Today our blog will discuss the symptoms, cause and management of a pesky little foot condition named ‘Plantar fasciitis’.
The reasoning behind my crusade against this affliction? Nothing more than a deep-rooted hatred born from a personal experience. Whilst out enjoying a run only this morning, I felt the beginnings of plantar fasciitis manifesting its way back into my life for the THIRD damn time (yes, none of us are safe). Hence my writing this blog.
As a past and now present sufferer, I’m committed to challenge this stubborn and painful ailment so we can all get back to sculpting those summer holiday bods.
What, where, how?
The best way to understand the role of plantar fascia is to picture a long, flat and slightly elastic web-like ligament that runs in a longitudinal direction along the underside of your foot. Essentially, it attaches the heel bone to the base of your toes.
‘An anatomical bow and arrow – Imagine the arch of the foot to be the bow and the fascia to be the bows string’
Here’s the sciency bit; the primary function of the structure is to upkeep and conserve, the naturally existing arch found on the inner side of both of your feet. It helps to do so by undergoing tension and providing elastic recoil in order to help to dissipate forces during weight bearing activities e.g. walking, running, jumping or dancing. In other words, it’s an important bit of kit that we put through Hell and back every day of our lives.
As is the case with many musculo-skeletal conditions, problems – like inflammation – often arise when an area of the body is over-used, over-burdened, and thus unable to cope with the demands placed upon it… but I’ll explain the reasons for that a little later.
“Matt, it feels like someone’s stabbed me in the F%@£#!G foot”
Diagnosing plantar fasciitis is simple, mainly because it presents in such a very similar manner each time – making it a relatively easy job for me. Sufferers typically experience a sharp pain at the base of their heel which may radiate along the inner sole of the foot.
My patients often tell me it feels worst during the first few steps in the morning or after a long period of rest. The symptoms settle shortly after moderate activity due to relaxation of contacted tissues but may return with vengeance if subjected to excessive periods of load bearing.
The severity of symptoms can be vast, ranging from portrayals of “a pebble in my shoe” to “walking on hot broken glass” – Ouchhh.
The pain is usually worse during:
- The first few steps in the morning
- Intense activity – running, dancing, jumping etc.
- When wearing unsupportive footwear – bare feet, flip-flops, pumps
- Climbing stairs
- When applying pressure to the sole of the foot
- After standing for long periods.
Why does it happen and who’s at risk?
Now, in order to avoid boring you to death with conflicting evidence and mounds of literature debating the exact cause of plantar fasciitis, I’ll keep it short and sweet – The structure becomes overloaded due to repetitive stress and excessive forces such as running, jumping and most things energetic, eventually causing a mechanical failure as the underside of the foot is unable to cope with the demands applied… micro-tears occur along the band of tissue and so, inflammation, thickening and degeneration occur.
Taking this into consideration, it’s no surprise that plantar fasciitis is one of the most common running injuries seen in athletes across the world; however, this does not mean that the slightly less active members of society are without risk.
Below are the main predisposing factors to this condition
Weight gain – yep, sorry guys I know we hate to hear it, but holding that extra weight is only increasing the stress on those feet of yours – so lose the gut or deal with the fut.
Poor body biomechanics – to put it simply, certain areas of the body may be working too much, too little or with not enough control so that the fascia is forced to compensate against its natural inclination. This may stem from the foot itself or anywhere up to the hips and core – but that’s my job to figure out.
Activity levels – this is often a case of ‘too much too soon’. Those who are taking up a new exercise, are increasing intensity of training, or simply beginning an occupation that requires standing for undue periods – beware!
High or low arches – too much of either can cause overloading and overuse; sensible shoes or orthotics may be necessary. I can advise you on this if needed
Tight calf muscles – considered to be on the most common causes, the attachment of the Achilles tendon can exert greater stresses upon the fascia
Pregnancy – swelling and weight gain associated with pregnancy can cause the tissue to relax, leading to mechanical problems and inflammation
Arthritic conditions – some types of arthritis can cause inflammation in the tissue, which may lead to plantar fasciitis
Diabetes and hypothyroidism – possibly due to weight increase, neuropathies, poor circulation and blood sugar levels; certain endocrine conditions are known to hold strong links to foot disorders such as plantar fasciitis.
