Issues associated with the plantar fascia affects around 10% of runners and accounts for around 80% of complaints regarding heel pain. It is most common between 40 – 60 years of age and affects women more than men. Plantar fasciitis is often the term used as a diagnosis which means inflammation of the fascia but inflammation is not always present! So what actually is it and how can we treat it?
Fascia is connective tissue that envelopes all tissues of the body. Plantar fascia refers to the fascia that is on the sole of the foot. It has remarkable tensile strength nearly twice as much as the strongest ligament in the foot! Its function is to provide stability to the foot including the arches during locomotion and relays information to the central nervous system regarding the position of the foot and surface of the ground.
The onset of plantar fasciitis or plantar heal pain is often gradual with micro trauma to the fascia as a result of a sudden increase in activity from an otherwise sedentary person that can lead to plantar heel pain. It can sometimes be debilitating and is usually worse in the morning. Pain is most commonly around the enthesis (the attachment site of the fascia to the heel) or along the medial arch of the foot.
Micro trauma to the fascia can lead to degenerative change in the tissue if its not managed appropriately. This can then lead to chronic inflammation of the fascia.
There can be other sources of pain around the plantar heel aspect of the foot such as bone spurs. However, bone spurs are often present in individuals that don’t experience any pain. Other sources of pain include injury to the fat pad (contusion), fractured calcaneum, nerve entrapment , vascular issues and achilles tendinopathies. It may also be a sequelae to rheumatological conditions.
It is important to get an understanding of the events leading up to the onset of pain and what the symptoms are followed by a physical examination to provide an appropriate treatment plan (or referral if necessary).
It is good to know that plantar heel pain has a good prognosis and can be successfully treated with conservative approaches such as advice on self-treatment and using a graded exposure approach with exercise to build and manage load tolerance of the tissues around the foot and ankle. Manual therapy may also help with other biomechanical issues throughout the body that might be contributing to plantar heel pain.