What is plantar fasciitis?

Plantar fasciitis (PLAN-tur fas-e-I-tis) involves pain and inflammation of a thick band of tissue, called the plantar fascia that runs across the bottom of your foot and connects your heel bone to your toes. Plantar fasciitis is one of the most common causes of heel pain.   Plantar fasciitis commonly causes stabbing pain that usually occurs with your very first steps in the morning. Once your foot limbers up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing or after getting up from a seated position.   Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. If tension on that bowstring becomes too great, it can create small tears in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed.   Factors that may increase your risk of developing plantar fasciitis include:  
  • Age. Plantar fasciitis is most common between the ages of 40 and 60.
  • Sex. Women are more likely than are men to develop plantar fasciitis.
  • Certain types of exercise. Activities that place a lot of stress on your heel and attached tissue — such as long-distance running, ballet dancing and dance aerobics — can contribute to an earlier onset of plantar fasciitis.
  • Faulty foot mechanics. Being flat-footed, having a high arch or even having an abnormal pattern of walking can adversely affect the way weight is distributed when you're standing and put added stress on the plantar fascia.
  • Obesity. Excess pounds put extra stress on your plantar fascia.
  • Occupations that keep you on your feet. Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can damage their plantar fascia.
  • Improper shoes. Avoid loose, thin-soled shoes, as well as shoes without enough arch support or flexible padding to absorb shock. If you regularly wear high heels, your Achilles tendon — which is attached to your heel — can contract and shorten, causing strain on the tissue around your heel.

What activities may aggravate Plantar Fascitis?

  • Running especially uphill or on uneven surfaces
  • Walking, standing and virtually everything in standing
  • Heel raises, hopping, jumping, change of direction activity with speed and agility
  • Basketball, tennis, squash, baseball, badminton, curling and virtually every sport in standing.

What is the prognosis of plantar fasciitis?

Patients with this condition typically experience pain in the region of the heel and undersurface of the foot over the calcaneal tubercle. Initially, patients may only experience a tenderness stepping down onto a hard surface after being off your feet such as fist thing in the morning. As it worsens you may only feel it following activities that place stress on the tendon or at the end of your walk or run. Eventually it will be painful throughout the activity and then all of the time and even at rest. Often the problem is deceiving because once you warm up it disappears, later to return when you are resting at night. In severe cases, patients may walk with a limp or be unable to weight bear on the affected foot. Patients may also experience swelling, tenderness on firmly touching the plantar fascia insertion, weakness and sometimes a palpable thickening of the affected area when compared with the unaffected side. The diagnosis is easy, morning pain and tenderness are classic, imaging may confirm with evidence of a bony spur suggesting a repetitive inflammation.  The recovery period depends on how long the condition has persisted and the state physical of your calves and feet.   Ignoring plantar fasciitis may result in chronic heel pain that hinders your regular activities. You may also develop foot, knee, hip or back problems because of the way plantar fasciitis changes your walking.   About 90 percent of the people who have plantar fasciitis recover with conservative treatments in just a few months.



Ask your doctor about medications. Medications to ease symptoms of plantar fasciitis may include Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve), may ease pain and inflammation, although they won't treat the underlying problem. In addition Corticosteroids may be suggested. This type of medication may be delivered through a process called iontophoresis, in which a corticosteroid solution is applied to the skin over the painful area and the medication is absorbed with the aid of a nonpainful electric current. Another delivery method is injection. Multiple injections aren't recommended because they can weaken your plantar fascia and possibly cause it to rupture, as well as shrink the fat pad covering your heel bone. Ultrasound guidance is sometimes used for more accurate placement of the corticosteroid injection.


Surgical or other procedures

When more-conservative measures aren't working, your doctor might recommend:  
  • Extracorporeal shock wave therapy. In this procedure, sound waves are directed at the area of heel pain to stimulate healing. It's usually used for chronic plantar fasciitis that hasn't responded to more-conservative treatments. This procedure may cause bruises, swelling, pain, numbness or tingling, and has not been shown to be consistently effective.
  • Surgery. Few people need surgery to detach the plantar fascia from the heel bone. It's generally an option only when the pain is severe and all else fails. Side effects include a weakening of the arch in your foot.

How can physiotherapy and massage therapy help plantar fasciitis?

