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.

Background
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:

Plantar Fasciitis typically affects active men ages 40–70 although I have treated more women with the condition.

Symptoms
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
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 :

Tips for Self Help Summary
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.