Physical Therapy for Plantar Fasciitis
Plantar fasciitis is one of the most common and painful conditions in the foot. This discomfort is characterized by pain in the heel and arch of the foot. Our patients typically report that their discomfort is most painful first thing in the morning, worse with prolonged standing, and aggravated with walking or running.
Similar to most injuries, plantar fasciitis can be more or less severe and impact each patient’s life differently. It is important to be clear that your pain is truly plantar fasciitis. Any pain on the sole of the foot is commonly assumed to be plantar fasciitis, but a professional evaluation is the best way to determine if you have it. Seeking out a medical professional that performs a full evaluation of the back, foot, and nerves at the foot and ankle will help to come to a proper diagnosis.
So… What’s causing your discomfort?
1. If it’s actually plantar fasciitis
Plantar fasciitis is inflammation, irritation, and possible structural change in the plantar fascia. While it is not clear exactly what causes this in every case, many cases are due to a chronic overload of the plantar fascia. If activity levels and forces are greater than what the plantar fascia is accustomed to, there may be an increase in irritation causing pain.
The plantar fascia works with your Achilles and calf muscles to hold you up in standing as well as propel you forward during walking and running. The Achilles, plantar fascia, and calf muscles must have the proper strength and endurance to tolerate the volume of activity that you perform as well as support your body weight. While bone spurs are commonly present on X-rays and MRIs, they may not be the cause of symptoms and patients often improve despite a bone spur.
2. If it’s coming from your back
In many cases, the nerves or disc tissue in the lower back can radiate pain into the foot or cause weakness that irritates the foot. This can mimic some of the pain locations that are seen with true plantar fasciitis. You do not have to have low back pain for this to be a cause of your symptoms.
3. If it’s coming from the medial plantar nerve
The medial plantar nerve passes through the inside of your ankle and then down into the inside of your foot to provide sensation to the arch of your foot. Irritation to this nerve at the back, the ankle, or the arch can lead to pain that is similar in pattern to plantar fasciitis. There are even cases where this nerve becomes irritated at the same time as plantar fasciitis, making the pain more severe.
4. If it’s muscular
Tender points in muscles at the foot or calf can sometimes radiate pain into the foot and heel. This is not as common as some of the symptoms listed above, but when present can mimic plantar fasciitis.
What can we do about the pain?
1. Get a proper diagnosis
The simplest way to have unsuccessful treatment of an injury is to have a poor diagnosis. While the internet is a great place for information, it is unable to replace the knowledge and decision-making process of a medical professional who asks evaluative questions and performs a thorough examination.
2. Decrease irritability and pain
Hands-on treatments provided by a physical therapist can often reduce pain levels or improve the range of motion to allow for less strain on the plantar fascia. Based on your specific case, there are exercises, self-massage techniques, and modifications to your activities that can be prescribed to decrease your pain in the early phases of care.
In some cases, orthotics, heel cups, or specific sneakers can help reduce your pain during the first phases of treatment. These options should not be used for the long term, but can help get you to a place where rehabilitation can begin.
3. Address range of motion and control
Proper range of motion at the foot and ankle is crucial to decreasing strain on the plantar fascia. This will vary in each case based on:
Limitations at the ankle
Considerations for a low arch
Considerations for a high arch
Limitations at the big toe
Once the normal passive range of motion is improved, learning to control your foot will allow for great progress toward strength and capacity.
4. Progressively load heel raises
Heel raises simulate the push-off phase of walking through the front of the foot. This directly works the calf muscles and how the calf transmits force to the front of the foot through the plantar fascia. Practicing proper mechanics and repeating exercises to facilitate progression, without worsening the injury, is what a physical therapist is specifically trained to do.
5. Progress daily activities and sports
It’s important to progress back into your specific activities! Treatment should not stop with hands-on work or heel raises. Devise a specific plan with your therapist to reincorporate aspects of daily life and athletics to finish your rehab and return to what you love.
Are You Experiencing Foot Pain?
Request an appointment with one of our highly trained physical therapists and begin the journey of rehabilitation. We can help to pinpoint the cause of your pain, and work to develop a specific plan to get you back to the life you want to live. Referrals are not required to receive an evaluation at Summit Physical Therapy. You can also call our office at 908-598-9009 for help scheduling your appointment.