Plantar Fasciitis

What is it?

It is a common condition affecting one or both feet causing pain to mainly the heel but also sole of the foot. The plantar fascia is a thick, fibrous connective tissue which is attached to the inside of the heel bone and fans out over the sole of the foot, attaching to each of the toes. Its function is important as it supports the whole foot structure and shock absorbs as much as nearly 3 times your body weight when walking.

What causes PF?

Because of the degree of stress that the plantar fascia is under, it makes it susceptible to micro-tearing. It is thought to be more of an overuse injury where the plantar fascia has become over stretched affecting sports and non-sports people alike. People with flat feet and high arches can be prone to this condition but tight calf muscles can add to the problem as well as weight gain including pregnancy which puts stress on the plantar fascia.

What are the symptoms of PF?

Heel and sometimes sole of foot pain too. Varying degrees of pain can be experienced depending on how stressed the plantar fascia is. The pain is more apparent after a period of inactivity i.e. first thing in the morning because the plantar fascia temporarily shortens but walking around can help ease the pain. Or if on your feet all day – the pain can be worse in the evening.

Client case history of PF

As this is a commonly found problem, I have treated a number of people with PF over the years and gladly with a successful outcome in most cases. Initially I advise the client to rest the foot and elevate it as much as possible but to also wear footwear that has a comfortable foot bed and good arch support if needed.

I take a case history of the client’s lifestyle including exercise regime and note any repetitive activities such as standing for many hours a day. This can often help me advise a self-care regime post treatment. I will also look at the client’s posture from all angles. Sometimes obvious imbalances can account for the problem but PF symptoms are very likely to be affected by an overuse issue from repetitive actions.

Treatment by massage

If the foot is inflamed i.e. hot and slightly swollen, I will not directly treat this area of the foot so as not to worsen the symptoms. Depending on what I find in the case history and postural assessment, I often like to use the following treatment modalities but in no particular order:

  • Hip mobilisation to begin to loosen the hip area as tightness can occur when walking is impeded by the pain of this condition.
  • Working on the calves, Achilles and the soles of the feet (if not inflamed) to start to loosen tightness in the muscles. Use some deeper techniques on adhesions in the muscle. Help loosen the metatarsal toe bones.
  • Soft tissue release which pins the muscle in a shortened position then either passively or ask the client to stretch the muscle to help loosen very tight areas. This can be done on the calves, shin muscles, foot muscles, muscle around the ankle – anywhere necessary.
  • Passively stretch the lower leg muscles and sometimes ask the client to push back against the stretch for a few seconds then I will take the muscle to a further stretch in order to relax the muscle further. This is a muscle energy technique (MET).

These are a few of the techniques I may use to treat this condition. Each treatment can be quite different depending on the results achieved and will differ from client to client. I will also give aftercare advice along the following lines:

  • Icing the foot – I suggest filling a small water bottle with water and freezing then rolling this under the inflamed area of the foot applying minimal pressure for about 10 minutes at a time. It is essential that a sock protects the foot from direct contact with the ice bottle.
  • Stretching the upper and lower calf muscles.
  • Supine ankle mobilisation such as circling the ankles
  • Resting from certain activities that could be aggravating the condition.

Here is a great link to Patient.co.uk for some easy foot pain exercises. Depending on how long the client has suffered with this  condition relates to how quickly their symptoms can be alleviated. A few weekly treatments and following the aftercare advise can show improvement in around 6 weeks. If in doubt of any of your symptoms, seek advise from your GP.