Treating plantar fasciitis - one step at a time

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This issue, often referred to as a ‘policeman’s heel’, affects most people at some point. Effective early management can prevent the problem developing into a more painful and chronic issue.

What is it and how does it come about?
The plantar fascia is an incredibly strong ligament running from the heel to the toes on the underside of the foot. Its primary functions are to maintain the arches of the foot and dissipate forces during weightbearing. As a result of repetitive stress, excessive forces and/or bad footwear choices, small tears in the fascia lead to inflammation and eventual thickening.

Symptoms
Sufferers experience pain in the underside of the foot, often at the heel, although it can radiate further forward. The pain can be sharp or have a burning quality to it.

Sufferers report that it is worse when first getting out of bed, as a result of wearing unsupportive footwear, during intense activity and/or following long periods standing.

Normal contributory factors

  • Tight calf muscles – these muscles can affect and stress the plantar fascia via the achilles tendon.

  • High or dropped arches – this can increase stress levels on the area and treatment may require orthotics or a change in footwear.

  • Increased weight – this will place more stress on the plantar fascia.

  • Increased activity levels – some activities involve less jumping, so these will offer an option for placing less stress through the area if needed.

  • Adaption and poor biomechanics – restriction, adaption or overloading of a muscle group or joint can cause changes in the way we walk or hold ourselves, thereby increasing stress to the plantar fascia.

  • Unsupportive footwear.

Self-management/rehabilitation

  • Rolling the underside of the foot – this is an effective technique to stretch the fascia. I like a rolling pin, but you can use a tennis ball, etc. Just roll from the heel into the fleshy underside of the foot. Don’t use too much body weight – it should be a bit uncomfortable, but avoid outright pain.

  • Calf stretching – gently at first. As symptoms improve you can increase the stretch. Additionally, upon waking in the morning try bending your toes back towards you to get a calf stretch – hold for 15 seconds. You can reinforce this stretch with a towel – hold onto each end, place under the foot and use it to bend your foot back towards you. This will decrease stress on the plantar fascia when you take your first steps in the morning.

  • Foam rolling – this is a way of self-massaging and loosening the calf.

  • Decrease activities that stress the plantar fascia – running is the main culprit, but I would advise against jumping in active classes; try some of the classes where bodyweight isn’t a factor instead. Once recovered, ease back into the more active classes as by then you should be doing all the right things.

  • Supportive shoes – always wear supportive shoes, eg supportive running trainers. No flip flops, pumps or high heels. Avoid walking barefoot in the house too, as this can prolong the issue.

  • Ice – as mentioned in the last article, ice helps to decrease inflammation and so can help with the pain and the small tears.

Remember, if you catch the problem and act early, you should save yourself a lot of anguish.

I am always happy to advise on your specific problem and can use a variety techniques to aid recovery – deep tissue massage, myofascial release, joint mobilisation, acupuncture, sport and/or kinesiotaping.