Physiotherapy and Massage Therapy

Physiotherapy and Massage can help you improve your overall health by supporting your foundation. Your feet are the foundation of your body.They support you during locomotion, when you stand, walk, change direction, when you balance, transfer, step, jog, run and sprint. Feet also help protect your spine, bones, and soft tissues from stress as you move. By stabilizing and balancing your feet, by restoring foot health, reducing pain, and correcting imbalances that lead to injury, your base of support can enhance your body’s performance and efficiency. Living a healthy lifestyle is one that incorporates movement and Physiotherapists and Massage Therapists focus on functional mobility.   A manual physiotherapist can instruct you in a series of exercises to release and stretch the plantar fascia and the lower leg muscles, which stabilize your ankle and heel. They may also teach you to apply athletic taping to support the bottom of your foot. Both a physiotherapist and massage therapist can perform a thorough assessment of muscle tension in the lower leg/calf, plantar fascia, and the hip muscles and this will direct our manual therapy goals. One of the key treatments is reducing tension in the lower calf and foot is through soft tissue release. Sometimes inflammation is too high in the plantar fascia to allow for direct release, but as inflammation reduces, soft tissue release will be performed as needed. The great toe (big toe) is a key joint to be assessed for stiffness and normally this joint has 70 degrees of extension. Lacking toe extension will compromise optimal mechanics at the foot and this restriction will significantly increase stress on the plantar fascia, often resulting in foot pain. The joint may be mobilized to restore this movement and self techniques of traction and joint mobility may be done as a home program. Due to abnormalities in foot structure and lower extremity alignment, compensations in gait may result in hip and back disorders and imbalances which should be assessed and addressed. Soft tissue release to the IT Band, abductors, and piriformis is common and stretching exercises can be shown to the patient as well.  Night splints may be an affective way to keep a prolonged stretch on the plantar fascia and calf while you seep. Orthotics and foot supports may also be effective to distribute pressure to your feet more evenly and correct structural imbalances.



There are a few key exercises that can be done to compliment the manual therapy and/or massage therapy sessions. Because plantar fasciitis often results from a combination of tightness through the plantar fascia and a pronated foot/lower extremity pattern, exercises will focus on releasing these tight structures as well as training a supinated pattern in the lower extremity.  This process is outlined below as an explanation of the Kinetic Chain. A Kinetic Chain assessment determines your specific imbalances and together with the orthopaedic examination findings, allows physiotherapists to provide their impression and physiotherapy diagnosis. They will then be able to assign the appropriate exercises to strengthen the weak muscles that are identified. Together with neuromuscular training of the lower extremities to posture in a supinated position, stress will be minimized and an optimal functional alignment may be reached.    

How can exercise and physical development help after plantar fasciitis?

The health and fitness industry can be overwhelming to the reader with information on training, fitness, nutrition, and rehabilitation.  In the face of this information, seeking sound advice from a health care provider will help you make intelligent choices with regard to training, recondition, and rehabilitation.


The Kinetic Chain

Our body functions best and with minimal stress when it is in optimal alignment and posture. Proper structural correction is achieved with proper footwear and support. Proper functional mechanics requires skill development and neuromuscular training and is the science of motor learning. The kinetic chain is a integrated functional unit of systems that work interdependently to allow structural and functional efficiency. It is made of the soft tissue system (muscle, ligament, tendon, and fascia), the Neural system ( peripheral nervous system of nerves and the central nervous system or brain), and the Articular system (joints). If any of these systems do not work efficiently, compensations and adaptations may occur in the other systems. A dysfunction in the kinetic chain leads to decreased performance and predictable patterns of injury.  Imbalances may result from postural stress, a pattern of overload, repetitive movement, a lack of core stability, and a lack of neuromuscular efficiency. All functional movement patterns involve deceleration, stabilization and acceleration, which occur at every joint in the kinetic chain and in all planes of motion at varying speeds.   Optimum posture and alignment provides optimal structural and functional efficiency to the kinetic chain. If one component is out of alignment, it creates predictable patterns of tissue overload and dysfunction, leads to decreased neuromuscular control and initiates the cumulative injury cycle. Muscle imbalance leads to abnormal neuromuscular control leads to overloaded tissue and tissue fatigue which leads to inflammation and eventually leads to tissue trauma or injury. The most common patterns of compensation are the Pronation Pattern of the lower body and the Forward Head Pattern of the upper body and these two patterns are the focus of our screen examination and our subsequent corrective preventative exercise plan. Identification of biomechanical imbalances in a way that is specifically related to the multi planner movements and that involves acceleration, deceleration, stabilization and occurs at multiple speeds in those specific body positions and posture activities of daily living.  Assessment of the muscular system (functional anatomy) the articular system (functional biomechanics) and the neural system (motor behavior) becomes important in the prevention and treatment of overuse injuries and repetitive strains. In order to live a healthy and active lifestyle, one has to train their body the way it moves during daily functional movements.


