How to manage Plantar Fasciitis

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It can be like walking around with a rock in your shoe!Plantar fasciitis

Maybe you’ve experienced it or currently have it. Maybe you know how plantar fasciitis can stop you playing sport or limit your ability to be at work on your feet all day. Perhaps your weight loss journey has been interrupted as the pain in your heel has meant you can’t persist with your walking program.

Plantar fasciitis is unfortunately common and can be quite debilitating. This blog is for you if you’re currently experiencing it, had it in the past or know someone who does. We’ll outline what it is, what causes it, what to expect from the recovery process and how you can manage it.

A note of clarification: It’s really important to to be aware that pain in you heel doesn’t necessarily mean you have plantar fasciitis. There a lots of other reasons for heel pain that has nothing to do with the fascia at the bottom of your foot. These things can be issues with your ankle joint, tendons at the back of the foot, small joint in your foot or even your low back. So before embarking on a treatment plan for plantar fasciitis it’s so important to make sure that’s an accurate diagnosis. A thorough physiotherapy assessment can help with that.

What exactly is plantar fasciitis?

Plantar fasciitis is a diagnosis made when pain is related to an irritation of the the plantar fascia. Your plantar fascia is a strong band of collagen (connective tissue – found all over our body) under your foot. It’s primarily responsible for maintaining the arches in your foot and transferring energy when you walk, run, jump etc. This band of tissue can become sensitised and painful. Damage to the fascia doesn’t have to occur for there to be pain, although sometimes small tears can appear in the collagen structure which can be seen on ultrasound.

What causes it?

Pain in the plantar fascia almost always occurs due to a recent and obvious change in load. Examples of a sudden change in load can be returning to sport (especially wearing hard boots or playing on hard surfaces) after a relatively sedentary off season, starting a new walking program, changing your current running program to add hard hill efforts.

Other factors can also lead to pain developing. These can be systemic like changes in hormones, variations in sleep quality or amount, acute or increased stress. However, the load going through your foot (how much or little) is usually the most significant factor for developing pain.

How long does recovery take?

Recovery can be slow and varied (unlike some of the other possible diagnoses mentioned earlier). An expectation of 3-9 months is realistic. Which I’m sure seems like a really long time. And compared to a lot of other injuries or pain presentations, it is quite slow.

One of the reasons it can take so long to recover is because of the inherent challenges in controlling loads through your foot. We often have a fair amount of variability of how much we’re on our feet throughout the week so controlling this can be challenging.

What do I need to do to recover?

Recovery can be broadly summed up by a process calming the pain down in the short term and then slowly progressively building up the tolerance of the tissues in the medium and long term.

Here are a few key things that make up a good recovery plan:

Strength training Plantar fasciitis

  1. Settle down the pain
    1. Reduce the loads that are causing/irritating the pain
    2. Taping to support your foot
    3. Change shoes/footwear
    4. Hands on techniques – soft tissue massage/needling etc
    5. Heel inserts can sometimes be effective at off loading the painful heel
  2. Start reloading (once the acute pain has settled)
    1. Work out how much load (eg steps per day) you can tolerate without aggravating the pain
      1. A good rule of thumb here is how many steps can you do per day that doesn’t leave you with a lasting increase in your symptoms (by lasting – longer that 20-30 minutes)
    2. Slowly increase the number of steps per day
      1. Increasing your step count by 10-20% per week can be a useful guide to a safe reloading program
      2. Keep increasing consistently each week
      3. Avoid big spikes of activity
  3. Address contributing factors
    1. Looking at other factors that can lead to increased loads going through your planta fascia is important to settle it down and prevent it returning down the track
    2. Contributing factors can include:
      1. Weakness in calf, foot intrinsic muscles, hamstring, hip and core
      2. Ankle and foot mobility
      3. Lumbar spine mobility
      4. Sleep patterns
      5. Stress
      6. Diet
    3. Be consistent on working these factors – anything that involves strength will take minimum 6 weeks to see change
  4. Prepare
    1. It’s a long recovery process so being prepared for the journey is key.
      1. Get the timeframes sorted in your mind – marathon effort not a sprint
      2. Celebrate the wins along the way
      3. Avoid all or nothing thinking – “I did too much today and I’m sore – everything is right back where I started!”
      4. Be optimistic about your recovery – if you stick with it you should expect to sort it out and be back toy your old self – even better
      5. Work with someone who can keep you on track

Whilst the recovery is slow  – if you do it well and stay optimistic through the process you should come out the other side stronger and more resilient than before you started.

 

 

 

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