If you have landed on this post then you probably already know what Plantar fasciitis is and have had it long enough to know that it can be a massive pain in the butt! It can affect anyone and everyone from office workers to walkers to runners !
For those of you who are new to this condition, it is an irritation in the connective tissue along the bottom of your foot. The plantar fascia does not have a great blood supply and hence if this problem is not addressed at its 'root cause' it can develop small tears within the plantar fascia over time and cause degeneration (plantar fasciosis) over time leaving it prone to rupture.
Plantar fasciitis usually starts as a pain around the foot or heel first thing in the morning but if not managed properly eventually turns into pain seemingly all the time and can be very limiting at times even to stand up and walk a few steps.
It can also have a massive impact on your lifestyle, as it progressively starts to limit the time that you can stand, walk or run. Most people decide to do something about it only when it gets to a stage that it stops them from doing something that is important to them, like:
Not being able to run more than a short distance
Not being able to work (because they can’t stand for very long without pain)
Cringe at the thought of shopping (as it involves walking!)
You realise they are gaining weight (because it limits the amount they exercise)
7 Reasons Why Plantar Fasciitis lasts longer than it should:
1) When you just started with pain in your heel, you thought that it would just go away on its own.
2) You searched on Dr. Google for all sorts of remedies and tried the You Tube stretches for plantar fasciitis, which either helped for a bit or made your pain worse?
3) You got yourself a new pair of shoes, iced the heck out of your foot, used orthotic inserts and even considered cortisone injections, hoping each time, that it will be a ‘quick fix’.( While some of the above measures may help in the short term, it will do nothing to fix the root cause of the problem long term, with Cortisone injections being the worst of all, due to its side-effects)
4) You take painkillers, which gives you temporary relief, but then the pain comes back again when the painkillers wear off? Pain-killers DONT solve a chronic problem, they only cover it up.
5) You tried wearing a night splint, stopped being active which seemed to help but as soon as you started exercising or walking again the pain came back again.
You tried different health professionals but it did not help. Each told you different things and you are understandably confused?
Does this sound like you? So you have tried some of the things above already and it is not working for you? The good news is that you at least now you know what doesn't work for you and you closer to finding the thing that does.
So, Why Did I Get Plantar Fasciitis to start with?
One word overload. Quite simply your total load through your foot has changed or increased faster than what your plantar fascia could handle Now what’s confusing for some people is that you may not have run or walked MORE. Often it’s a change of footwear, a change in terrain or a change in a combination of things rather than just total distance.
Sometimes it is just an increased distance over time and sometimes it’s just one acute increase in load like doing stairs or hill sprints or moving house.
Whilst the condition can last for 6-12-18-24 months or more we feel at Empower Physio that too many people are suffering for too long. You should notice significant improvement on a weekly basis in the first 8-12 weeks. There really is no excuse to have this condition hampering you for >6-12 months.
How to Fix Plantar Fasciitis?
I will outline our multimodal approach and how we attack these conditions from several angles as well as the common points in rehab AND where people go wrong
Phase 1:
MULTIMODAL APPROACH (AKA ATTACKING IT FROM ALL ANGLES)
REDUCE LOAD;
I will start by asking you to reduce your load by 50%-70% depending on how bad your symptoms are. Even if it’s mild I might still go 50%. It also doesn’t matter if you’re running 15km per week or 60km per week. We need to pull your load right back and see if we get a change in symptoms. My tip for you to maintain fitness but limit stress through your plantar fascia is to vary your training.
Get on your bike. Go for a swim. Do things like the rower, so you’re not constantly training on hard ground. If you miss this crucial first step, of reducing the load aggressively, where we can settle your symptoms down to a 2-3/10 pain, then you have no base to work from.
In fact, the most common mistake we see people make, who have had issues for >3months, is a failure to aggressively reduce their load in the first 2 weeks. The beauty of being so strict in the first 2-3 weeks is to get a rapid change and for you to know that your symptoms are changeable. Now we are working with something.
MONITOR YOUR PLANTAR FASCIA PAIN;
This is crucial as too often it is hard to recall exactly what triggered your symptoms or on the flip side what made you feel better. A simple spreadsheet, diary or A4 paper on the fridge to record when it feels worse and then note down the activity you did in the last 24 hours before it felt a bit worse. This list will then help to avoid the things that consistently made it worse and help to settle down the inflammation.
