WHAT IS PLANTAR FASCIITIS?
Plantar fascia is a tough, fibrous band of connective tissue on the underneath (plantar surface) of the foot. This tissue connects the calcaneus (heel) to the front end of the foot.
The role of the plantar fascia is to support the muscles and arch of the foot to prevent flattening of the arch and relay sensory information about the position of the ankle and foot back to the brain.
Inflammation of the plantar fascia (fasciitis) can cause a sharp pain in the arch especially towards the inside of the heel area (see figure above). More recent research has shown that if the inflammatory stage of plantar fasciitis is not resolved it frequently turns into a chronic condition. Evidence shows degenerative changes to the collagen fibres of the fibrous band (Jade et al 2003). Some therapists have termed this chronic plantar heel pain or CPHP.
The pain is often of gradual onset and is worse in the morning or when getting up from sitting. Stretching the foot can be sore and pressing into the heel will not be something you’d want to experience more than once or twice.
WHAT CAUSES PLANTAR FASCIITIS
This condition is quite common in both dancers (jumping) and runners or those who work long periods on their feet however anyone can display signs and symptoms, especially pregnant women or those who are carrying a bit of extra weight.
We as osteopaths would need to question and examine the patient to determine the cause of their symptoms, but many of the following could be contributing factors:
- Tight calf muscles can put extra stress on the plantar fasciitis if there is lack of flexibility in the ankle.
- Repeated stretching of this fibrous band due to overuse ie: sudden increase in running or walking distance and or speed.
- Poor footwear with thin soles or routinely wearying high heels can put pressure through the Achilles’ tendon making it harder to dorsiflex the foot and pull on the plantar fascia.
- The shape of a patient’s foot or weak arches should also be considered as those with high arches and flat feet often have changes in gait that can contribute to their symptoms.
- The gluteus medius (one of the muscles in your backside) is often overlooked when helping diagnose the cause of plantar fasciitis. The gluteus medius is responsible for keeping the pelvis level. If this muscle weakens then a patient will start to lean inwards which would affects a patient’s ability to weight bear through the middle of their foot. Force will then move towards the inside of their foot, changing gait and putting extra pressure on the plantar tissues.
- An acute trauma ie: jumping bare foot onto a sharp stone can also cause inflammation and bruising to the fascia and lead to a more chronic condition if not recognised and treated.
HOW CAN AN OSTEOPATH HELP?
An osteopath will provide a biomechanical approach and focus more on how the plantar fasciitis developed rather that just treating the symptoms. We will look locally at the foot, heel and toes while also looking further away from the symptomatic area, (knee, hip, pelvis or the already mentioned gluteus medius) before deciding what treatment, advice and exercise would be appropriate.
In general, stretching the calf muscles is normally appropriate. Place one foot behind the other while slowly and gently bending the front knee forward to feel the stretch in the calf of the back leg. This stretch can be held for 15 to 30 seconds before reversing the position of your legs.
Easing up or refraining from to running for one or two weeks and trying a non weight bearing activity such as cycling or better still swimming would be beneficial. During the initial acute or inflammatory stage icing the area and taking an anti-inflammatory tablets should reduce the symptoms but once you are out of the acute stage ie; beyond 5-7 days it is thought that applying heat is more effective.
Buying shoes that provide the support your body needs is also recommended by the American Academy of Orthopaedic Surgeons as are appropriate insoles. Most sport shops or running stores offer a treadmill gait analysis to guide you to the correct trainer.
Plantar fascia issues can be temperamental and those that don’t appear to be responding to a conservative treatment protocol, may require more specialist treatment such as shock wave therapy.
If you feel that you may have plantar fasciitis, then it would be wise to see your osteopath for a diagnosis & treatment with exercise prescription and if required referral for further investigations and/or treatment.