The Complete Guide to Plantar Fasciitis
Heel Pain or Plantar Fasciitis is an extremely frustrating and stubborn condition. It can affect anyone and everyone from office workers to walkers to runners. Quite simply it is when the long ligament under your foot becomes irritated and painful.
Why Do I Have Plantar Fasciitis?
One word overload. Quite simply your total load through your foot has changed or increased faster than what your plantar fascia could handle. Now what’s confusing for some people is that you may not have run or walked MORE. Often it’s a change of footwear, a change in terrain or a change in a combination of things rather than just total distance.
Sometimes it is just an increased distance over time and sometimes it’s just one acute increase in load like doing stairs or hill sprints or moving house.
How Long Does It Take and Why So Long?
Sometimes we can settle Plantar Fasciitis down in 6-12 weeks – The Lucky Ones. Others it can hang around for 6-12 months. The reason it takes so long is it’s hard to truly offload your foot. It is always weight bearing.
The more aggressive we can offload it at the start the sooner it starts to improve. For a runner 1-2 weeks off may well be better than trying to reduce your load for 4-6 weeks. We would make these decisions together.
How Do I Get It Better at the Start?
What’s key is offloading your foot at the start of the condition as quickly and as aggressively as we can. This can come in a number of forms depending on how much your plantar fascia is irritating you.
Taping, orthotics and a change of footwear can be a great way to change the load through your foot in the short term to help reduce symptoms and calm your foot and heel pain down. Though it is not the long term solution we may recommend this as a starting point.
Reducing your load is the obvious answer. If we can start by cutting your time on feet by 50% and measure the symptom change this can give us a good baseline to get started with strengthening.
How Do I Get it Better in the Long Term and Keep it Away?
Strengthening. 8-12 weeks of quality, graded strength work is the best evidence we have to get plantar fasciitis better. We want to strengthen both the calf, soleus (muscle behind the calf) and the foot muscles.
Not only do we need to strengthen these muscles with a range of calf raise (straight leg, bent leg, toe under towel), we also want to add 10-20% of our body weight to these exercises. Not only does this get us stronger it adds a buffer for the next time our load increases and can serve as a long term preventative measure to keep your plantar fasciitis away.
Cortisone has been shown to reduce short term pain but doesn’t seem to add anything in the long term. Arguments can be made that if your pain is better quicker we could do strengthening sooner and get better quicker.
With this in mind we generally advise against cortisone as it is an invasive technique, unless patients are struggling to settle down symptoms with conservative measures in the first 2-3 weeks.
What Should I Do Now?
See a good Physio who understands the condition and is always encouraging you to add strength to your foot and calf complex. Make sure you stick at being diligent and progressing your exercises for at least 8-12 weeks. Whilst progress can be slow you should notice definite and gradual improvement.
As always feel free to message us on the drift chat box, email or book in online at 1 of our 3 locations in Sydney;