How To Treat Plantar Fasciitis Downtown Toronto Podiatrist

What Is Plantar Fasciitis? 

Plantar fasciitis is known as plantar fasciosis to our podiatrist and chiropodist in our Downtown Toronto location. This is where collagen in the tissue is in a degenerative condition. Literature shows that this condition is actually not inflammation, but more so erratic cellular tissue activity which attracts water into the tissues.

How Does This Happen?

Abnormal stresses placed on the tissue can cause injury. What causes the stress?  Think of our tissues as a scale where on one side of the scale is the amount of overall stress we put on our feet each day ( walking, running, standing etc),  where the other side of the scale is the capacity in which our body can tolerate what we are doing. When our scale gets out of balance, that’s when injuries can happen.

Phases of Treatment

It’s important to note that the average time span someone can deal with his injury is six months to a year. So it is not going to go away right away, which is why it’s important to follow a structured rehab protocol with regular check-in’s in order to progress your rehab forward. Interventions for treatment can vary depending on the phase of injury. For instance, our chiropodist at our Downtown Toronto Location, Laura Desjardins, would not prescribe plyometric work at the initial stage of an injury. However, that is excellent for the final stages of returning to running.

Initial Treatment Phases 

In initial stage,  it’s all about reducing pain so that’s offering protection to the tissues as well as reducing how much time is spent on the feet, and sometimes the use of anti-inflammatory medications, when not contraindicated.

In the initial phase of injury, it’s important to immediately address the factor called, “load”,  which is placing an excessive amount of stress on the tissue.

  • It is wise to reduce how walking is done in a day.

  • Opting to sit when prepping food/ preparing meals

  • No bare feet in the house when injured

  • Taping, orthotics and inserts to protect the injured tissue while weight bearing.

  •  Non Weight bearing exercises banded hip exercises banded foot intrinsic and ankle strengthening exercises

  • Stretching of the calf muscles.

  • Anti inflammatory medication has been proven to help calm the irregular cellular activity that is happening within the tissue down, thus reducing pain.

This is not a Band-Aid fix, this is in order to alleviate pain in the short term so that your life is less miserable.

Once Sharp and Severe Pain Reduce

After the initial acute pain has subsided, we can then start to emphasize more weight-bearing activities in rehabilitation.

  • Stretching for the Gastrocnemius and Soleus, which are two muscles that are situated in the lower leg at the back of your shin. There has been literature demonstrating that Gastroc-soleus complex tightness is associated with plantar fasciitis. So it makes sense stretching that out can help with symptoms as well as be part of a treatment plan. Long static stretches done regularly are best to give results for this type of exercise.

  • Slowly incorporate entire kinetic chain movements, which means movements that we use on a regular basis. That might be calf raises done in a specific way that doesn’t flare up the plantar fascia.
  • Incorporating movements that encourage good mechanics, as opposed to poor mechanics. Faulty mechanics due to weaknesses is usually the culprit for injuries.
  • Using a rolled up towel under the toes to do a calf raise is a staple plantar fasciitis exercise. This can be done with two feet, progressing to one, then with weight.

  •  Heavy, slow resistance training.

  • Banded ankle and foot strengthening.

  • Extracorporeal Shockwave Therapy

 

Returning to Play/ Sport Specific Needs

If your main exercise entails fast moving movements, then that needs to be incorporated into the rehab program. If someone walks, walking is the extent that has to happen in someone’s rehab program. We cannot just do strength work and expect someone to be able to run, because it’s very important to make those loads that happen in running, similar to those we do in rehab, to prepare the body to withstand these loads. Remember, a sport like running  is three times our bodyweight back onto our feet.

At our clinic in Downtown Toronto, we have a chiropodist, chiropractors, sports medicine doctors, podiatrist and chiropodist that can all help  guide you back to rehabilitation.

What about Orthotics and Supportive Footwear? 

Taping is an excellent temporary measure to help give the injured plantar fascia tissue some help. Taping is short lived and used as an indicator if an orthotic will help provide some pain relief or not.

There has been literature about supportive devices helping with the load placed on the tissues. If you look at an anatomy picture of the plantar fascia band, you will see it is the very bottom layer of your entire body and when it’s injured there’s nothing below it, except skin and fat,  between the plantar fascia band and the ground. This study indicates the manner is which different modalities, including orthotics and how they can help.  https://bjsm.bmj.com/content/early/2023/08/23/bjsports-2022-106403 . 

If we sit around all the time and do not challenge the body with load, it will lose that capacity. Orthotics help to bridge the gap between injury and play. It allows to blunt the stress placed on the injured tissue to allow for other activities and daily life to resume with a reduced stress to the plantar fascia.

What If Pain Persists?

Our philosophy is to always try to do our best with rehabilitation and time. If the body does not respond to conservative measures there are other interventions such as

  • Ultrasound guided injections

These type of treatment are there to increase accuracy of the medication best discussed with our sport medicine doctor to help you with your pain management.

Keep in mind nothing is a magic wand, and even after injection therapy, a  rehabilitation program should subsequently follow.

Here at InStride Partner of LiveActive Sport Medicine, we treat plantar fasciitis and can make custom foot orthotics specific for plantar fasciitis.

 

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