Plantar Fasciitis – Limping In The Morning?

What Is It?

Well erm it’s foot pain, vague I know, but that’s the truth. If we translate the Latin it means inflammation of the Plantar Fascia. For those not in the know (and you will be forgiven!) this is the thick band of connective tissue what runs along the whole length of our feet – from the front of your heel down to your toes. So it effectively means inflammation of the something along the bottom of your foot. Given that most cases aren’t inflammatory then this old fashioned description is as much use as chocolate tea pot! For now if we consider the term Plantar Fasciitis a label for pain on the underside of the foot, that will be a good start.

What’s Causing The Pain?
How long have you got? Without going into too much detail (I don’t want you falling asleep!) every case is very different and as such should be treated that way. I’ve certainly never seen two cases that are the same. What we can be reasonably certain of is that the Tibial Nerve (click the link here to see the a picture) will be involved in reporting pain back to the brain. We can also be reasonably sure that our myofascial line the Superficial Back Line will be involved – again click the link here to see what we’re talking about. Looking at the picture you can see how the Plantar Fascia of the foot is continuous with the calf muscles, into the hamstring via your backside (sacrotuberous ligament for my fellow anatomy geeks out there!), the erector muscles of the back and into the neck. Indeed I have fixed a number of cases of Plantar Fasciitis by treating people’s necks!

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 bio-mechanical correction.

How Do I Not Get It?

Before we lose the interest of those who’ve not suffered with the condition before here’s a few tips how not to get this condition in the first place. Firstly we can talk about the fairly standard stuff that is true for all overuse conditions. 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 if it’s work that’s getting to you. Emotional stress is a large factor in a lot of cases that we see.

The emotional element can simply be sitting in a more tense position at work with you toes on the floor and heel in the air for hours on end – putting the plantar fascia in a stretched position for prolonged periods. Or equally gripping the floor or your shoes with your toes – putting the plantar fascia in a contracted position. Other specifics to avoid are walking around barefoot on cold floors (does the coldness shorten the plantar fascia, or irritate the tibial nerve?) and choosing good well fitting shoes, trainers and work boots. It essential that all shoes have enough flexibility at the ankle.

Are There Any Quick Fixes?

Coming to see us is your best bet of course (01793 613352 or info@SwindonSportsTherapy.co.uk)! Back in the day a Strasbourg Sock was often used. Looks a bit medieval to me! Research on is can only be described as mixed and has fallen out of fashion as a treatment. Silicon Gel Pad’s to protect the painful can be useful but this only really treats the symptom rather than the cause.

So How Can We Help With Your Pain?

As mentioned previously each case if different. Firstly we need to identify which structure in the foot is causing you most pain – it will rarely be just one thing. We need to assess your Plantar Fascia – how tight it is, where on the foot the pain is, is there any inflammation? We then need to assess the muscles deep to the plantar fascia to see if they are the source of the tenderness. We then move to assessing the tibial nerve – is it more tight than the opposite side? This will give us an indication as to which are the most important structures to address your pain – fascia, muscle or nerve.

Then comes the clever bit. We assess the rest of your body to understand why the structure causing the pain is overworked, and for want of a better expression, grumpy! We then treat these issues, correcting you movement patterns and changing the way you work to take pressure off the painful structure – reducing their sensitivity. In many cases this will resolve the problem without the need to treatment on the local area. Which, lets face it, would be very painful. Sometimes we do need to work the local structures to finish the job off, but only when the sensitivity of the condition is down to a level which makes the treatment more comfortable.

In Summary

Plantar Fasciitis in modern Physiotherapy is just a label for pain on the underside of the foot. Each case therefore is a unique set of biomechanical issues which need to be corrected and treated. If you want to truly get rid of the pain and discomfort that you feel you need to get the condition properly assessed by a professional who will find and treat the source of the pain. Or you could just wait 18 months! Click the contact us button below to book a session or speak to a therapist

You can find more information on our Sports Therapists’ approach and how that can help you on our home page.

This article first appeared on our Brighton site.