• Most people achieve complete resolution of their symptoms within a year (7), although with the correct physiotherapy advice many will recover sooner.
Plantar fasciitis, or ‘policeman’s foot’, is a common condition that causes pain in the undersurface of the heel and the arch of the foot. The plantar fascia is the ‘webbing’ of the foot and this connective tissue originates from the inside surface of the heel bone and fans across the bottom surface of the foot, connecting with the tendons which cause each individual toe to move. Most notably, this fascia inserts along the tendon (tendons attach muscle to bone) of the big toe with the purpose of supporting the arch of the foot and acting as a shock absorber for the pressure placed on the foot.
The exact cause of plantar fasciitis is unknown. However, it is believed to be a degenerative process where we often see collagen (substance found in connective tissue) wear and tear in which inflammation is not the main feature (8). Whilst plantar fasciitis remains the most used terminology for this condition, a more accurate name is plantar fasciopathy. When ‘itis’ is used to describe a condition, it indicates that inflammation is the main contributing factor. However, as detailed degeneration is thought to be the main contributing factor, plantar fasciopathy is a more accurate description.
Pain in the plantar fascia can develop as a result of a relatively sudden increase in load or activity whereby the plantar fascia cannot effectively adapt. Your musculoskeletal physiotherapist will be able to determine factors that may be contributing to the onset of this condition and identify patterns which may be contributing to your symptoms.
This is not an exhaustive list. These factors could increase the likelihood of someone developing plantar fasciitis. It does not mean everyone with these risk factors will develop symptoms.
It is estimated that this condition will affect between 4%-7% in the general and older populations respectively (2), and occurs in approximately 8%-10% of all regular runners (3).
Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.
Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made. Imaging studies like an MRI or ultrasound scans are usually not required to achieve a working diagnosis, but in unusual presentations, they may be warranted.
As part of the sessions with your physiotherapist, they will help you to understand your condition and what you need to do to help the recovery from your plantar fasciitis. This may include reducing the amount or type of activity, as well as other advice aimed at reducing your pain. It is important that you try and complete the exercises you are provided as regularly as possible to help with your recovery. Rehabilitation exercises are not always a quick fix, but if done consistently over weeks and months then they will, in most cases, make a significant difference. It is worth noting that true plantar fasciitis will likely take months rather than weeks to improve.
Other self-care options include:
Research is very clear that modifying the load that goes through the tissue is the key element that stimulates recovery. Recovery can take some time as the speed of plantar fascia regeneration is much slower than other structures in the body.
Below are three rehabilitation programmes created by our specialist physiotherapists targeted at addressing plantar fasciitis. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, these programmes provide an excellent starting point as well as clearly highlighting exercise progression.
This programme focuses on maintaining range of movement/flexibility within the foot and ankle, appropriate loading of the affected tissue and maintenance of lower limb strength and stability. We suggest you carry this out once a day for approximately 2-6 weeks as pain allows. We can work into pain during these exercises but ideally, this should not exceed any more than 5/10 on your self-perceived pain scale.
This is the next progression. More focus is given to progressive loading/strengthening of the tissue. As with the early programme some pain is to be expected but ideally, we do not want this to be any more than 4/10 on your self-perceived pain scale.
This programme is a further progression with challenging progressive loading of the affected tissue. Again, some pain is acceptable but ideally, we do not want it to exceed 4/10 on your self-perceived pain scale.
For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage. Before returning to sport, a rehabilitation programme should incorporate plyometric-based exercises; this might include things like bounding, cutting and sprinting exercises.
As part of a multi-modal treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering, you might benefit from a further assessment to ensure you are making progress and establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence.
Podiatry referral to address significant alterations in lower limb alignment may be helpful in the short term if symptoms are severe or not responding after a few months of the aforementioned treatments.
Corticosteroid injections should only be considered as a last resort, if appropriate, and progressive conservative management has failed. Even if conservative management does not achieve a 100% improvement, careful consideration is heavily encouraged as in some cases corticosteroid injections cause more harm than good, including in rare instances plantar fascia ruptures.
Surgery should only be the last option if all other treatment attempts have been exhausted.
Pain, swelling and stiffness of the achilles tendon that joins the heel bone to the calf muscles.
The main arch of the foot loses its height giving the appearance that the foot sits flat on the floor.
With PCN partnerships from Cornwall to Durham, Weston-Super-Mare to Southwold, our network of specialist physiotherapists operate face-to-face or remotely depending on your local needs.
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