Treatment for Plantar Fasciitis using orthotics
Treating Plantar Fasciitis and Plantar Fasciopathy
Plantar Fasciitis (PF) is a degenerative syndrome of the plantar fascia resulting from repeated trauma at its origin at the calcaneus. Plantar fasciopathy is an irritation of the plantar fascia which is the fibrous connective tissue that helps support the arch of your foot.
These are reported to be the most common cause of inferior heel pain in adults, typically felt as pain at the base of the heel that is worse with weight bearing and can be quite bad when first taking weight after a period of rest.
Plantar fasciitis is also known as painful heel syndrome, heel spur syndrome, runner’s heel, policemen’s heel, subcalcaneal pain, calcaneodynia. and calcancal periostitis.
Valmassey refers to plantar fasciitis as affecting both pes planus and pes cavus foot types – with opinion being that different pain regions may be suffered depending upon the foot structure (watch video).
Plantar fasciopathy usually occurs when the plantar fascia is exposed to an unaccustomed load. This may be related to a change in activity (amount or type), suboptimal footwear, prolonged periods of time standing or walking, or suboptimal foot mechanics.
Treating the causative factors of plantar fasciitis is key to designing a treatment for your patient. Using the point of pain test will indicate if the pain is Lateral, Central or Medial.
Generally speaking the following often applies:
- Lateral Heel Pain is often associated with an uncorrected forefoot valgus and pes cavus foot type.
- Central Heel Pain often indicates a forefoot valgus is present, in addition to rearfoot pronation.
- Medial Heel Pain generally indicates the patient will exhibit excessive rearfoot pronation.
In some cases, treatment will involve prescribing an orthotic device to control rearfoot pronation and provide biomechanical correction.
Treatment of plantar fasciopathy usually involves determining and addressing what contributed to the overload (this may include taping in the short term), exercises to improve the capacity of the plantar fascia, footwear advice and activity modification with progression back to your desired loads and activities.
In the cases of Central and Medial pain, a heel deflection (referred to as a ‘horse shoe deflection’) in the orthotic can also assist by relieving pressure on the attachment. Low Dye Strapping can be used to provide short-term pain relief, as it mimics the support and control offered by an orthotic device. Shockwave therapy has also been used to some effect in breaking up scar tissue. Anti-inflammatory medications, massage and surgery are generally less successful in the long-term treatment of Plantar Fasciitis.
- Cornwall MW. McPoil TG., Plantar fasciitis : Etiology and Treatment. Orthopaedic Sports Phys iotherapy (1999);29:756-76
- Singh D. Angel J. Becky G. Trevino SG.,Fortnightly review. Plantar fasciitis. BMJ (1997):315:172-17.S.
Lemont H, Ammiiati KM, Usen N. Plantar Fasciitis: A Degenerative Process (fasciosis)
- Without Inflammation. American Journal Podiatric Medicine Assoc (2003); 93:234-237
- R.L. Valmassey, Clinical Biomechanics of the Lower Extremities. (1996) p76