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Let’s Talk ‘Plantar Fasciitis’
I’ve treated a number of clients who have Plantar Fascia, or have advancing signs of this condition. In my initial encounters I was sceptical on how effective my treatments would be on this ‘notoriously’ hard-to-treat condition. To my initial surprise, and joy of my clients, the treatments and follow-on advice has been very effective and produced great results.
This article covers some background to this common condition, including the type of treatment that can be used and some of useful tips for self help.
Plantar Fasciitis, or sometimes called Plantar Aponeurosis, is a thick fibrous band of connective tissue originating on the bottom surface of the Calcaneus (heel bone) and extending along the sole of the foot and blends with the ligaments attached to the toes. Plantar Fasciitis is irritation and swelling of this thick tissue on the bottom of the foot manifesting as pain surrounding its insertion at the Calcaneal Tubercle (heel).
This band of tissue acts like a rubber band to create tension which maintains the arch of the foot. If the band is long it allows the arch of the foot to be low, (commonly known as flat footed). A short band of tissue causes a high arch. Tenderness at the heel usually is apparent on palpation and is increased with passive Dorsi-Flexion of the toes. When the fascia is overstretched or overused, it can become inflamed. When the fascia is inflamed, it can be painful and make walking more difficult. Treatment is often painful so good communication with the client is essential during treatment to ensure tolerable pressure.
The Plantar Fascia is designed to absorb the high stresses and strains we place on our feet. But, sometimes, overuse, too much pressure damages or tears the tissues. The body’s natural response to injury is inflammation, which results in the heel pain and stiffness of the plantar fasciitis. This condition is one of the most common conditions affecting the foot.
Plantar Fasciitis is commonly thought of as being responsible for the creation of a ‘Heel Spur’ (a small bony calcification), but this is not the case as heel spurs are seen in people with and without Plantar Fasciitis.
Risk Factor & Possible Causes
Risk factors for Plantar Fasciitis include:
- Foot arch problems (both flat feet and high arches)
- Obesity or sudden weight gain
- Overuse, repetitive impact activity eg from long-distance running, especially running downhill
- Tight Achilles Tendon
- Shoes with poor arch support or soft soles
- Walking gait – I have found some Forces personnel are more susceptible to this condition due to their gait.
Pain and tenderness in the bottom of the heel, usually worse in the mornings but usually improves throughout the day and improves with rest. Pain normally gets worse when Dorsi-Flexion of the foot or pressure on the plantar fascia. The pain improves when toes are flexed down.
Treatment varies and no particular treatment has been demonstrated to be superior. The condition has been known to last from several months to 2 years with treatment before symptoms improve. Over 90% of patients will be cured by non-operative treatment and surgical treatment is only considered in only a small subset of patients with severe symptoms.
Treatment (non surgical) usually consists of :
- Massage of lower leg and foot – I use various advanced massage techniques as well as hot and cold stones and sound waves.
- Anti-inflammatory drugs
- Stretching exercises and maintaining good flexibility around the ankle, particularly the Achilles tendon and calf muscles
- Rest and best to stop any activities where your feet pound on hard surfaces
- Wearing an orthotic (i.e. foot support), device. I recommend trying an off-the-shelf orthotic before considering a customised one.
- Wearing good quality and properly fitting shoes that are supportive – no flip-flops!
- I have found that taping has some short-term relief
- Cortisone injections – a type of steroid and powerful anti-inflammatory drug injected into the Plantar Fascia to reduce inflammation and pain
- Pain with the first steps of the day can be reduced by stretching the Plantar Fascia and Achilles Tendon before getting out of bed. Night splints can be used to keep the foot in a dorsi-flexed position (5o) during sleep to improve calf muscle flexibility and decrease pain on waking.
- Most of my clients have also found SCENAR treatment to be very effective, which reduces the pain level greatly before manual treatment, and speeds up the recovery process.
- See a specialist early for help before the condition sets in, who can give you detailed advice and treat you as necessary.
- Make sure you self-stretch the Plantar Fascia.
Eg. This stretch is performed in the seated position. Cross your affected foot over the knee of your other leg. Grasp the toes of your painful foot and slowly pull them toward you in a controlled fashion. Place your other hand along the plantar fascia. The fascia should feel like a tight band along the bottom of your foot when stretched. Hold the stretch for 10 seconds. Repeat it 20 times. This exercise is best done in the morning before standing or walking.
- Use a tumble dryer ball or frozen plastic shaped coke bottle – stand on it and roll it around.
Plantar Fasciitis is a fairly common condition that is painful and does affect people lives. If you have any symptoms make sure you get them checked early as this is not an easy condition to treat with good short term results. Good directed self-treatment is also very important.
Recently, I had a client come to me who been diagnosed by their Doctor. Their GP told them they had Plantar Fasciitis. They ask me to have a look and I found it was not the case, but in fact it was the Fibularis/Peroneus muscles that have been the cause of their problem, which is much more easily treated.
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