Plantar fasciitis can be a very painful and debilitating condition of the foot, I have had it a few times now. It affects the plantar fascia, which is the fascia on the sole of the foot and pain is experienced where it attaches to the heel, particularly on the inside of the foot.
The term ‘itis’ suggests inflammation, but clinicians’ agree that it is a degeneration, rather than inflammation, of the fascia and therefore it’s a ‘fasciopathy’ most likely due to age-related collagen disrepair. Ultrasound investigations often find the fascia has thickened compared to the non-affected side.
This condition is multifactorial in nature; therefore, its treatment can be as well.
Why is the plantar fascia important?
Not only is it a ‘dynamic shock absorber’ when our foot meets the ground when walking or running, it also acts as a spring when the big toe is extended (see picture) becoming a ridged lever making foot propulsion possible. This is called the ‘Windlass mechanism’ of the foot and if this mechanism is impaired, it can cause problems, especially to the plantar fascia.
Risk factors
- Tight Achilles tendon and calves.
- Reduced ankle mobility (dorsi-flexion) and excessive pronation at the sub-talar ankle joint.
- Reduction in the extension of the big toe joint.
- Runners, particularly those who run excessively, suddenly increase their distances, change their footwear or indeed use poorly cushioned footwear inappropriate for their running gait.
- Jobs that involve a lot of standing, particularly on hard surfaces.
- Being female – We girls have a greater ‘Quadriceps angle’ due to a naturally wider pelvis, this predisposes to greater forces running through the inside of the knee, which causes compensatory internal rotation from the tibia (shin bone), altering the force through the Achilles tendon and ultimately restricting ankle mobility.
- Reduced strength of the hip abductors (weak Gluteus Medius).
- Being overweight.
- High or low arches of the foot.
- An age range of between 40 and 60 years.
Symptoms
- Gradual onset of pain along the heel.
- Soreness on rising in the morning, many people commonly experienced classic ‘first-step’ pain upon waking with relief after a bit of activity. This is because, during sleep, the Achilles tendon and plantar fascia tighten with the foot in a plantar-flexed position.
- The pain is aggravated by daytime activity and will ache in the evening especially after an active day.
- Pain is eased by rest and rubbing of the foot arch.
Other conditions to rule out.
- An acute tear of the plantar fascia.
- Neural pathologies such as Tarsal Tunnel Syndrome, neuroma of the medial calcaneal nerve or lateral plantar nerve entrapment.
- A bruise to the heel fat pad (this separates the heel bone from the plantar fascia).
- A stress fracture of the calcaneus (heel bone).
- Bone spurs on the heel.
How do we treat it?
A thorough examination and assessment of the foot, ankle and hip (yes, the hip can play a part in foot problems!) will allow for identification of any weaknesses or biomechanical problems.
When I see clients with this condition, I would typically target the stiff calf muscles with deep tissue massage and subsequent passive stretching, address restricted ankle mobility (there are a few ways we can achieve this), I like to dry-cup the sole of the foot (I absolutely love this being done to my own feet) and I would lastly kinesio tape the foot and calf (see picture) to offload the muscles and provide some immediate pain relief while the bigger causative factors are identified and addressed.
I always give my clients homework, which generally involves strengthening the weak muscles we have identified and to maintain mobility of the ankle which may be achieved by foam rolling the calves at home.