Library Project
Emily Bucher
Plantar Fasciitis
Plantar fasciitis is one of the most common musculoskeletal disorders of the foot
and ankle.,6 This condition affects many different populations of people, but is most
commonly seen in runners, those who are on their feet for excessive periods of time, and
sedentary and/or overweight individuals.1,3,6 It is also common in those who abnormally
pronate in the push-off phase of gait, and those with decreaed ankle dorsiflexion. 5.6
The plantar aponeurosis or fascia is located on the plantar surface of the foot. It
consists of three bands: lateral, medial, and central. The central band attaches to the
calcaneus and the proximal phalanx of each toe. This thick sheet of connective tissue
supports the arch of the foot.6 For various reasons, the tissue may become inflamed,
causing the pain associated with plantar fasciitis. This condition can range from being a
mild nuisance to becoming debilitating and causing severe pain.
Treatment of plantar fasciitis is typically conservative. Unfortunately, there is
little scientific evidence to indicate that traditional approaches to treatment substantially
improve patients' long-term outcome.3 Some common treatments include medications,
stretching of the calf muscles, ice, night splints, massage, and conditioning exercises for
the foot, which help to relieve stress on the plantar fascia by strengthening supporting
structures.3
Manual therapies are the most popular form of treatment. These include
stretching, massage, and foam-rolling. Stretching helps to warm-up the tissue and
increases blood flow to the area, which can help prevent future tearing. One study
found that calf-stretching and plantar fascial stretching can be used to provide short-term
relief, typically lasting about two to four months.6 Conversely, another study reported
that
calf stretching was not proven to show any beneficial effects on relieving the pain
associated with this condition.1
Foam-rolling of the gastrocnemius is another technique recommended by
therapists.2 The hard foam roller massages deep into the muscles, releasing any muscular
knots and relaxing the muscle. By loosening the calf muscles, the tension in the plantar
fascia is lessened. Rolling a golf ball underneath the foot is another method that is
commonly used, as it can help to soften and relax the tightened fascia.
Devices have been used with success in treating plantar fasciitis. These may
include foot orthoses, tape, and night splints. In one study, researchers found that foot
orthoses in patients with plantar fasciitis reduced pain and increased function.4,6 The
orthoses can aid in correcting any body mechanic issues that may have contributed to the
condition. Calcaneal taping has shown positive short-term effects, typically lasting for 710 days.6 Night splints resemble a sock that hold the ankle in a neutral position and the
toes in slight extension. They are recommended for patients who have had symptoms for
longer than six months.6
Corticosteroid injections have proven to be successful in acute cases of plantar
fasciitis. These injections, “work by modulating the production of inflammatory and antiinflammatory proteins within the cell. The long-term effect of these injections on plantar
fascia is less well understood, and no or incomplete relief often is seen several days or
weeks after the procedure. The injections are associated with rupture of the plantar fascia
and atrophy of the fat pad of the heel and, thus, should be used judiciously.”3
Surgery is one of the less common options for patients. Surgical release is
indicated for severe plantar fascial pain after prolonged attempts at nonoperative
treatment.3 The surgeon will cut the plantar fascia to relieve the pressure. Unfortunately,
this can produce scar tissue and cause great issues in the future.
Plantar fasciitis can be a difficult condition to treat, though in many cases, it
improves spontaneously.3 It is a debilitating condition with side effects that can
range from mild to severe, and may even require surgery. While physical therapists have
an arsenal of techniques with which to treat this condition, many of them, unfortunately,
are short term treatments. On a positive note, many promising new approaches to
treatment-resistant plantar fasciitis are under investigation.3
References
1. Buchbinder R, Cook C, Landorf K, Radford J. Effectiveness of calf muscle stretching
for the short-term treatment of plantar heel pain: a randomized trial. BMC
Musculoskeletal Disorders. April 2007; 8:36.
2. Chait E, Cooper G. Physical therapy prescriptions for musculoskeletal disorders. 1st ed.
Philadelphia, PA: Wotters Kluwer Health/Lippincott Willimans and Wilkins; 2011.
3. Fink B. Management of plantar fasciitis evolving. The Journal of Musculoskeletal
Medicine. Febraury 2012; 29(1): 16-20. Aavailable from: CINAHL. Accessed October
31, 2012.
4. Hertel J, Lee S, McKeon P. Does the use of orthoses improve self-reported pain and
function measures in patients with plantar fasciitis? Physical Therapy in Sport. 2009;
10(1):12-18.
(From the Database of Abstracts of Reviews of Effects. 2012 Issue 4. Cochrane Library)
5. Wooden, D. Orthopaedic physical therapy. 3rd ed. NY, New York: Churchill
Livingstone; 2001.
6. Cornwall M, Godges J, Irrgang J, Martin R, McPoil G, Wukich D. Heel pain-plantar
fasciits: clinical practice guidelines linked to the international classification of function,
disability, and health. The Journal of Orthopedic Sports Physical Therapy. 2008; 38(4).
A1-A18.