Plantar Fasciitis and Heel Pain in Soccer Players
Introduction
Plantar fasciitis is a condition causing heel pain. It affects players of all ages and when it becomes chronic it can be very debilitating even prevent you from playing soccer .
Learn how this condition develops and more important how to treat it.
What is Plantar Fasciitis (The Correct name is Fasciopathy)?
Plantar Fasciopathy is a condition causing heel pain. Supporting the arch, the plantar fascia, a thick band of tissue connecting the heel to the ball of the foot, can become inflamed or can tear.
The condition develops when repeated weight-bearing activities put a strain on the plantar fascia.
Plantar Fasciopathy is a degenerative Process characterized by Collagen Breakdown, nerve and vascular ingrowth.
In late stages of the condition it can progress to Calcifications .
The correct term for this condition should be Fasciopathy instead of Fasciitis since there is no real inflammatory process involved. As with the Achilles Tendinopathy, there are structural changes in the Fascia as a result of collagen breakdown that cause pain rather that inflammation.
Incidence and Causes of Plantar Fasciopathy
Incidence
Plantar fasciitis occurs most frequently in people in their 40s but can occur in all age groups.
The condition can develop in athletes who run a great deal and in non-athletes who are on their feet most of the day, such as police officers, cashiers, or restaurant workers.
Plantar Fasciopathy is a common foot condition. It occurs in as many as 2 million Americans per year and 10% of the population over their lifetimes.
Plantar Fasciopathy affects people of all ages, both athletes and non-athletes. Men and women have an equal chance of developing the condition.
Causes of Plantar Fasciopathy
Factors that contribute to the development of plantar Fasciopathy include:
Age (over 40 years)
Rapid increases in length or levels of activity, such as beginning a new soccer season or preseason program
Decreased calf muscle flexibility
Reduced ankle dorsiflexion in combination with reduced Great Toe Extension.
Reduced Toe flexor and evertor strength and decreased Hamstring Flexibility ( Sullivan et al 2015)
Increased body weight (Body Mass Index greater than 30)
Tendency to have a flat foot (pronation)
Plantar Fasciopathy highly related to Tightness in Calf muscles ?
In the picture above you can appreciate how the ankle and the great toe work together to push the body forward when walking or running . You can also see how a normal combined movement between Ankle Dorsiflexion and Great toe Extension are necessary to avoid excessive tension in the fascia. Any restrictions in these joints or their surrounding muscles will create excessive loading in the fascia creating the Fasciopathy if the movement is not restored.
Signs and Symptoms
People with plantar fasciitis may experience pain:
In the morning, when stepping out of bed and taking the first steps of the day
With prolonged standing
When standing up after sitting for awhile
After an intense weight-bearing activity such as running
When climbing stairs
When walking barefoot or in shoes with poor support
As your body warms up, your pain may actually decrease during the day but then worsen again toward the end of the day because of extended walking. Severe symptoms may cause you to limp.
How Physical Therapy can help ?
First of all, Plantar fasciopathy should ruled-in and other conditions like fat pad irritation, stress fractures, nerve entrapment or arthropathies should be ruled-out .
Once you are diagnosed with plantar fasciitis, your physical therapist will work with you to develop a program to decrease your symptoms that may include:
Improve the flexibility of your ankle and the plantar fascia
Use of a night splint to maintain correct ankle and toe positions
Selection of supportive footwear and/or shoe inserts that minimize foot pronation and reduce stress to the plantar fascia
Iontophoresis (a gentle way to deliver medication through the skin)
Taping of the foot to provide short-term relief
Increase Plantar Flexor capacity
Increase Great Toe mobility and Range of movement
Increase strength and flexibility of the Lower Extremity as a whole.
Research shows that most cases of plantar fasciitis improve over time with these conservative treatments, and surgery is rarely required.
Plantar Fasciopathy is a self-limiting condition of variable duration
With treatment symptoms usually improved in 3-6 months (some cases up to 9 months)
Stages of Rehabilitation
Pain Dominant Phase
Plantar Fascia becomes sensitive to load. Pain and stiffness when stepping out of bed and taking the first steps of the day. Pain with activities like walking long distance or prolonged standing. This phase can last 2-8 weeks.
Interventions
Control pain by reducing or modifying aggravating Activities: load management , reduce running distance or frequency of games played. For example if you are playing soccer 2 o 3 times a week this is the time where you only play once a week to allow time to recover from game to game.
Improve the flexibility of your ankle and the plantar fascia: mobility work for ankle and foot with emphasis on reducing tightness in calf and posterior chain.
Increase Plantar Flexor capacity: mainly Isometric strengthening progressing to light Isotonic strengthening as tolerate.
Increase Great Toe mobility and Range of movement: big emphasis on Improving Great toe extension to help with shock absorption and power generation in the stride.
Increase strength and flexibility of the Lower Extremity as a whole: quadriceps and Gluteal muscles assist with load absorption during the run so by strengthening these muscles group we help unloading the fascia.
Bicycle is a good option to maintain some aerobic capacity while allowing the fascia to heal . Players should avoid running or walking long distance during this phase.
Plantar Fascia Mobilization - Stretch
In sitting with the foot resting on your opposite knee, bend the ankle and big toe up holding for 10 -15 seconds and repeat 10 times
Ankle Strengthening
Turn the ankle out against the band and then in . 8-12 reps to each side
Isometric Toe Flexion
Push the big toe down as hard as possible and tolerated, Hold the contraction for 3-5 seconds . Repeat 5-10 times each foot.
Also in the Pain Dominant Phase we must address any excessive foot deviation by using over-the-counter orthotics or Taping for short-term pain management. If these help it may grant the investment in custom-made orthotics down the road.
Load Dominant Stage
We can move to the next phase once the Pain at 1st step in the morning improves and increases walking tolerance. Symptoms remain stable unless the fascia is overloaded ( runs or games) .
Interventions:
Increase Plantar Flexor capacity: progressing from Isotonics to Eccentric movements of the calf
Interval training to increase load capacity to develop calf endurance and Power : plyometrics.
Some exercises we like to use during this phase are shown below which are intended to create ankle Dorsiflexion and Great toe extension and at the same time mobility and strengthening of the plantar fascia and calf-ankle-foot- Toe complex muscles
Great Toe sliders
Great Toes - Plantar Fascia Strengthening - Push off
Double leg Heel raise with towel
Once the patient can do the above exercises and pain remains at a minimum or has disappeared we start thinking and the Return to Play Strategy: start with light jogging, increasing time and distance as tolerated and with no irritation (or minimal irritation). Then from there to sprinting , cutting and jumping. This stage must be guided by a Physical Therapist to assure a safe return to Play .
Conclusion
Plantar Fasciopathy and heel pain affect a large population of soccer players
Conventional physical or chiropractic treatment usually fails to address all the possible causes of this condition
Improve and restore plantar fascia length and Plantar Flexion Capacity with emphasis on Great Toe strength are the main goals of the treatment.
Our comprehensive approach is backed-up by the most recent research. Once you resolve the root of the problem the Plantar Fascia becomes pain free
Education and load management are key factors for people with Plantar Fasciopathy
White Bay Sports Physical Therapy is a Sports-Injury clinic that specializes in Plantar Fasciitis treatment .
Lionel Pannunzio is a Physical Therapist Certified in Sports Injuries. With more than 20 years of experience helping athletes return to their sports after an injury. He is the Owner of White Bay Sports Physical Therapy and Fitness, conveniently located in the beautiful City of Weston, where he treats Soccer Players and Athletes of all ages
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