Innovative Management of Plantar Fasciitis

Plantar Fasciitis – Chronic Heel Pain

Chronic Heel pain that just won’t go away? New research is now leading to more success!

At Back On Track Physiotherapy we commonly we see people who have tried numerous treatments that just don’t quite fix the issue commonly used interventions include:

  • Cortisone injection.
  • Massage with a frozen water bottle.
  • Previous Physiotherapy.
  • Anti-inflammatories.

Plantar fasciitis (commonly referred to as a heel spur) is a very common injury, that will affect up to 10% of the population at some stage during their life.

Those people who have this condition understand the pain that occurs every morning when they place their foot on the ground and hobble through to the kitchen or bathroom.  Alarmingly it is not unknown to see clients that have had this condition for up to 2-4 years!

A recent scientific study has suggested that a strength program focusing on improving the strength of the foot musculature and actually improving the capacity of the plantar fascia to absorb load can be more effective in reducing pain when compared to a stretching program.

To understand this we will take a step back.

A recent understanding from tendon pain may be applicable to the management of plantar fasciitis.  The concept of “mechanotherapy” in which a progressive strengthening exercise program can improve the capacity tissues (such as the plantar fascia or tendons) to tolerate workload.

What often occurs in this injury is that the capacity of the plantar fascia to absorb “load”, such as the forces associated with walking or running becomes less than the capacity required for these tasks.

Balancing Tissue Workload

HEALTHY BALANCE

AT RISK WORKLOAD

2015-08-06_atrisk

Capacity

The problem with plantar fasciitis is that at this point people tend to reduce their workload, they stop running or walking and sometimes the pain goes away quite quickly, however sometimes the pain continues……

REST AS MANAGEMENT

Sometimes it is important to take a short break from activity that aggravates the condition.  However complete rest for an active person or an athlete is not sufficient to fix the problem.

REST

Whilst rest will assist decreasing workload and likely decrease pain, continued rest  will reduce the workload capacity of the tendon.  This is a familiar concept; you don’t use it, you lose it.

Rest for lengthy periods will reduce the capacity of the tissue further.  As such when you wish to return to activity, the tissue capacity will be less than what it was previously and pain may return.

ULTIMATELY THE TISSUE NEEDS TO HAVE THE CAPACITY TO TOLERATE THE WORKLOAD YOU WANT IT TO PERFORM.

This is where the new research conducted by Michael Rathleff is important.  In these cases of heel pain that won’t resolve it is often crucial to improve the capacity of the tissues in the foot to tolerate the demands that you place on them.

This is an innovative way of managing these types of conditions that regularly provides significant improvement.  However, a word of warning, the exercise program must be individual and set at your level for the current ability of your tissues.

Unfortunately when attempting to condition the body to improve muscle size or the capacity of the tissues, it can take work and time.  Often it takes 2 weeks for you to see improvement, 4-6 weeks for you to see marked improvement and 8-12 weeks before everyone can see your improvement.

Take charge and start your road to recovery with a thorough assessment from our expert Physiotherapists at Back On Track Physiotherapy.

Jeremy Carr

Reference: Rathleff, M, Moolgard, Fredberg, U. et al., (2015).  High load strength training improves outcome in patients with plantar fasciitis, A Randomized controlled study with 12 month follow-up.  Scandinavian Journal of Medicine and science in sports, vol. 24 pp, 292 – 300.