SHOES - FINDING THE RIGHT PAIR - USING MULTIPLE;
In your first 2 weeks it is a great idea to trial 2-3 different pairs of shoes and see which ones have you feeling better or worse. Again symptoms that are changing are a great sign and often, even a shoe that makes you worse is a good clue. Once you find the shoe that has you feeling 1-2 points better we might stick with this for a week.
There is also a good argument to rotate your shoes once your symptoms are settling. Every shoe will load your structures in a different way and it is this variability that can help settle your plantar fascia down.
TAPE
Use of tape to offload the plantar fascia, can offer temporary relief. There are a few different ways that it can be done depending on which movement loads the Plantar Fascia the most for You. Often times, patients enjoy the relief that comes from it and express desire to continue with taping .Whilst we know that the taping doesn’t hold for very long and loosens a bit, it is actually a desirable effect, as this offers variability in the way we load and use our foot and really helps the irritated plantar fascia to settle down. Initially, I will often tape someone 2-3 days on and half day off to keep it nice and strong and avoid skin irritation and then taper the use of tape as we introduce exercises to strengthen your foot muscles which in turn keeps it from excessively loading the plantar fascia. This lays the groundwork for Phase 2.
Phase 2
We now enter Phase 2, which is all about finding the right load and staying in a decent symptom range. Not symptom free but a decent symptom range. The most common mistake happens now, which is although you have a less painful heel, it is more vulnerable because you have cutback the load on it by 50 percent in the last couple of weeks, and if you re-introduce the amount of load too quickly it will relapse. However this isn’t the end of the world, it just means you have to re-adjust the load.This phase is all about progressively, strengthening the leg muscles and working on YOUR SPECIFIC weaknesses or imbalances to prevent abnormal stresses going through your plantar fascia. Your weakness or imbalance can be in the foot, or leg muscles and varies from person to person. Hence any generic exercises won’t work as they won’t address the root cause for YOUR heel pain.
Photo Credit: Adam Meakins
Phase 3
Big Mistake: Returning to your normal load, pain free, and stopping your exercises. “WHAT!!??, I’ve got no pain, I’m back doing what I need to be doing, but I’m not done yet?” - Not even close. If you want to keep this away and progress your activity you need to get better than pre-injury status. This is our goal for everyone that comes through to Empower Physio. “Better than pre-injury status”. It was your pre injury status that got you injured, right? So we need to be stronger than that. Ignoring this phase, can undo all the work you have put in this far, as you still carry a higher risk of re-injury, it is only a matter of time.
What you can do if you have been suffering with plantar fasciitis for 2 months or more?
1. First off, You need to make a decision about getting help. We find that too many people suffer from this condition for much longer than they have to.
So many people procrastinate for so long, thinking that the pain will ‘just go away with time’, but then 6 months down the line they’re still putting up with it, and nothing’s changed… Or it gets worse and they’re still not playing sport, or are restricted in their sport or activity.
2. Next, do the RIGHT exercises - One of the best things to help you recover quicker is to do the right series of progressed exercises - the right exercises given to you by a Physiotherapist will offload/strengthen the right structures and also prevent long-term over-compensation by other body parts. Thus, help in healing the irritated plantar fascia, and allow you to return to your sport/running/walking again stronger and longer than your pre-injury state.
3. Avoid “too much rest” - while rest is an important part of the initial recovery process, too much rest won’t do anything to help you recover quick. Many people believe that recovery means total rest from all exercise and often is longer than called for. But in order for the irritated plantar fascia to heal, blood flow is needed which rest prevents. It would really help if you were given appropriate recovery and strengthening exercises to heal the injury, alongside hands-on treatment, to get you active again as quickly as possible.
“How Can Choosing Empower Physiotherapy Help You Get Rid of Your Plantar Fasciitis ?”
Here’s just a few of the things we can do for you:
We can take away the pain.
We can help you find out what’s really going on, and get to the root cause for the irritation of YOUR Plantar Fascia (which can be different from person to person); so that it goes away and stays away.
Heel Pain can put a real damper on your active lifestyle and limit your ability to play your favourite sport; we can help you get back to enjoying that fulfilling feeling again and return you to what you love.
We will ensure that your problem is “corrected” properly - and we will provide you with the right set of exercises that will speed up your recovery
We can help you put an end to needing to take all of those pain pills which are obviously not very good for your health long-term
We can help you get back to enjoying quality time with family and friends that your heel pain has taken from you...
We can help you avoid surgery - and painful injections
We can help you to be able to enjoy running, walking, or whatever it is that is limiting you from doing.
Basically… we can help you get back to living life free from daily, annoying and frustrating plantar fasciitis heel pain.
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