Planter Heel Pain – Plantar Fasciitis

What Is PHP?

Plantar heel pain (PHP), commonly known as Plantar Fasciitis, refers to pain beneath the heel that is typically worse with weight-bearing activities. It is commonly characterized by pain on the first few steps in the morning, tenderness on the inside of the heel bone and increased pain walking barefoot on hard surfaces. The plantar fascia is thought to be the main source of this pain.

Why Is Treatment Important?

Planter heel pain affects up to 10% of populations and predominantly affects sedentary middle-aged and older adults. It is estimated to account for 8.0% of all injuries related to running. It is the most common foot condition treated in physiotherapy clinics.

How Do We Treat PHP?

A recent best practice guide¹ suggests treatment for people with PHP should include stretching, taping, and individualized education. Patients may also benefit from shockwave therapy, followed by custom foot orthotics.

How Can Physiotherapy Help?

Your Physiotherapists can diagnose your heel pain as well as identify the risk factors which can trigger plantar heel pain. They can help you through the management of this condition with individualized treatment such as stretching, manual therapy, taping, and modalities (ultrasound, electrical stimulation or shockwave therapy). At Sun City Physiotherapy, we use an evidence based practice to treat your Plantar heel pain and get you back to pain free movement!

¹Morrissey, D., Cotchett, M., J’Bari, A. S., Prior, T., Griffiths, I. B., Rathleff, M. S., … & Barton, C. J. (2021). Management of plantar heel pain: a best practice guide informed by a systematic review, expert clinical reasoning and patient values. British Journal of Sports Medicine, 55(19), 1106-1118.

← Previous Article

Sun City Physiotherapy Locations

Full recovery after an ankle sprain.

Foot and Ankle

Full recovery after an ankle sprain.

It was a crisp autumn day when Sue decided to go for a hike. All of a sudden she caught her foot on the unstable ground and rolled her ankle. Her ankle was sore, swollen, tender to the touch and she felt unstable while walking on it. Eventually, after a couple weeks of rest, ice, elevation and gentle movement she was again able to resume most of her usual activities of daily living. She thought she would rest over the winter and be ready to get back to hiking in the spring.

Fast forward to spring. The snow is melting, the birds are chirping and Sue is getting ready to once again get back to hiking and soccer. This time though, she observes some odd changes. Sue notices that her ankle still feels weak and she is worried about slipping when she goes out for her long hikes. She decides not to play soccer in the spring out the fear that running on the field with opponents may result in rolling her ankle again. She even feels unstable while standing on one foot and very stiff in her ankle when having to kneel or squat.

Sue is a classic example of someone who has recovered well from the acute symptoms of an ankle sprain but has not done the proper rehabilitation to recover fully from the injury. Ongoing symptoms of stiffness, weakness and poor balance are common. If someone has been limping or using crutches for a period of time after the initial injury, general weakness in that leg is also quite common. Due to the residual ankle weakness and reduced balance, there may be an increased risk of rolling the ankle again with return to sports and activities.

A physiotherapist can help get you on track for a full recovery. During an initial assessment, a physiotherapist will ask you questions about your specific injury and assess your mobility, strength and balance. Based on the findings of the assessment and your specific goals, your physiotherapist can come up with a personalized home exercise program for you. Manual therapy, which involves hands on techniques, is also used to treat stiffness and reduced range of motion. Following a physiotherapy treatment program most people are able to safely and confidently return to their regular sports and activities.

← Previous Article Next Article →

ACL Rehabilitation

Foot and Ankle

There are four main ligaments that provide stability of the knee joint – the medial and lateral collateral ligaments on either side of the knee, and criss-crossing deep inside the joint are the posterior and anterior cruciate ligaments. The anterior cruciate ligament (ACL) is a thick ligament that attaches from the lower surface of the femur (thigh bone) onto the upper surface of the tibia (shin bone) in a way that will resist the tibia from slipping too far forward or rotating too far inwards on the femur. If – as can happen during sports that involve twisting, jumping, or pivoting – the knee twists too far with a lot of force, then part of all of the ACL can be torn.

ACL injuries are one of the most common knee injuries and they are managed in different ways depending on the severity of the injury and the age and activity level of the person.

Non-operative management consists of physiotherapy treatment with focus on reducing the inflammation and working through a strengthening protocol in order for the muscles around the knee to support the knee joint as much as possible. In these cases the surrounding muscle support is crucial as the knee will be lacking some stability if the ACL hasn’t been repaired. A knee brace may also be useful to provide extra support once the person is taking on more activity at the end of the rehab and beyond.

In many cases surgery will be required. The repair is normally made with a graft taken from the persons own hamstring or patellar tendon. Once the surgery is done, the rehab begins immediately. Whereas in the past the knee might have been put in a cast and rested, current protocols involve early weight bearing and range of motion exercises. It is very important to regain the knee range of motion early on otherwise it can be hard to progress and achieve goals further down the line.

