Plantar Fasciitis is a generic catch all physiotherapy phrase for heel pain. In this article we’ll consider all aspects of physiotherapy treatment for plantar fasciitis and our thoughts on the most effective ways to resolve the condition.
We’ll outline all the things we consider, and think you should too, when trying to remedy plantar fasciitis. For those considering coming to see us, so you can make an informed decision about whether this is the right approach for you. For those not it’s intended to provide inspiration and ideas on how you might begin to help yourself.
If you go to your doctor with plantar fasciitis they often say don’t worry about it, it will probably get better in 18 months! This is statistically true. For those who haven’t got 18 months to be hanging around in pain here’s what you need to know.
What Is Plantar Fasciitis Really?
Well it’s foot pain. Vague I know. More specifically it’s on the underside of the foot in your plantar fascia – which is a thickened bit of connective tissue which runs from your heel to your toes. Plantar fasciitis is sometimes referred to as Policeman’s heel. I guess due to policemen being commonly afflicted with the condition. More on why that might be later.
The pain can be anywhere along the plantar fascia. Most commonly the pain is centred in and around the heel bone (calcaneus).
The main symptom is heel pain on walking. Especially first thing in the morning. If we translate plantar fasciitis it means inflammation of the Plantar Fascia. Whilst there can be visible swelling with this condition, this is the exception rather than the rule.
After the inflammation theory it was considered to be a degenerative condition. As soon as we see the word degeneration it just sounds scary. Which is exactly what we want to avoid! See previous article on what is pain? Simply put the more scared we are by something the more painful it will feel to us. Protection = Pain.
So to reduce the threat level and move onto the good stuff let’s just consider plantar fasciitis as a label for pain, or even better, just tension, along the underside of the foot.
What Causes Plantar Fasciitis?
The answer is we simply don’t know. If you look at all the research it simply states the mechanisms are not fully understood. Which would make this a very short article! Thankfully there are some regular patterns we see both clinically and in the research. Let’s look at these now.
- Reduced ankle dorsiflexion – pulling your foot up towards your shin
- Work-related weight-bearing – as in Policeman’s Heel as they stand up a lot
- Middle age – the truth hurts!
- Flat feet
- High Arches
There’s certainly not a lot any of us can do about getting older. If we are overweight it will take time to lose weight and it can be tricky as we know. Work related weight bearing again, we might be able to change some things about our work environment, but wholesale changes might be challenging to implement.
The other three factors appearing in the research are worth considering and we find it useful to do so with our clients. But that’s only the start of the fun…
What Do We Do In Our Physiotherapy Treatments For Plantar Fasciitis
We treat plantar fasciitis, as we do every other condition, as a whole body condition. Of course the plantar fascia is the area that we feel the pain but is all the pain really just the plantar fascia’s fault? Resoundingly no. Consistently we find the plantar fascia is the scape goat. The true cause can be a multitude of things.
This is the way we treat every injury we see at the clinic as a completely new, never been seen before, condition. We feel this is hugely important to get a successful outcome. It will be impossible to write everything we consider for each case of plantar fasciitis. To simplify things let’s just consider the limitation in dorsiflexion. The movement demonstrated here by a calf stretch. We commonly find that if we can improve this movement we can improve your plantar fasciitis symptoms.
When we consider the wider muscle and fascia implications it’s easy to see why the condition is linked with reduced dorsiflexion – from now on we’ll refer to this as calf tension – though I am aware there can be other reasons for limited dorsiflexion. Consider the image below which is our representation of the Anatomy Train’s superficial back line (SBL):
So you can see here that in myofascial terms (that simply means muscle and connective tissue) the plantar fascia is continuous with calf muscles. Hence if either are tight they can limit dorsiflexion. Is the lack of dorsiflexion a cause of plantar fasciitis or an effect? Following the picture up you can see that tension in the hamstrings, back and neck can, and often does, contribute to pain in the plantar fascia. This is the kind of thing we need to consider, treat and find out what is most relevant for the person in front of us.
Traditionally the irritation was thought to be caused by bone spurs which lead to the inflammation. Whilst this can be the case I would say that this is very rare. Indeed in many cases where bone spurs exist, pain levels can be reduced and even removed with biomechanical correction and calming the nervous system. In fact, fearing that you might have a bone spur, will make things worse. Regardless whether you have one or not! The fear of what you might have causes tension which maintains the pain. Protection very rarely helps. Broken legs, fracture vertebrae etc. aside!
How Do I Not Get Plantar Fasciitis?
Namely do not increase the amount of stress on your body too quickly. In a physical sense that means don’t increase your training too quickly. On an emotional level don’t get stressed! Easy to say, more tricky to do. See our previous post on mindfulness for some ideas of how to get a bit closer to enlightenment!
Every emotion has a physical reflection in our body. When we get tense we might go up on our toes whilst sitting, we might cling to the floor with our toes. All affecting the plantar fascia locally and our sensitivity across the whole body.
Other specifics to avoid are walking around barefoot on cold floors (does the coldness shorten the plantar fascia, or increase the sensitivity of the nerve that runs along the bottom of the foot – the tibial nerve?) and choosing good well-fitting shoes, trainers and work boots. It essential that all shoes have enough flexibility at the ankle.
What Not To Do With Plantar Fasciitis
Panic! Don’t fear the worst. Don’t worry about how long it might be around or what it might stop you from doing. That will increase your sensitivity in your body and increase the protection and maintain or worsen the pain.
Don’t stop doing everything for fear of making it worse. Certainly modify what you’re doing and don’t try to just smash through everything. I describe this as the difference between being sensible and cautious. We want to be sensible to give the sensitivity time to calm down whilst the changes we are striving for take effect.
Treatment For Plantar Fasciitis
It’s important to remind ourselves that the prognosis for plantar fasciitis is a good one. This research suggests 90% of cases respond to a combination of interventions such as rest, massage, pain killers, night splints, heel pads, injections, casts, and physiotherapy.
I’d add to that and say I’ve not even heard of anyone who’s needed surgery on their plantar fascia in 18 years of practice.
If you do need an operation this research makes interesting reading. It suggests that post surgery 75% of cases were pain-free or in minimal pain – which is pretty decent as I understand it by surgery standards. But it said that only 20 out of 41 (less than 50%) were totally satisfied post-surgery. Which kind of suggests to me it’s a coin toss!
This is why we always try to sort things out without the need for surgery. Surgery is always the last resort.
Exercises For Plantar Fasciitis
From our perspective addressing the reasons for plantar fasciitis above is the way to go. Here’s a few options for you to try. Please do not stretch to pain with any of these. Always stretch to the point where it just feels nice, rather than painful. And aim to stretch for at least a minute. So long as it remains pain free.
Calf Stretch For Plantar Fasciitis
Hamstring Stretching For Plantar Fasciitis
Glute Stretching For Plantar Fasciitis
Plantar Fasciitis Conclusion
As we’ve said already don’t be put off by the scary sounding name of Plantar Fasciitis. Be assured by the fact that it will go away and trust in that. Modify your behaviour to allow it to calm down but don’t stop doing everything for fear of making it worse. Pain does not mean you’re making it worse.
Get it assessed by a professional. As we’ve mentioned many times it’s a unique condition in every instance. We’ve outlined the kind of process we go through to help our clients. Many cases are quite straightforward to get rid of. That said, some can be tricky, but it’s important to get on the right path sooner rather than later.
If our approach sounds of interest to you then give us a call on 01273 921831 or mail us at: info@BrightonSportsTherapy.co.uk and we’ll do all we can to get those symptoms moving in the right direction as quickly as possible.