Talofa Samoa and welcome back to your weekly Physiotherapy column! This week’s column will answer some frequently asked questions about heel pain and plantar fasciitis.

What is the plantar fascia? What does the plantar fascia do?

The foot is a complex joint made up of several structures. In the foot, you have many bones; the tarsal bones (your ankle, heel, and the five bones that form the arch of the foot), the metatarsals (the five bones that make up the middle of the foot), and the phalanges (the bones in your toes). The plantar fascia is a thick band of connective tissue that spreads out on the underside of the foot to support the arch of your foot. It starts from the bottom of your heel (one of the tarsal bones) and fans out to attach to the bottom of your toes (your metatarsals). The plantar fascia undergoes a lot of tension during walking and running when the foot bears weight; during walking the plantar fascia acts like a spring to provide dynamic shock absorption as well as static support.

How does it become painful and turn into plantar fasciitis?

Plantar fasciitis tends to develop as a result of overstretching or overuse of this thick band of tissue, although a tear or small tears in the fascia tissue can also cause pain. Your foot structure can also predispose you to developing plantar fasciitis. Active men and women between the ages of 40 and 70 are at the highest risk of developing plantar fasciitis. It’s also slightly more common in women than men. Women who are pregnant often experience bouts of plantar fasciitis, particularly during late pregnancy. You’re at a greater risk of developing plantar fasciitis if you; are overweight or obese (this is due to the increased pressure on your plantar fascia ligaments, especially if you have sudden weight gain); are a long-distance runner; have an active job where you are often on your feet, such as working in a factory or being a restaurant server; have structural foot issues, such high arches or flat feet; have tight Achilles tendons which are the tendons attaching your calf muscles to your heels; often wear shoes with soft soles and poor arch support.

What are the signs of plantar fasciitis?

The most common signs and symptoms are; heel pain with taking the first steps in the morning or after prolonged periods of not putting weight through the foot; tenderness at the bottom of the heel when pressed; limited or reduced movement at the ankle; increased pain when walking barefoot or on hard surfaces.

How is plantar fasciitis treated?

Plantar fasciitis can be disabling when it isn’t managed properly. Physical therapy management can involve several different treatments. Physiotherapy is important in the diagnosis and management of plantar fasciitis. An accurate diagnosis is necessary to ensure a successful outcome. Treatment is largely dependent on what is found during your assessment, however, a combined approach is normally taken. The most common treatments are rehabilitation programs that include strength training as well as stretching, taping, and sometimes night splints. Surgery or anti-inflammatory injections are sometimes considered in some individuals if conservative treatment has been exhausted.

Eliana Viali is a physiotherapist and can be contacted at [email protected] for further inquiries.