Plantar fasciopathy – previously coined fasciitis or policeman’s foot, is a common condition that causes pain in the under surface of the heel and the arch of the foot. The plantar fascia is the ‘webbing’ of the foot and comprises of connective tissue which supports & stabilises the foot, helping to maintain its shape during weight bearing and ensuring efficient energy transfer with locomotion.
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 curl up. Most notably, this fascia inserts along the tendon of the big toe which helps form our medial arch and is vital for efficient forward propulsion when walking. Our Physiotherapists at Pure will be able to assess these local structures to determine if your pain is originating from this region.
Pain related to this condition can last up to 6 months or longer and is reasonably common particularly in the middle-aged population with a slightly increased susceptibility in females and athletic populations. Pain in the plantar fascia is typically developed as a result of a relatively sudden increase in load or activity intensity/volume and cannot effectively adapt. At Pure Physiotherapy, our highly skilled clinicians will be able to determine factors that may be contributing to the onset of this disorder and identify symptom patterns which may be indicative of plantar fasciopathy.
This condition is commonly characterised by significant pain in the heel during the first steps in the morning and when getting up on to your feet after being rested. Patients will typically present with pain in the front inside region of the heel which can cause limping or offloading of this area – the discomfort can also travel through the sole of the foot and tends to be worse when barefoot or walking on hard surfaces with direct pressure on the area. Alongside these symptoms, the ability to bend the ankle towards the head (dorsiflexion) tends to be limited with tightness in the calf complex. Through thorough subjective assessment, the Physiotherapy team at Pure will be able to delve into detail regarding changes in activity – as unassuming at they may be, which could have played a role in overloading the plantar fascia, leading to the discomfort experienced.
Management for this condition comprises of activity modification and strength training. Plantar fasciopathy is managed like other tendon issues. The fascia and big toe tendon should be exposed to high-load training on an alternating daily pattern to augment the response to loading whilst allowing for recovery and adaptation to take place. Your Physiotherapist at Pure will be able to devise an individualised self-management and strengthening plan to suit your activity needs & goals with the aim to negate the chances of this re-occurring.
To favour loading the big toe tendon, the heel raise exercise (up on to tip toes) modified with the big toe extended is recommended. This can be performed using everyday objects such as a rolled-up towel, magazine or broom stick handle as seen below.
We recommend performing this exercise for up to 12 reps for 3 sets with a degree of pain/discomfort. On a scale of 0-10 (10 being the most severe pain imaginable) you should not exceed 6/10 after performing the exercise or 24 hours following a ‘loading’ day. Alternating between a loading day followed by a rest day allows you to gauge the irritability of the tendon whilst also establishing the ‘sweet spot’ for load that it responds positively to. With this patterning, we also recommend that you plan your physical activity on the same day as loading so that you can the most explicit ‘on’ and ‘off’ days within practical limits.
If this is managed well, you should find that your symptoms will progressively decrease. Whilst massage will not solve the issue, it may help make you more comfortable. One of the easiest ways to do this is using a cricket/golf ball or a bottle which you can add warm/cold water to.
At Pure Physiotherapy, we will equip you with the skills and knowledge to manage you condition and take back control and get back and beyond your normal levels of physical activity.