Now, fortunately for our plantar fasciitis, the 21st century has allowed us to become a relatively lazy bunch of beings and so, contemporary footwear, use of ‘sit down and relax’ transport and gym facilities providing us with the ability to build a sweat without pounding cross country means that whatever your demands, we should be able to give those feet the break they deserve- there is no excuse!
So let’s gets down to it… speedy pain relief and condition management: here are my top tips for settling those symptoms.
Plantar fasciitis night sock – this funky little ensemble is likely to kill the mood quicker than the speed of light, but hey, these night garments can work wonders for morning pain. They help to keep the fascia stretched out and avoid tissues tightening – Give it a go!
Rest – sounds simple enough right? But believe me, despite the pain people will still try to push through and continue aggravating these conditions through sporting activity. Plantar fasciitis is caused by repetitive straining of the tissue; in order for the structure to heal, continuous loading must be halted.
Pain relief and inflammation – ‘BRRRRR is better than AARRRRR’ Pain killers, ice and anti-inflammatory medications/gels can be particularly useful, especially in the acute stages – remember to always discuss any concerns with your pharmacist to avoid medication interactions. As an alternative, or in conjunction with, apply a cold compression such as an ice pack to the base of the foot 3-4 times daily; 10 minutes on x 5 minutes off, and repeat.
Taping – I find that that applying sports and kinesiology tape in very specific fashion can provide support and relieve tension.
Footwear – Sorry ladies, put the Louboutin’s back on the shelf. High heels, pumps, flip-flops and anything not providing a soft supportive sole is going to be trouble – and this includes walking around bare foot! Opt for a comfy pair of running trainers or purchase cushioned heel pad or arch support specific for plantar fasciitis relief.
Ball rolling – Place a tennis ball on the ground and gently roll it under foot for a couple of minutes to help loosen up your plantar fascia. This should make it much less likely to become irritated. You should aim to apply enough pressure on the ball to get a deep massage. You may feel some discomfort, so back off if you feel any pain.
Stretching in bed ‘agggggghhh’ – As I’m sure you’re already aware, mornings are a pain in the… foot. This is primarily due to contraction of muscular tissues as our foot remains in a motionless positon overnight. When we eventually drag ourselves from bed and place our weight onto the foot, the tissues become stretched out and re-aggravated causing a nasty cycle of inflammation and pain.
Keep a towel by the side of the bed use it to help stretch out the fascia by wrapping it around the ball of the feet and pulling into dorsiflexion (back towards you). Do this for 20 seconds x 3 on each side.
Calf muscles – As discussed earlier; the more supple the calf muscles, the happier the foot! In the initial stages use very gentle calf stretches to decrease tension – this should never be strong enough to cause pain! Other options are massage or foam rolling. As the pain becomes less severe, you should be able to increase the intensity of the stretch.
*remember there is a huge association with tight calves and plantar fasciitis, so keeping these muscles loose may be integral to your recovery!
Cardio – For many of us it’s important to stay fit, or possibly just necessary to lose some weight. Try switching your road or treadmill running for ‘off-weight bearing’ activities. Swimming, cycling and even the cross trainer are all great alternatives
When you do finally return to your desired training activity, ease yourself back into it slowly, avoid hard surfaces or hills, give yourself rest days in-between training sessions and for the love of the Foot God… warm up and warm down properly!
What we can do for you
My above tips are great for pain relief and may just be enough to keep you on track without any reoccurrences. However, as stated previously, often these conditions typically arise due to mechanical failures elsewhere in the body, causing the affected structure to have become overworked.
Treating the symptoms alone could be compared to driving a car with a slow puncture – you can keep filling that tyre with air, but until the puncture is repaired, the tyre will continue to deflate – it’s our job as healthcare practitioners to deal with that puncture.
This may be as simple as advice on running technique, orthotic use and footwear or it may simply require you to re-train, strengthen or stretch a particular group of muscles to correct the imbalance. Wherever the primary issue has arisen, your osteopath should be able to perform tests and examinations to narrow it down and provide you with suitable rehab programme to keep those niggles at bay!
- Joint mobilisation
- Deep tissue massage
- Myofascial release
- Sports taping
…and general advice tailored specifically to you.
Contact us to find out how we could help you!
Good luck, The Osteo Practice