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Conditions, Foot

Plantar Fasciitis

Physiotherapy at HelloPhysio brings the latest treatments to help relieve heel and foot pain caused by plantar fasciitis. From Shockwave Therapy, INDIBA®, Red Light Therapy, sports massage and physical therapy exercises, learn how our physiotherapists bring the latest clinical research into practice to treat plantar fasciitis.

Plantar fasciitis is a degenerative condition that affects athletes, especially those involved in frequent running and jumping. It is characterized by intense heel pain with inflammation and tiny tears in the plantar fascia, the thick band of tissue that links the heel to the toes. This overuse injury can occur when excessive stress is placed on the feet.

The most common symptoms include a persistent ache in the heel or along the bottom of the foot, particularly noticeable upon taking the first steps after waking or after prolonged periods of sitting. Risk factors for developing plantar fasciitis include obesity, abnormal gait or foot position, wearing high-heeled shoes, or extensive periods of standing.

Athletes who are obese, have high arches or wear unsupportive shoes are at an increased risk of developing plantar fasciitis.

Playing certain sports can also increase the risk of plantar fasciitis. For example, soccer players may be at risk due to the extensive running in the sport and the potential for foot issues caused by worn-out cleats. Basketball players may also be at risk due to the frequent jumping and landing, which can put significant pressure on the feet. Football players may be affected by the sport’s demands for running, cutting, stopping, and starting, which can all strain the plantar fascia.

If an athlete develops plantar fasciitis, it is important to rest and avoid activities that exacerbate the pain. Custom orthotics and night splints may help support the foot and promote healing. The treatment plan may also recommend rest, nonsteroidal anti-inflammatory medications, physical therapy and adjunctive modalities. In rare cases, surgery may be necessary to address the condition.

Physiotherapy for Plantar Fasciitis

There are several treatment options available for athletes with plantar fasciitis. The first step is to rest and avoid activities that exacerbate the pain. This may involve temporarily switching to low-impact activities such as swimming or cycling. 

Stretching and strengthening exercises can benefit plantar fasciitis’s long-term management. These may include calf stretches, toe curls, and exercises to improve ankle mobility and balance.

Physical therapy may also be recommended to help athletes with plantar fasciitis. This may involve stretching and strengthening exercises and ultrasound or electrical stimulation modalities.

In some cases, orthotics or shoe inserts may be recommended to help support the foot arch and reduce stress on the plantar fascia.

Plantar Fasciitis Treatments

Shockwave Therapy is a noninvasive treatment option for plantar fasciitis that uses high levels of targeted acoustic energy to promote healing and reduce pain. It effectively improves foot function in patients with plantar fasciitis, either as a standalone treatment or in combination with routine care such as exercise and physical therapy. 

Shockwave Therapy generates interstitial and extracellular responses, producing beneficial effects such as pain relief, vascularization, protein biosynthesis, cell proliferation, neuro and chondroprotection, and breakdown of calcium deposits in musculoskeletal structures. These effects can lead to tissue regeneration and significant pain alleviation, improving functional outcomes in injured tissue. 

The proposed mechanism of action for Shockwave Therapy is based on mechano-transduction, where the delivery of mechanical acoustic energy to the target tissue induces molecular, cellular and tissue responses. 

Shockwave Therapy has also been shown to promote the expression of various angiogenic and osteogenic growth factors, such as vascular endothelial growth factor (VEGF) and bone morphogenetic protein (BMP), further promoting tissue regeneration. Additionally, Shockwave Therapy is anti-inflammatory by modulating the expression of interleukins (IL-6 and IL-10) and other cytokines.

INDIBA® Therapy uses radiofrequency energy to stimulate stable cell regeneration without heat effect. The thermal effect of INDIBA® increases vascularization and oxygenation of body tissues, improving local blood circulation, healing damaged tissues, and reducing swelling and pain. 

The therapy also boosts cellular metabolism, increases fibroblast activity, and accelerates collagen production within the treated tissues, aiding in repairing damaged knee structures and restoring elasticity. Additionally, INDIBA® Therapy reduces nerve fiber activity in the area, diminishes pain sensations and addresses inflammation at its source, offering substantial relief from discomfort.

