Plantar fasciitis is common in our running population at Physiohaus.

Patients often experience pain with the first step in the morning or after prolonged sitting. Symptoms limit their ability to perform many standing, walking, and recreational activities.

You may be surprised to know that researchers have found minimal inflammatory cells within the plantar fascia among patients with heel pain. The lack of inflammation is one reason for the failure of anti-inflammatory treatments, such as medications and injections, in the management of this condition.

Researchers are finding significant atrophy and weakness in the arch muscles of the foot within this population. Strengthening of the foot musculature has been shown to be a promising treatment to reduce sensitivity and symptoms from the tissues of the foot. A new review of the evidence highlights the importance of these exercises.

“Plantar fasciitis” is a painful diagnosis limiting a patient's ability to stand, walk, or run. The -itis of the name is a misnomer because very few cases of plantar heel pain involve an inflammatory process. Instead, a breakdown of soft tissue fibers and cells is noted in the plantar fascia.

This can be caused by:

• Stiff ankle
• Tight calf muscles
• Foot weakness

At Physiohaus, we treat this condition with manual therapy, dry-needling and soft tissue work, and evidence informed home exercises.

A recent review of the available literature on the utilization of manual therapy for patients with heel pain was conducted (Fraser, J. et al. J Man Manip Ther. 2018). Authors included 7 previous randomized, controlled trials on the utilization of this treatment in patients with plantar fasciitis. They reported a significant short (4 weeks) and long term (6 month) improvement in patient function when Physical Therapists included manual therapy into their treatment sessions. The authors recommended clinicians utilize both joint and soft tissue treatments, in addition to, high level exercise when treating patients with plantar fasciitis.

A recent review of the literature highlighted the impact of strength training on these heel conditions as well as the development of intrinsic foot strength.   The authors reviewed 7 articles on the subject and found strength training was effective for treatment of plantar fasciitis as well as increasing intrinsic foot strength. Interesting, despite improvements in strength, function, and pain the exercises did not show changes in plantar fascia. This is likely similar to what we see in many tendon conditions where benefits are seen before true tissue changes take place, often requiring up to 1 year for complete healing.

One last study by McClinton and colleagues (JOSPT 2016) compared 27 patients with heel pain compared to matched peers who did not have any heel pain. Participants' foot strength was tested using two clinical tests for foot "core" strength. Not surprisingly, the patients with heel pain had significantly less foot strength than their asymptomatic peers.

While these studies support strength work and manual therapy, each case is unique and benefits from professional assessment. Give our team at Physiohaus a call to discuss your case.