Exercise and Physical Development

The final step is to establish a personal improvement health plan to continue to develop physically throughout your life. This is especially necessary after injury or an accident when you have become deconditioned. All of our staff have a combination of health sciences and sports sciences training, having dual training in both kinesiology and physiotherapy and allowing us to provide a biomechanical focus. Once you have recovered from your painful arthritis, our therapists will perform a functional movement screen and analysis to identify individual muscle imbalances that are unique to your inherited structure, to your movement patterns, and to your goals and interests in living a healthy physical life. We develop a individualized program that focus on:
  • Your specific imbalances and movement patterns at work, home, and those evident during the activities that you participate in.
  • You structural and genetic posture and alignment characterizes and how they affect your interests to do activity etc.
  • We look at the ergonomics specific to your workplace and home

How can low intensity laser therapy help with plantar fasciitis?

Low Intensity Laser Therapy (LILT) is the use of monochromatic light. Meditech Bioflex has been producing this technology for 20 years and has an extensive in house clinical lab.   The light source is placed in contact with the skin allowing the photon energy to penetrate tissue, where it interacts with various intracellular biomolecules resulting in the restoration of normal cell morphology and function. This process also enhances the body's natural healing propensities.   Low Intensity Laser Therapy does not heat or cut tissue. Unlike many pharmacological treatments that mask pain or only address the symptoms of the disease, Laser Therapy treats the underlying condition or pathology to promote healing. The technology utilizes superluminous laser diodes to irradiate diseased or traumatized tissue with photons. These particles of energy are selectively absorbed by the cell membrane and intracellular molecules, resulting in the initiation of a cascade of complex physiological reactions, leading to the restoration of normal cell structure and function.   The process is curative and therefore results in the elimination of symptoms including pain. In addition, it enhances the body’s immune system response and facilitates natural healing. The therapy is completely safe and has no adverse side effects. The technology is highly effective in the treatment of musculoskeletal conditions, arthritis, sports injuries, wound healing and a wide range of dermatological conditions. Whiplash injury typically involves injury to muscles, ligaments, and joints and typically involve several levels and a more wide spread area of injury due to the force full nature of the injury. Muscles of the neck, although short, cross over several joints and so the discomfort is generally more global initially. Laser therapy directed by multiple diodes are able to reach these tissues.    

Physiological effects of Low Intensity Laser Therapy

With LILT there is an increased production and release of:  
  • Endorphins which - natural analgesics
  • Cortisol – a precursor of cortisone
  • Growth hormone – instrumental in tissue repair
  • ATP – improves and regulates cellular metabolism
  • An increase in protein synthesis – collagen, DNA, fibroblasts
  • A facilitated venous and lymphatic flow
  • Increased angiogenesis – the elevation of oxygen saturation
  • Enhanced immune response
  These responses are some of the many processes that accelerate cellular regeneration (cartilage, epithelium) and restore normal cell morphology and function. Treatments are typically 25 minutes to over 1 hour depending on the condition and area being treated   The most popular technical / clinical information requested is available on the Meditech website under Laser Reports. You may visit the Meditech website research section directly for detailed abstracts, case profiles and articles on a variety of topics relating to the use of low intensity laser therapy in the treatment of various medical conditions.  

What life style and self-care measures can you do for yourself to relieve plantar fasciitis?

  • Footwear. Proper foot support is important in the prevention of foot pain and plantar fasciitis. Avoid loose, thin-soled shoes, as well as shoes without enough arch support or flexible padding to absorb shock. If you regularly wear high heels, your Achilles tendon — which is attached to your heel — can contract and shorten, causing strain on the tissue around your heel.
  • Flexibility. Specifically calf and foot suppleness is something that can be effective in correcting and preventing plantar fascitis
  • Avoidance of long distance running on uneven surfaces and or with excessive weight.
  • Seek physiotherapy to correct your faulty foot mechanics. Being flat-footed, having a pronation pattern or even having an abnormal pattern of walking can adversely affect the way weight is distributed and this pattern can be corrected with corrective exercises
  • Loose excessive weight.  Excess pounds put extra stress on your plantar fascia.
  • Avoid walking bear footed even indoors. Hard kitchen floors and hardwood can cause excessive stress on the structures of the foot and may lead to a painful heal.
  • Use heat and self massage and stretching techniques to prevent soft tissue tightness

Legal Disclaimer

Always consult your physician before beginning any exercise program. Never disregard medical advice or delay in seeing your doctor because of something you have read on healthfxtoronto.com. Any content or information provide by healthfxtoronto.com is for informational and educational purposes only and any use thereof is solely at your own risk. Neither healthfxtoronto.com nor its operators or staff or video presenters bears any responsibility thereof.

The information contained herein is not intended to be a substitute for professional medical advice, diagnosis or treatment in any manner. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding any medical condition. All information contained in heatlfhxtoronto.com including but not limited to text, graphics, images, videos, information, third party information and or advice, food, recipes, exercises, diets, psychology, websites, links, including but not limited to any content by employees, consultants or writers and contributors and or any other material contained herein are for informational and educational purposes only.