Plantar Fasciitis

Plantar fasciitis is something I’ve seen lots of patients with, and have had symptoms of myself as well, so can fully sympathise! Over the years I’ve picked up on the best things that help and advice for patients to take away to help themselves, so I thought I’d share this with you.

What is it?

The strong band of fibrous tissue on the bottom of the foot from the heel to the bases of the toes is called the ‘plantar fascia’, it acts as a shock absorber and arch support and literally gives you a spring in your step! It helps propel you forward and soften your landing while active on your feet and takes quite a beating in its day to day life, generally unscathed as this is its job after all, but for a few of us, we get this horrid, burning sharp debilitating pain on weight bearing and walking which can take time to heal. The ‘it is’ in this condition just means ‘inflammation’ of this area.

Think of the ‘stretch’ and strain this ‘band’ of tissue undergoes when we ‘overstress’ it. The body adapts and copes with as much as it can, but sometimes things get a bit much, of over stressors can be: chronic or sudden weight gain or forces with carrying loads(extra pressure on the feet), increased running or going back to running after a break, spending a long time standing, pregnancy, increased physical or mental stress, increased walking, uphill walking, can slowly bring on symptoms of strain under the foot. These things alone don’t normally cause the symptoms, there’s normally a combination of factors that have contributed over time.

What can be done?

Traditionally I would have looked at the bio-mechanics of the foot- springiness, compliance under pressure, movement to absorb shock etc, and up into the limb to check positioning on the ground etc, which is still relevant in some cases, and we can advise and help with treatment here, though these things aren’t always relevant, there’s more to the picture we’ll gain from a full case history to recognise the triggers. When looking more locally at the strain itself of the plantar facia – it needs short term ‘protecting’ and guarding, with slow exposure to exercise again as you would treat any strain or sprain.

There is generally an inflammatory reaction with plantar fasciitis, which chemicals in the area get to working on the fascia to ‘repair’ it- although these chemicals are doing a good job, it makes it painful for us as they irritate the nervous system and any stretch or pressure first thing in the morning for example where this chemical has build up at rest, will be especially painful. So before putting your feet on the ground after sleep or long sitting or standing, where possible, manipulate the feet, massage the soles to ‘prep’ them and push away some of the inflammation that’s build up, likewise putting a cold compress on for 10-20 minutes at a time can ebb away some of this inflammation for a temporary period making things more comfortable on weight bearing and walking, you can try combining massage with cold by putting a bottle of water in the freezer and with it placed on the floor rolling your foot up and down over this frozen water bottle, to cool and massage with a bit of pressure. Massaging the feet and icing them on the soles before bed can also be beneficial.

Depending on how bad this ‘sprain’ is, you may benefit from walking in rigid soled shoes while it’s healing- this stops the foot from having to over stretch on walking which might help you get around with less pain. Some patients also find a gel heel lift inserted into the shoe relieves a little pain as this shortens the Achilles stretch on the heel a touch.

Some patients like to stretch the ‘posterior chain’; so that all the muscles on the backs of the legs, thighs, buttock, and lower and upper back are not contributing overly to tightness that has built up here, as can inadvertently lead to increased tension at the heel. So, while the traditional calf, soleus, hamstring, glutes and back stretches are all nice to do- don’t over stretch – there’s no need! Just gentle pain free stretching daily to aid flexibility and take a little strain off.

When the acute (very painful) phase is coming to an end (this can take days, weeks or even months in some cases, depending on lifestyle and demands placed on your body), then we can discuss slowly starting to load the feet again to build up their resistance to forces and stretch with exercises specific to the planter fascia.