Plant Fascia Management – What are the treatment options?
What is it?
Plantar heel pain is commonly caused by plantar fasciitis a condition linked with tissue degeneration, leading to non-healing micro-tears and subsequent inflammation (1).
The plantar fascia is a structure which provides support and power generation in the foot, and runs from the medial calcaneal tubercle to the phalanges (2) There are few high quality epidemiological studies, however 2 million Americans are estimated to be effected (3). Incidence is specifically more common within sedentary middle-aged adults, the elderly and athletic populations (4).
How does it present?
Plantar fasciitis commonly presents with pain at the plantar or medial aspect of the heel, and can radiate through the plantar aspect of the foot (3). Symptoms are usually worse first thing in the morning, or after long periods of being sedentary (5), and as the condition progresses, can eventually limit the patients ability to weight-bare (4).
What are the risk factors?
Along with the populations noted above, other risk factors include
- high levels of weight bearing with work or daily activities,
- poor dorsi-flexion range of the ankle, and
- individuals who run greater than 64km per week (4,6)
Can it masquerade as something else?
Although plantar heel pain is most commonly caused by plantar fasciitis, a physiotherapy assessment is recommended to rule out other possible causes. One such common differential diagnosis is a fat pad contusion. Less common but also to be considered include but are not limited to stress and traumatic fractures, nerve entrapment, tarsal tunnel syndrome, bursitis, and osteoid osteoma (4).
What treatment options are available?
Current evidence recommends the use of non-invasive treatments as a first-line management of plantar fasciitis, with 9/10 cases resolving with conservative treatments (3). This includes an exercise-based program which targets deficits identified by a thorough assessment. One example of this is the common association between plantar fasciitis and strength deficits of the leg and foot (7).
It is recommended that non-invasive symptom management is used alongside exercise and strengthening, such as manual therapy and load-management plans (1). Following these interventions, mildly invasive options such as dry-needling may be used if symptoms are persisting (1).
What is Not Recommended by the Evidence?
Treatments which are currently not supported by the evidence include pulsed radiofrequency electromagnetic fields (PRFE), calf-muscle stretching, plantar fascia stretching and low-dye taping (3).
What About Corticosteroids?
Non-invasive and minimally-invasive intervention options show similar, if not better results when compared to corticosteroid injections. Avoidance of corticosteroids reduces the risk of a number of associated complications, including infections, contact allergic dermatitis, skin atrophy, osteomyelitis of the calcaneus and plantar fascia rupture (1,8,9).
Donvale Rehabilitation Hospital’s Day Rehabilitation department is a progressive and passionate team of multidisciplinary healthcare professionals. We manage a variety of musculoskeletal conditions in adults of all ages, employing evidence-based practice in a high quality rehabilitation environment.
To ensure your patients achieve best possible outcomes, please contact us. Referrals should be addressed to:
- Al-Boloushi, López-Royo, Arian, Gómez-Trullén & Herrero, 2019
- (Bolgla, & Malone, 2004; Huffer, Hing, Newton & Clair, 2017
- Salvioli, Guidi & Marcotulli, 2019
- Huffer, Hing, Newton & Clair, 2017
- Thing et.al., 2012
- Riddle, Pulisic, Pidcoe, and Johnson, 2003
- Latey, Burns, Hiller, & Nightingale, 2014
- Canyilmaz et al., 2015
- Karimzadeh et al., 2017