Plantar Fasciitis and Physical Therapy

The hallmark sign of plantar fasciitis typically is sharp, severe pain in the foot immediately upon getting out of bed in the morning. Plantar fasciitis is one of the most common sources of foot pain, and more specifically heel pain in the U.S.. 

This band of connective tissue serves as a major defense component in the over flattening of your foot’s arch.  When this part of your body becomes inflamed or sustains small microscopic tears, PAIN and limitations in weight bearing function can occur.  

Who suffers with plantar fasciitis?

With 10% of the population in this country experiencing this persistent pain it falls into a cluster of common orthopedic issues affecting a wide spectrum of people.  This diagnosis is prevalent in active runners but also affects individuals who may be overweight and exerting excessive force on the lower extremities. 

Proper Diagnosis

Undoubtedly you have heard your co-worker, BFF, or next door neighbor tell you all about his or her “Sciatica”, “Rotary cup tear”, or “Plantar Fasciitis”.  The important thing to remember when digesting this diagnosis and deciding how to go about treating it, is to first acknowledge that the internet (and your cousin’s mailman’s ex boss) is full of information and misinformation.    So as always let’s look at what the CURRENT research and science says……  

What are the most effective treatments?

In 2014 JOPST (Journal of Orthopedic & Sports Physical Therapy) published a comprehensive update on clinical practice guidelines for treatment of plantar fasciitis.  This reassessment of the guidelines formally proposed in 2008 rated various treatment’s effectiveness on a letter grading scale with A being the strongest and F being the lowest. 

Manual therapy, stretching, taping, foot orthoses, and night splints all received grades of A’s in their effectiveness.  Physical agents such as low-level laser therapy, phonophoresis, and ultrasound received C grades.  Electrotherapy and dry needling received the lowest grades with ratings of D and F respectively. 

How about steroid shots?

If conservative treatments are not effectively reducing pain symptoms after several months, other options may be explored.  Typically imaging tests are unnecessary but an X-ray or MRI may be suggested if a compressed nerve or stress fracture is suspected. 

Or Antiinflammatories?

Pain relievers like Ibuprofen may reduce some of the inflammatory response in the foot and cortisone/steroid injections may be administered.  These options typically will only provide temporary relief.  It may be detrimental to have multiple steroid injections as they can actually reduce the integrity of the plantar fascia and weaken it.

Why choose physical therapy for plantar fasciitis?

Despite the strong evidence for conservative treatment of plantar fasciitis, physical therapy is often under-utilized by patients and their physicians.  In a study published this past February researchers looked at a database of over 800,000 individual cases of plantar fasciitis and discovered that only 7.1% of these individuals were prescribed physical therapy. 

If you suspect you have plantar fasciitis and it is limiting your daily functional activity consult with a physical therapist.  He or she can help both with manual treatment and developing a guided and progressive exercise program.  With the state of Maryland being a “direct access” state you may be able to see a physical therapist initially without requiring a visit with or script from your physician.

 

Greg Chrest , DPT, Reisterstown Clinic Director

Greg graduated from Elon University in 2011 with a Doctorate of Physical Therapy after completing his undergraduate degree in 2006 where he majored in exercise sports science with a minor in psychology. He worked as a Personal Trainer in Charleston, South Carolina where he was able to focus on his love of adult fitness along with getting people of all ages interested in exercise and living a healthy lifestyle. His special interest is continuing to cultivate his manual therapy skills along with sports medicine and management of chronic pain. Growing up in Bel Air, Greg is a die-hard Oriole and Raven fan, and spends his free time training for triathlons and road races, playing the guitar, and sharing time with his family and friends.

Click here to contact Greg Chrest

 

Chesapeake Bay Aquatic and Physical Therapy performs injury assessment at no cost to you or your insurance.  If you suspect you have plantar fasciitis contact us for an appointment.

 

REFERENCES

  1. Fraser et al, titled “Utilization of Physical Therapy Intervention Among Patients With Plantar Fasciitis in the United States” (J Orthop Sports Phys Ther 2017;47(2):49–55. doi:10.2519/jospt.2017.6999).

  2. Martin RL, Davenport TE, Reischl SF, et al. Heel pain—plantar fasciitis: revision 2014. J Orthop Sports Phys Ther 2014;44(11):A1-A23.

  3. “Plantar Fasciitis”. Mayo Clinic Staff. http://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/diagnosis-treatment/treatment/txc-20268820. November 16, 2016.