A strengthening program, developed by your physiotherapist, will be started post operatively in order to begin to regain some of the knee strength and stability. The strengthening program for ACL reconstruction rehab is quite specific because the exercises need to strengthen all of the important muscles without placing too much stress on the healing ACL graft. A gradual progression of strengthening is done, beginning with simple light exercises and building up until eventually more complex exercises that are specific to your sport can be achieved.

By the end of the rehab the goal is to have sufficient strength in the muscles and ACL graft to give the knee the functional stability it needs to cope with the demands placed on it during activity. A return to sport is typically achieved in around 9-12 months following surgery.

Knee Osteoarthritis

Foot and Ankle

Knee Osteoarthritis

You wake up, the sun is shining, you climb out of bed and realize that your knee feels stiff. Again. After about ten minutes the stiffness eases and you head out for your morning walk. You notice that you can’t walk as fast as you could a couple months ago, and you have started shortening your walking distance due to the pain in your knee. Over the last month you have also noticed weakness in the muscles around the knee, reduced balance and grinding in the knee joint with movement.

Does any of that sound familiar? If so, you may have knee osteoarthritis. Osteoarthritis is a common degenerative condition that often involves the spine, hip and knee joints. When the articular cartilage between two bones breaks down, the underlying bone becomes exposed, which can be painful. An x-ray of the knee can help confirm the diagnosis of osteoarthritis, although symptoms do not always correlate with the degree of degenerative change seen on x-ray.

While it is usually not possible to identify the exact cause of this condition, factors which increase the risk of osteoarthritis include increasing age, a family history of osteoarthritis, obesity, a previous injury that has caused trauma to the joint and a sport or occupation that has involved repetitive stress on the knee joint over an extended period of time.

There are a wide range of physiotherapy treatments that can be quite effective at alleviating pain, reducing stiffness and improving range of motion, flexibility, muscle strength, balance and overall function. These treatments may include education, manual therapy, exercise prescription, modalities and use of a gait aid, such as a cane.

Exercise can be quite beneficial to help reduce symptoms and improve function. Consider your physiotherapist your exercise expert who can put together a home exercise program for you which includes specific exercises for range of motion, stretching, strengthening, aerobic exercise and balance training. As well, swimming and/or cycling are often well tolerated and help improve aerobic conditioning, joint lubrication and can help with weight management.

Manual therapy involves different hands on techniques performed by your physiotherapist which can help reduce stiffness and improve range of motion. We will often measure knee range of motion before and after treatment and between physiotherapy visits to determine how effective the treatment is for you. Modalities, which include heat, cold, electrical stimulation, ultrasound and acupuncture may also help to reduce symptoms. Ultimately, our goal is to reduce pain and improve function and the treatment you choose will depend on your goals, the severity of your symptoms and your current level of function.

← Previous Article Next Article →

Sun City Physiotherapy Locations

A Pain in the Achilles

Foot and Ankle

Physiotherapy » Category: "Foot and Ankle"

A Pain in the Achilles

The Achilles tendon is the strongest tendon in the body, connecting the calf muscles to their insertion on the heel bone, or calcaneus. Achilles tendinitis is a common overuse injury in sport. It can be a killjoy – it affects walking, hiking and many sporting activities.

Pain in the rearfoot can arise from several sources – the most common site is in the mid-portion of the tendon, or at its insertion point at the heel. Classically, the tendon becomes thickened, stiff and very tender to touch. Other conditions that can cause pain in this region are bursitis, and rarely – a neuroma in the nerve that runs along the inside of the tendon.
The term “Achilles tendinitis” is somewhat misleading, “itis” meaning inflammation. Often, the tendon’s cellular make-up is degraded, and the more accurate term would be “tendonosis”, or “tendinopathy”. This is why anti-inflammatory medications often don’t work – as the underlying problem may not be inflammation.

There are several factors that predispose to Achilles tendinopathy: years of running (runners have a 30 times greater risk of tendinopathy), a recent change or poor choice of footwear, excessive calf tightness or calf weakness, and most commonly – a sudden increase in activity, such as speed, distance or volume of uphill running. Non-runners can develop Achilles pain – some have feet that pronate excessively. In over-pronators, a whipping motion of the heel is created which produces strain in the mid-portion of the Achilles tendon.

Your physiotherapist can provide several different treatment options for Achilles tendinopathy. These vary according to the location of the lesion and whether the condition is acute or chronic. A physiotherapy assessment is helpful to identify whether there are biomechanical factors that have contributed to the problem. It is important to rule out a partial tear – which may require a diagnostic ultrasound to determine.

