Orthotics and Plantar Fasciitis

Orthotics and Plantar Fasciitis

Have You Heard of Plantar Fasciitis?

If like me you’re of a certain age, let’s say over 30, there’s a good chance that you’ve heard of plantar fasciitis.

At some stage in many people’s lives that ugly term will raise it’s head. 

A very painful debilitating condition which can totally stop you from enjoying so many activities that you love, whether that’s running after the kids or grandkids, running, walking, hiking trails and even sometimes cycling.

So, obviously you’re going to want to know the most effective treatment’s available.

In this post I’m mainly going to discuss one treatment, custom foot orthotics,

To learn more about other forms of treatment for heel pain click here.

In this post I will cover:

  • A brief review of plantar fasciitis,
  • Where do custom orthotics come into the treatment picture,
  • What do orthotics actually do to help you get back to activity
  • A quick review of what else to do

A Brief Review of Plantar Fasciitis

As mentioned I have covered most of this in a previous post, but just a brief recap.

Plantar fasciitis is characterised by the following:

  • sharp pain in the bottom of the heel. Many people will rate it at 9 or 10/10 on the pain scale.
  • pain on getting out of bed or after a rest
  • Usually eases as you “warm up”
  • Can become chronic so that any weight-bearing activity causes severe pain.
A woman holds her sore heel which is shown in red

Can Orthotics Help Plantar Fasciitis?

In a word, yes, they can certainly help.

Every year we see hundreds of patients with plantar fasciitis and we help them to get resolution through several treatment techniques including custom or semi-custom foot orthotics.

The role that orthotics play in the resolution of plantar fasciitis includes:

1. Increasing the surface area of pressure

In many people’s feet the pressure of walking and running is absorbed over a small area, mainly the heel bone (calcaneus) and the forefoot (metatarsal heads). 
By adding in a pair of custom orthotics made from 3D laser scans of your feet, the pressure area is greatly increased, reducing the amount on the heel.

2. Offloading using cushioning and apertures

When there is acute pain in the plantar (bottom surface) of the heels an aperture (basically a hole) in the heel area often filled with a very soft but highly shock absorbing material (poron) can really take the sting out of it.

3. Overcoming pathological forces of the feet and legs.

Often there is what we call a biomechanical (alignment and movement) cause for your plantar fasciitis.
Gone are the days when we used to try to make everyone’s feet look straight, because we now know that everyone’s feet are different and there is no such thing as normal. But sometimes the alignment can cause undue high stress to a tissue such as the plantar fascia causing injury. 
By conducting a full biomechanical assessment including high tech gait assessment with our pressure plate treadmill and high speed camera, we are able to identify these high forces and know exactly how we need to realign the foot, ankle and leg to reduce the forces thereby allowing the soft tissue to heal.

Learn more about how we use technology for better gait assessment here.

4. Improving the Windlass mechanism of the foot. 

There’s one you may not have heard of! The windlass mechanism consists of the big toe and it’s joint to the foot (metatarsal-phalangeal joint) and the plantar fascia.
Flexion of the big toe upwards as we move forwards, tightens the plantar fascia and allows it to prevent collapse of the medial arch of the foot from weight bearing forces. This allows the foot to become a lever from which we can propel ourselves forwards.

Sometimes the big toe joint is restricted or tight and cannot perform the windlass mechanism as efficiently. 
Using foot orthotics we are able to assist the big toe joint so that it is either capable of flexing further, or we “bring the ground up” allowing it to not need as much flexion. 

A diagram of the windlass mechanism showing flexion of the big toe and tightening of the plantar fascia

5. Supporting the medial arch of the foot.

In some cases the arch just needs a bit of help to not collapse under body weight. This can occur in people who are overweight, or also in people with very flexible ligaments.
The foot relies on a certain amount of tension in the ligament between the small bones in the foot (there are 26 bones in each foot!) to help to maintain an arch and not collapse.
In some people the lack of tension in the ligaments or ligamentous laxity, allows gravity and body weight to win and force the arch to collapse.
Collapse of the arch in turn stretches the plantar fascia, and if it is stretched more than it’s capacity, then fibres will break down and eventually an injury to the plantar fascia will occur, usually at the base of the heel.
Orthotics support the medial arch of the feet whilst still providing enough flexion to allow for normal shock absorption and take the stress out of the plantar fascia.

Other Treatments We Regularly Use

Orthotics of course are not the only treatment we use for treating plantar fasciitis, but they are often a very crucial part of our treatment and usually the best way to keep the condition at bay long term.

Some of the other treatments we will use as appropriate are:

  • Footwear advice – this is usually the very first thing we will look at,
  • Shockwave therapy – a very safe and effective way of speeding up your recovery from plantar fasciitis – to learn more click here.
  • cold therapy, reducing the inflammation can give relief of acute symptoms,
  • Strapping – using strapping tape we can support the feet and reduce some of the excessive forces involved,
  • heel raises – believe it or not going a bit higher in the heel will often help, because it reduces the amount of stretch on the plantar fascia,
  • dry needling – using little acupuncture needles we can target trigger points in the small muscles of the feet which often get overworked and become very reactive,
  • physical therapy – massage and trigger point palpation can often reduce tension in the muscles around the feet and ankles,
  • Stretching and strengthening exercises – getting you to do daily stretches and strengthening of the muscles involved around the feet and ankles and legs can help to reduce the tension and stress on the plantar fascia.
Dynamic Podiatry Team

If you need help with plantar fasciitis or any other condition of the feet, ankles, legs, knees,or hips – then call 3351 8878 or book online on th green button below

The Dynamic Podiatry logo orange and navy with a foot in the "D"