Wednesday, November 15, 2017

Plantar Fasciopathy- Part 2 of 2


Rest, ice & protection– One of the first lines of treatment for Plantar fasciopathy is to give the structure relative rest and protect the area. Specifically this means reducing aggravating activity but not stopping all activity completely. Ice is also thought to help as there is often some swelling around the Plantar Fascia in the acute (early) stages of injury.

Non Steroidal Anti Inflammatories (NSAIDS)– NSAIDS such as Ibuprofen or Nurofen are commonly used in the acute stages of this injury to assist with any associated inflammation. Fix Physio advises all patients to seek medical advice before starting NSAIDS and to make sure they eat prior to taking them.

Deep Soft Tissue massage– Massage of the Plantar fascia itself as well as surrounding structures such as the calf muscles and Achilles tendon can ease some of the pain symptoms in the short term.

Acupuncture/ dry needling– Acupuncture or dry needling of the Plantar Fascia can be a good adjunct to other modalities when treating Plantar Fasciitis. The benefits are thought to be 2 fold: A. An anti inflammatory response- the needles pierce the Plantar Fascia and cause micro tears of its structure. This micro tearing causes the brain to release extra blood flow to the area to assist with the healing process. This excess blood picks up the waste products of inflammation and carries it away from the area of injury. B. Production of endorphins locally around the needles has been shown to offer pain relief. Endorphins are thought of as “feel good factors” released over the whole body when we exercise but they do also have analgesic (Pain killing) properties.

Footwear advice– ? podiatry for orthotics- Footwear can be an integral part of the recovery process with Plantar fasciitis. At Fix Physio, the first thing we do is look at what our patients are wearing on their feet. Sandals or thongs (flip flops) are a definite “No” as they generally lack any kind of arch support. Furthermore, if there is no strap around the heel on these sandals or thongs, the toes are likely to be gripping the shoes as they walk- this aggravates the Plantar fascia. Secondly, hard inner sole shoes such as formal shoes or hard orthotics should be avoided as they cause compression of the Plantar Fascia- soft inner soles or orthotics are much better. Thirdly, prescribed orthotics by a Podiatrist can make a big difference in putting the foot in a better biomechanical position and therefore reduce the load on the Plantar fascia.



Foot taping- rigid/ kinesiotape– Similar to orthotics, foot taping with rigid tape using a low dye tape technique or kinesiotape can offload the Plantar fascia by putting the foot in a better biomechanics position.

Foot intrinsic exercises and Rathleff program– Pain tends to inhibit muscular activity with most areas of the body and Plantar fasciopathy is no different. Traditionally, as Physios we have strengthened the deep intrinsic muscles of the foot- think core stability muscles for the foot, in order to support the bony and arch structures of the foot to prevent over pronation (foot excessively rolling in) and therefore reduce load on the Plantar fascia. This approach worked well for the majority Plantar Fasciopathy patients but there were still a handful that still had symptoms 1-2 years later.

However, in 2014 Michael Rathleff and his colleagues searched for a better solution to this difficult injury. They tested the theory that weight bearing strengthening of the Plantar fascia through regular, very specific standing exercises would help strengthen it and therefore alleviate the symptoms. The results were consistently impressive and since then, the Rathleff exercise program for Plantar Fasciopathy has been an integral part of recovery from Plantar Fasciopathy. See below You Tube video for how to do Rathleff exercises.

Rathleff exercises for Plantar Fascia strengthening

Lower limb strength & mobility work– As well as looking at the overall strength and mobility of the foot itself for plantar fascia injuries, it is important to look further up the kinetic chain as far as the pelvis and lower back. Muscle imbalances or joint stiffness higher up the chain can lead to the foot and ankle having to take extra load which can exceed this structures capacity. This is when injury of the Plantar Fascia occurs.

Activity Specific advice– As Physio’s, we must always look at what our patient is doing on a regular basis that could potentially be slowing their recovery down. For example, if a runner is continuously heel striking (landing on their heel) rather than on their mid foot or ball of their foot as is commonly accepted to be the preferred method, then there will be increased compression of the Plantar Fascia origin. This will in turn lead to increase incidence of Plantar Fasciitis.

As such, a large part of our treatment plan should be in the correction of running
pattern to prevent a heel striking running technique.

Cortisone injection– Much like ESWT, cortisone (steroid) injection for Plantar fasciopathy is not a first line treatment and should only be considered if more conservative treatment options are not effective. A cortisone injection is where a dose of strong anti inflammatories are delivered specifically to the area of injury. This can assist with settling any inflammation in the area.

Extra Corporeal Shockwave Treatment (ESWT) – As mentioned earlier, if ESWT is necessary, the patient first requires an MRI or USS to confirm there are no tears in the plantar fascia. ESWT is a treatment modality usually carried out by a Podiatrist, whereby a hand held probe is used to administer a dose of very high energy sound waves to the effected area. In the case of Plantar Fasciopathy the treatment is delivered to the sole of the foot, particularly the heel and the arch of the foot. These sound waves increase blood flow to the affected area and stimulate tissue regeneration which in turn speeds up the healing process.

Each ESWT session will last approximately 4 minutes and Plantar fasciopathy typically
requires 3-6 sessions over the course of a few weeks. The pain relieving effects of each
ESWT session can last upto 5 days. The amount of vibrational pressure from the probe
will gradually increase throughout each session as the patient becomes de-sensitised
to the pressure. Pain relief from ESWT is usually present within 1-2 minutes of
commencing treatment.

If you or someone you know is struggling with Plantar Fasciopathy, call (02) 9231 0420 or book online at Fix Physio online booking to start your journey to……