An eccentric heel drop program works very well with chronic tendinopathy in the mid-third of the Achilles tendon. This is a graded exercise protocol. The heel is lowered over the edge of a step repeatedly, one set with the knee flexed, another with the knee straight. The volume of repetitions and speed are increased over time, generally 6-8 weeks.

Therapeutic ultrasound, and friction massage, performed by your physiotherapist, can help. Both provide an increase in the volume of collagen, an important component of tendon tissue. If tight areas in the calf muscles are found, massage, acupuncture and soft tissue release can help. Other issues in the rearfoot, such as a stiff subtalar joint (just above the heel) can be mobilized to help improve shock absorption. In some cases, a temporary slight heel lift can provide short-term relief. Kinesiotape, a one-way stretch tape applied along the tendon and margins of the calf muscle often provides immediate reduction in pain as the tendon is repairing. Relative rest and a change in training patterns for runners is critical in many cases to allow the cells in the tendon to repair and regenerate.

In cases where the tendon problems don’t respond to conservative therapy, there are other medical options available.

← Previous Article Next Article →

Sun City Physiotherapy Locations

Jumper’s Knee

Foot and Ankle

Jumper’s Knee

Patellar tendonitis, commonly referred to as ‘Jumper’s Knee’, is a breakdown of the soft-tissue structure connecting the knee cap (patella) to the shin bone. We see this condition quite frequently in the clinic, and it tends to affect people participating in any activity involving repetitive squatting movements, or repeated jumping. This would include volleyball and basketball players, gardeners, and runners just to name a few.

Excessive physical stress can cause micro-tears in the fibers comprising a tendon. The body recognizes this and sends inflammation to the tendon to start the healing process. Special cells start to lay down new tissue (a form of scar tissue) and clean up damaged tissue. Pain, swelling, redness, heat, and loss of function are common signs associated with this inflammatory process. When inflammation occurs in the tendon connecting the knee cap to the shin bone, we call it patellar tendonitis. Your physiotherapist can help you rehabilitate from this injury in many ways.

In the early phases (acute phase) of injury the inflammation in the tendon needs to be resolved. Icing the injured tendon for 10 minutes at a time several times a day will help this process in the first few days of aggravation. The proper use of a patellar strap can also help in decreasing the inflammation. A patellar strap is a piece of neoprene or tubing that is attached just below the knee cap directly on the patellar tendon. It helps to decrease or redirect the forces traveling through the tendon, therefore limiting the amount of inflammation created during the day. Also, your physiotherapist may use modalities in the clinic such as ultrasound, cold laser, and interferential current that may help to speed up removal of the inflammation.

After about 5-7 days, the tissue enters a new phase of healing called the sub-acute phase. New tissue starts getting laid down. This new tissue your body has put down on the injured tendon needs to be re-modeled so it is aligned along the lines of stress and has appropriate length. This can be accomplished with a physiotherapy technique called deep transverse friction massage along with appropriate stretching exercises for the quadriceps muscle group in the front of your thigh.

Along side tissue remodeling and stretching, the new tissue also needs to be strengthened in a controlled environment. Drop squats are exercise of choice for these types of tendonitis. This involves a progressive squatting program of speed and load. Parameters provided by your physiotherapist are vital for success.

Other strategies your physiotherapist may employ include analyzing the alignment of your whole lower extremity, and screening the biomechanics of surrounding joints (hip and ankle), muscles and ligaments. There are often secondary instigators of patellar tendonitis such as excessively tight quadriceps muscles that increase the potential for the patellar tendon to break down, or poor arch control in the foot that can increase the angle of force through the knee and respective patellar tendon. Your physiotherapist may also revise factors such as your training progression, or modify the way you perform certain activities such as squatting in the garden.

Depending on the severity of the patellar tendonitis, in about 4-6 weeks you’ll be jumping for joy and back doing the activities you love once again.

A Pain in the Achilles →

Sun City Physiotherapy Locations

Kevin Bos, B.Sc.PT, FCAMPT, Dip Manips, Sports Cert, CGIMS

Kevin Bos is a co-owner of Sun City Physiotherapy and has been working as a physiotherapist for over 17 yrs. He graduated from the University of British Columbia in 1996 with a Bachelors of Science in Physical Therapy and worked for several years in the Fraser Valley before moving to the Okanagan.

suncityphysiotherapy.com/our-team/the-downtown-kelowna-team/kevin-bos/

Planter Heel Pain – Plantar Fasciitis

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006

Full recovery after an ankle sprain.

Knee Osteoarthritis

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006

A Pain in the Achilles

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006

Jumper’s Knee

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006

Sun City Physiotherapy Locations

Phone: 250-861-8056

Phone: 250-762-6313

Phone: 250-766-2544

Phone: 778-699-2006