Stretching exercises are particularly effective in alleviating the symptoms of plantar fasciitis. The top five exercises for this condition include a gastrocnemius stretch, where the patient stands on the edge of a step or box and slowly lowers their heels to stretch the calf muscles. A toe curl with a towel where the patient curls a towel towards them using only their toes helps strengthen the foot muscles. Toe extension exercise is when the patient bends their toes and ankles upwards as far as possible to stretch the arch and calf muscles. These exercises are designed to target the muscles and tissues that support the arch of the foot, providing relief from plantar fasciitis symptoms. Before starting any exercise routine, it is important to consult with a physiotherapist to ensure the exercises are suitable for your specific biomechanics.

Sports massage is a helpful method for managing plantar fasciitis pain caused by the shortening and stiffening of the plantar fascia. The deep massage techniques break down the scar tissue on the fascia, improving blood flow and lymphatic circulation and enhancing the absorption of oxygen and reparative nutrients to the area. The physiological benefits of sports massage for heel pain include increasing blood circulation, reducing pain signals via the pain gate theory, and temporarily relieving chronic pain conditions. Sports massage can also be part of a holistic treatment plan for plantar fasciitis.

Red Light Therapy is a non-invasive treatment that reduces inflammation, speeds tissue repair, decreases pain in patients with plantar fasciitis, and improves skin health. In managing plantar fasciitis, Red Light Therapy penetrates deep into the tissue, alleviating inflammation, reducing pain, and enhancing healing. The therapy harnesses the power of red and near-infrared light, which can aid in accelerating tissue healing.

Dry needling is a treatment option that involves the insertion of thin needles into specific trigger points in the foot and heel to alleviate pain associated with plantar fasciitis. This therapy can relieve symptoms by eliciting a local twitch response, improving blood flow, and altering nerve signals. Dry needling can effectively reduce the pain associated with plantar fasciitis by targeting trigger points in the foot and calf muscles, which in turn helps relieve tension and reduce inflammation in the plantar fascia. Additionally, combining dry needling with other treatments, such as physical therapy and stretching exercises, can enhance its effectiveness.

Risk Factors for Developing Plantar Fasciitis

The exact cause of plantar fasciitis is not entirely clear, as various factors can contribute to heel pain. The plantar fascia, a thick fibrous band of connective tissue, originates from the heel bone and extends along the sole to the base of the toes, supporting the foot’s arch. 

Repetitive microtrauma, such as prolonged standing or increased physical activity, can lead to a structural breakdown of the plantar fascia, resulting in plantar fasciitis. Additionally, disruptions in the normal mechanical movement of the plantar fascia during standing and walking can place excessive strain on the calcaneal tuberosity (a bony prominence found on the underside of the heel bone), further contributing to the development of the condition.

Additionally, studies have suggested that plantar fasciitis may not be due to an inflamed plantar fascia but rather a tendon injury involving the flexor digitorum brevis muscle located immediately deep into the plantar fascia in the middle of the sole of the foot. 

Several risk factors can increase the likelihood of developing plantar fasciitis, including:

  • Aging: The risk of plantar fasciitis increases with age, particularly in individuals between 40 and 70
  • Extra pounds: Individuals who are overweight or obese are at increased risk of developing plantar fasciitis
  • Foot factors: Certain foot types, such as flat feet or very high arches, can increase the risk of plantar fasciitis
  • Type of work: Individuals who spend most of their workday on their feet, such as those in the service or manufacturing industries, are at increased risk of developing plantar fasciitis
  • Diabetes: Individuals with diabetes are at increased risk of developing plantar fasciitis
  • Limited ankle dorsiflexion: Individuals with limited ankle dorsiflexion, or the ability to flex the foot upward towards the shin, are at increased risk of developing plantar fasciitis
  • Increased plantarflexion range of motion: In physically active individuals, increased plantarflexion range may be a risk factor for developing plantar fasciitis

If you are concerned about your risk of developing plantar fasciitis or experiencing heel pain or discomfort, speak with HelloPhysio’sclinical team, which is highly skilled in treating musculoskeletal dysfunctions, orthopedic disorders, acute conditions, and sports injuries.

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