however that swelling will return until you have full recovery of flexibility.

 

4.) Surgery can be used to stretch the plantar fascia.  This requires months in a boot/shoe, time off work, and is the most costly course of treatment.  Then the patient normally will go to therapy for progressive stretching and rehab.

This leads us back to the best treatment option; stretching.  To fully remodel adaptive shortened tissue, the stretch must first be performed often; this typically means every 2-3 hours. Second, the stretch must be progressed frequently with increasing force as tolerated. This is a crucial stage in recovery and should only be done under the supervision of a physical therapist.

There are benefits to both orthotics and injections in many other medical cases but in the case of plantar fasciitis the main focus needs to be on flexibility. We at Tillman Physical Therapy are dedicated to fixing your problem long term.   Please contact us if you are ready to take your first step to recovery.