A Guide to Physical Therapy for Plantar Fasciitis
Plantar fasciitis is a condition that the affects the bottom of the foot. Those with plantar fasciitis will typically experience pain at the heel when they stand and walk after sitting or resting for some time.
Foot pain can limit your ability participate in activities that require being on their feet — such as walking, shopping, or house chores.
In 2017, one million outpatient visits were attributed to plantar fasciitis.1 While this condition is frustrating to deal with, it can be treated by a physical therapist. Pain from plantar fasciitis shouldn't knock you off of your feet.CityPT is here to help.
- Understanding Plantar Fasciitis
- Symptoms of Plantar Fasciitis
- What are the Most Common Causes of Plantar Fasciitis?
- Diagnosing Plantar Fasciitis
- What to Expect from Physical Therapy
- What If Conservative Treatment Doesn't Work?
- Preventing Plantar Fasciitis
- Is It Time to Seek Treatment?
The plantar fascia is a thick band of connective tissue located at the bottom of the foot. These tissues run from the heel to the base of the toes. The job of the plantar fascia is to support the arch and add critical stability with weight bearing activities. The plantar fascia absorbs shock when performing activities such as walking, running and jumping.2
Irritation at the area where the plantar fascia connects to the calcaneus (heel) can lead to pain. This painful condition is known as plantar fasciitis.
A Note on Inflammation
In the past, we have used the "-itis" ending to describe an area that is inflammed, or swollen. For example, achilles tendonitis is a term to describe swelling and pain at the tendon at the back of the ankle.
As more studies on the human body have been complete, we have learned that there often isn't any swelling at an area where the tissues are irritated. Another ending "-osis" can describe when the tissue is starting to break down without swelling, or inflammation. Therefore, sometimes this condition may be more accurately be referred to as plantar fasciosis in some cases.
Pain located at the heel is one of the hallmark symptoms of plantar fasciitis. Activities such as the following can increase the pain from plantar fasciitis, or make it worse:3
- Standing and walking in the morning
- Standing after sitting for prolonged periods
- Walking, running, or exercise on hard surfaces
Other symptoms of plantar fasciitis can include:
- Tenderness at the heel
- Stiffness at the ankle
- Loss of movement at the ankle
- Walking with a limp
Repeated trauma to the plantar fascia where it attaches to the calcaneus (heel bone) can lead to either inflammation and/or breakdown of the tissue. This inflammation and tissue breakdown can lead to pain when pressure is placed on the plantar fascia with weight-bearing activities.
Activities that can lead to foot-related trauma include:
- High impact sports
- Long distance running
- Dance, such as ballet
- Aerobic exercise classes
- Prolonged standing on hard surfaces, common with factory workers and teachers
Common risk factors of plantar fasciitis can include:3
- Decreased dorsiflexion range of motion (ability to flex the ankle)
- Tight achilles tendon (the tendon that attaches your calf muscle to the back of your ankle)
- High arches at the foot
- Low arches at the foot (or flat feet)
If you believe that you have plantar fasciitis, you can see a physical therapist for help. The physical therapist can determine whether your pain is due to plantar fasciitis, or another issue. The physical therapist can then work with you on an effective treatment plan.
A physician can also determine whether or not you have plantar fasciitis. If you do have plantar fasciitis, the physician may then refer you to physical therapy for treatment.
A diagnosis of plantar fasciitis is often made with a clinical evaluation. During this evaluation, the physician or physical therapist will examine your feet and ankles. A clinical evaluation to determine whether or not you have plantar fasciitis may include the following:4
- Palpation (touching) of your feet to determine the painful area
- Examination of your ankle movement
- Testing of your foot and leg strength
- Assessment of your gait (walking or running)
- Special tests to rule out other foot and ankles injuries
Not only can a physical therapist can help you to determine if the plantar fascia is causing your pain; they can also help you to identify what led to your pain in the first place. Understanding the underlying cause of your pain can make treatment more effective.
The physical therapist can also provide treatment for plantar fasciitis, and other foot conditions. Physical therapist treatment for plantar fasciitis can include the following:1
- Manual therapy (hands-on treatment) to improve circulation and increase soft tissue extensibility. This can help relieve the stress placed on the plantar fascia
- Stretching exercises to help improve ankle and foot mobility and coordination with daily weight-bearing activities
- Strengthening exercises, functional activities, and biomechanical training to help improve ankle and foot stability
- Advice on appropriate footwear
- Advice on bracing or orthotics for the foot
How CityPT can help
When working with a CityPT physical therapist, you can expect the following:
- A subjective evaluation and comprehensive interview
- An in-depth discussion of your goals, and activities that you would like to return to
- A physical examination done remotely using telehealth, or in person
- Assessment of your ankle range of motion, strength, and movement patterns
- A treatment plan to reach your goals
Approximately 85%-90% of patients with plantar fasciitis get better without surgery. If your symptoms do not improve with a few months of conservative treatment, your physical therapist may recommend that you see a physician (foot specialist). The physician can then help to determine the next step in your care.4
Since there are risk factors for plantar fasciitis, managing some of those risk factors may help to prevent this painful condition. A physical therapist can also help to guide you on how to prevent plantar fasciitis.
Steps to prevent plantar fasciitis may include:
- Maintaining a health body weight
- Increasing activity level at a reasonable rate
- Maintaining adequate ankle mobility and strength with regular exercise
- Wearing appropriate footwear when active
- Getting adequate sleep to help the body to repair damaged tissue
- Following a healthy diet to help promote tissue health (and a healthy body weight)
Do you think that you may have plantar fasciitis. If you think that you may be at risk for developing plantar fasciitis, CityPT is here to help.
A CityPT physical therapist can help to determine if your foot pain is due to plantar fasciitis, or another cause. We can also provide treatment for plantar fasciitis, or work with you so that you can stay active while avoiding this painful condition.
This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.
Fraser JJ, Glaviano NR, Hertel J. Utilization of Physical Therapy Intervention Among Patients with Plantar Fasciitis in the United States. J Orthop Sports Phys Ther. 2017 January; 47(2): 49-55 https://www.jospt.org/doi/full/10.2519/jospt.2017.6999 ↩ ↩2
Stecco C, Corradin M, Macchi V, et al. Plantar fascia anatomy and its relationship with Achilles tendon and paratenon. J Anat. 2013 November; 223(6): 665-676 https://onlinelibrary.wiley.com/doi/epdf/10.1111/joa.12111 ↩
Cutts S, Obi N, Pasapula C, Chan W. Plantar Fasciitis. Ann R Coll Surg Engl. 2012 November; 94(8): 539-542 https://publishing.rcseng.ac.uk/doi/epdf/10.1308/003588412X13171221592456 ↩ ↩2
Thompson JV, Saini SS, Reb CW, Daniel JN, Diagnosis and Management of Plantar Fasciitis. J Am Osteopath Assoc. 2014 December; 114(12): 900-901 https://www.degruyter.com/document/doi/10.7556/jaoa.2014.177/html ↩ ↩2