How Is Plantar Fasciitis Diagnosed?
A physiotherapist can typically diagnose plantar fasciitis through using the history of the condition and a clinical examination. X-rays can be used to investigate for the presence of a heel spur, which are calcium deposits that build up on the underside of the heel bone. Heel spurs are a process that usually occurs over a period of many months and are frequently associated with plantar fasciitis and repetitive stress loading to the plantar fascia. MRI and Ultrasound scans can also be used in the diagnosing and ongoing management of heel pain, these investigations can be of use in identifying potential plantar fascia tears, calcification, inflammation, as well as assisting in highlighting any other causes of pain in the heel area like, fat pad bruising, tibialis posterior tendinopathy, bursitis, Achilles tendon pathology….
Physiotherapy Management For Heel Pain?
At our practice your physiotherapist will assess your heel pain and if they reach the diagnosis of plantar fasciitis, then it is most likely they will look at any obvious predisposing factors and try to work with you to reduce the stress on the plantar fascia by minimizing these, as well as using therapeutic techniques to help promote healing. The good news is that despite all the horror stories you may hear around plantar fasciitis, it is actually quite treatable and the majority of people with plantar fasciitis improve significantly within months of their initial treatment. In my experience it is only a very select and unlucky few, who have the inconvenience of suffering heel pain for a year, or longer.
Physiotherapy And Heel Pain
When treating heel pain, assessing foot and leg biomechanics as well as the individuals day to day, as well as sporting footwear is crucial. Occasionally your physiotherapist may suggest you to see a podiatrist for further assessment and potentially the prescription of customized orthotics to help support your arch and alter your foot biomechanics.
As a rule of thumb, an element of rest from aggravating activities is required both at the onset of and potentially throughout the rehabilitation process. As well as modified and/or reduced activity your physiotherapist may also suggest any of the following therapeutic approaches:
- Taping techniques can be used to support the plantar fascia and impact foot biomechanics
- Stretching of the lower limb soft tissues including the calf muscles.
- As well stretching, strengthening exercises for the intrinsic and extrinsic foot muscles.
- Acupuncture and dry needling techniques,
- Massage and other soft tissue techniques, as well as joint mobilizations
- Ultrasound therapy and laser therapy electrotherapeutic devices.
At Sydney Physio Clinic something we have found very useful in the treatment of plantar fasciitis over the years is shockwave therapy. As with most tendinopathies, the use of shockwave treatment can be a really effective approach with plantar fasciitis / plantar fasciosis. Shockwave therapy can assist by helping kick start the bodies natural healing process and is ideal for treating chronic soft tissue complaints, as well as addressing calcification (such as heel spurs). At Sydney Physio Clinic we have a shockwave therapy machine which can easily be incorporated into any individuals plantar fasciitis / plantar fasciosis rehabilitation program for the treatment of their heel pain.
Restoring Normal Foot Biomechanics
Foot biomechanics is considered one of the main predisposing factors in developing plantar fasciitis. Taping techniques may be used to help improve biomechanics temporarily and off load the stress on the plantar fascia. The prescription of prefabricated orthotics, or as mentioned previously a custom made orthotic prescribed by a podiatrist may be necessary address any biomechanical issues in the longer term. This can be particularly relevant if taping techniques were found to be beneficial in the short term.
Combined with the use of any taping techniques or orthotics prescription, footwear advice also plays a crucial role. It is often poorly designed/ suited footwear that can predispose an individual to injury. Personally I find almost nine out of ten times, any rehabilitation program for heel pain will involve an individual purchasing some new shoes, or at least require them to make some changes to their footwear habits.
Returning To Play After Plantar Fasciosis
If your plantar fasciosis is the result of repetitive activities placing excessive forces on your plantar fascia during sport, then in order to prevent a recurrence as you return to play, technique adjustments and corrective exercises may play a role in the rehabilitation process. Adjustments can help both prevent a recurrence of pain and ultimately may also improve sporting performance.
Disclaimer: Sydney Physio Clinic does not endorse any treatments, procedures, products mentioned. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific advice or assistance regarding Heel Pain Physiotherapy Treatment should consult his or her orthopaedic surgeon, general practitioner, sports medicine specialist or physiotherapist.