Physiotherapy and Pilates For Plantar Fasciitis

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Physiotherapy and Pilates For Plantar Fasciitis
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• Damian Wyard is a registered physiotherapist in
  Downtown Toronto. He combines manual
  physiotherapy techniques, with the classic
  Pilates equipment, to treat overuse and sports
  injuries.

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What is Plantar Fasciitis?

• Plantar fasciitis is the most common type of heel
  pain seen in out patient clinics. Up to 10 of
  the population will have this condition over a
  lifetime.

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• Most of these will be working adults between 25
  and 65 years old. It is usually felt as pain on
  the underside of the heel bone where the plantar
  fascia attaches.

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• The plantar fascia provides a strong mechanical
  link between the heel bone and the toes so that
  it supports the impact of weigh bearing through
  the foot. Pain is usaully worse first thing in
  the morning and also with increased weight
  bearing activity.

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• Walking or jumping will increase the pain.
  Diagnosis is made in the clinic from the patients
  history. Palpation of the underside of the heel
  bone and slightly distally will be tender.

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Why Does Plantar Fasciitis occur?

• Generally there are a number of factors that may
  cause it in any one patient. Some patients report
  a sudden increase in activity or a change of
  shoes.

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• Other factors include reduced ankle flexibility
  and tight calf muscles. Excessive pronation
  caused by tight calves and weak foot muscles can
  result in too much loading through the planar
  fascia.

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• Research has highlighted other risk factors
  increased body mass index stiff ankle and big
  toe joints pronation and prolonged standing.

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• In runners and other impact sports the problem is
  usually one of the fascia being over-loaded. In
  runners we look at your running technique to see
  if there is anything causing it.

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• An example is over-striding which increases the
  impact through the foot and may also cause to
  much pronation.

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• The calf and foot may not be strong enough to
  support your current running schedule. We make
  adjustments to your current training and
  technique and provide a rehabilitation program
  that allows the tissues to heal.

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• In really acute cases there has to be a period of
  relative rest from training if it is still
  causing pain.

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Treatment for Plantar Fasciitis

• The research supports both stretching and
  strengthening for this condition. More recent
  studies support strengthening the ankle and foot
  muscles.

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• The recommendation is to treat the fascia like
  any other tendon injury and improve its loading
  capacity. This makes sense as the fascia has to
  stretch and contract to support the weight of the
  body.

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• We also know that this is not just an
  inflammatory condition but also degenerative one.
  The plantar fascia needs to be strengthened in
  the same way we treat tendon injuries.

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  Treatment in the Acute Painful Stage

• In the acute and painful stage the treatment is
  focused on calming down the symptoms. I have had
  some success with taping the foot and
  recommending over-the-counter insoles.

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• You do not have to run out and pay 500 plus for
  custom orthotics. You would not buy a brace for
  acute neck pain, so no need to do this for your
  feet.

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• Orthotics are often recommended to make money
  without addressing the underlying issues and
  patients are advised to buy them inappropriately.

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• An over-the-counter soft insole/arch support is
  ideal instead of hard supports that press into
  the irritated tissue.

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• Some of my patients have had success with
  Birkenstock arch supports. Wearing these all the
  time as well as indoors will give the painful
  tissue some relief.

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• There are some basic exercises that can start to
  promote healing and repair without aggravating
  it. Isometric strengthening and light stretching
  is recommended with ice.

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• In the runners and active population, we can
  modify your training schedule and technique to
  keep you running. Changing your shoes to
  something more supportive and with a softer
  insole will also help.

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Strengthening/Stretching Stage

• Once the symptoms are less acute and painful you
  can start the strengthening phase with some
  stretching. The common approach has been to just
  stretch the fascia and there is some research to
  support this.

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• More recent studies have shown that straightening
  the foot and ankle muscles is also effective.
  This makes sense clinically as well as the fascia
  has to elongate as you bear weight but also
  support the arches.

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• If the fascia suffers degeneration as a result of
  this condition it needs to strengthened. Every
  case is different so if you have tight toes
  flexors and calf muscles, then you will need
  stretching as well as the strengthening exercises.

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Summary

• Plantar Fasciitis can affect both the athletic
  and more sedentary population. There are a number
  of factors that can cause the plantar fascia to
  become irritated. Most of these can be assessed
  in the clinic and addressed in the treatment.

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• Generally research and clinical experience
  supports both strengthening and stretching
  programs. Runners and very active patients will
  need a more specific program to deal with the
  training demands on the plantar fascia.

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• More sedentary patients will still need an
  exercise based approach to treat the underlying
  cause.

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• It can be a stubborn injury to settle down as we
  are on our feet a lot, so it can be difficult to
  rest the foot. However there are lots of
  treatment options to assist with this recovery
  period.

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