Plantar fasciitis – chances are you’ve heard this term, whether your dad has it, a co-worker is complaining about it, or one day you told a friend your foot hurts and they said ‘you must have plantar fasciitis’. But what does this actually mean? What is the plantar fascia?

Your plantar fascia, or plantar aponeurosis, is a thick, broad, band of fibrous connective tissue that runs from your heel and fans out towards your toes. The role of the plantar fascia is to work with all of the other muscles, tendons and ligaments in your foot to help protect and support the arch of your foot(1). Your foot is made up of 26 bones, 32 joints, 19 muscles and 107 ligaments! Sounds crazy right. All of these structures need to work together every time you walk, run, or simply stand on your feet. So what happens if there is some sort of breakdown in this area? When we spend the majority of our days in shoes
and supportive footwear, we effectively weaken the muscles in our feet because we are no longer using them or having to rely on them to control the movement in all those small joints. If our feet have gotten weaker overtime, and suddenly you decide to sign up for your first half marathon and started running 3 times a week, or maybe you went on vacation and walked twice as much as you normally would, you may wake up in the morning with a nagging pain in the arch of your foot or in your heel. This is because we put an increased load or demand on soft tissue structures that our body was not used to, and it led to pain.  

Although we tend to still use the term fasci’itis’ (itis means inflammation), this can be misleading. Pain originating from the plantar fascia is not so much an issue of inflammation, but instead a breakdown of collagen and connective tissue that leads to vascular cell death and a disorganization of these tissues (2). Various factors can predispose people to this condition, but generally, if you have weakness in the muscles and tendons in your feet and legs, combined with a change in load (vacation, running, a new job requiring you to be on your feet instead of at a desk), this is a recipe for developing heel pain. 

The good thing is that we have lots of strategies we can use to help get you back on your feet and get rid of that frustrating pain. Although each individual person’s foot is different, typically a combination of hands on techniques to help decrease pain and improve stiffness, shockwave to help accelerate the re-organization of connective tissue, education on appropriate activity modifications in the short term, and most importantly exercises to strengthen those intrinisic foot muscles are a good starting point for most individuals. 

If any of this sounds familiar to you, book an assessment with one of our physiotherapists to help determine what the cause of your foot pain is, and how we can help you treat it. 

References 

Weaning S, Smeathers J, Urry S, Henning E, Hills P. The pathomechanics of plantar fasciitis. Sports Medicine. 2006; 36: 585-611

Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003;93(3):234–7

Ridge S, Olsen M, Bruening D, et al. Walking in minimalist shoes is effective for strengthening foot muscles. Med Sci Sports Exerc. 2019; 51(1): 104-113

Rathleff M, Mølgaard C, Fredberg U, et al. 2015. High‐load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12‐month follow‐up. Scand J Med Sci Sports, 25(3)

DioGiovanni BF, Nawoczenski DA, Lintal ME et al. Tissue-specific plantar fascia-stretching exercise enhance outcomes in patients with chronic heel pain. J Bone Joint Surg. 2003;85(A):1270-77

Young B, Walker MJ, Strunce J et al. A combined treatment approach emphasizing impairment-based manual physical therapy for plantar heel pain: A case series. JOSPT. 2004;34:725-733.

Xiong Y, Wu Q, Mi B, et al. Comparison of efficacy of shock-wave therapy vs corticosteroids in plantar fasciitis: A meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg. 2019;139(4):529-536

Li H, XIong Y, Zhou W, et al. Shockwave therapy improved outcome with plantar fasciitis: A meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg. 2019;139(12): 1763-70