Plantar fasciitis is one of the most common and annoying of orthopedic conditions. Almost everyone has either had a bout of it or knows someone who has. But what is it and why is it so debilitating?
The plantar fascia, a piece of tissue which spans almost the entire underside of the foot, runs from the heel forward and spreads out under the toes. Unlike muscle, it does not contract or lengthen. Instead, it functions more like a rope than an elastic band and its main purpose is to hold up the arch in the foot.
The ankle joint functions as a hinge which moves up and down, as well as some inwards and outwards roll. This combination should occur without restriction. The arch of the foot is a vital part of this process: it gradually drops as we cushion our foot with initial contact, and reestablishes itself into a firm platform when we push off to the next step.
Like many other orthopedic conditions, plantar fasciitis occurs when the normal mechanics of the muscles around the joints and bones are disturbed.
If you have plantar fasciitis, you know it! Symptoms are easily recognized. Pain occurs, usually near or at the heel, and usually on taking the first few steps after getting out of bed, or after long periods of inactivity. Often more pain is felt after, rather than during, activity.
When it hits, plantar fasciitis can feel as though you’ve just stepped on a piece of glass, and initially you may not be able to put any weight on the foot. The pain can last for days, weeks or months in varying degrees of severity, and once you’ve had a bout of plantar fasciitis, you are more susceptible to experiencing it again. While many doctors predict it will take up to six months to clear completely, others are more realistic and warn patients it can take up to 18 months in severe cases.
A single, or more often, combination of factors may be involved. Here are the main causes:
1. Tight calf muscles are the most common culprit. With time, this can inflict wear and tear on the tissue, causing pain and inflammation. Calf stretches should help, but if stretching has limited success in loosening the tissue, try deep massage and other similar soft tissue work on the calf.
For this reason, high heels – while deemed chic by the fashion-conscious – are actually the plantar fascia’s worst enemy! This abnormal foot position perpetuates shortening of the calf muscle and achilles tendon complex, with dire consequences for foot health generally, and particularly for the plantar fascia.
Fashionistas might not want to hear this, but comfortable, sensible shoes with some arch support, as well as realistic heels, are essential.
2. Sometimes it is the mechanics at the joints themselves, rather than the surrounding muscles, which restrict movement. No amount of stretching or soft tissue work will help. In this situation, a therapist needs to do joint mobilizations to allow proper movement at the joints. The therapist can determine if soft tissue work or joint mobilizations, or a combination, are required.
3. Another cause of plantar fasciitis is overpronation. When this occurs, the foot rolls inward excessively while we walk, run or jump. This puts pressure on the arch of the foot as it struggles to accommodate the body weight, particularly if a person has experienced sudden weight gain. The plantar fascia will be stressed and eventually become inflamed.
A podiatrist may be required to perform a gait assessment (analysis of the patient’s walking style), and the various muscles that control motion in the entire pelvis and leg and help to hold up the arch, may need strengthening. Orthotics might provide some physical assistance to limit the degree to which the arch collapses.
4. Plantar fasciitis can also result from aggressive boosts in exercise activity. Increasing your exercise levels gradually, and wearing proper footwear when you exercise (poor footwear is also often at fault), will also help prevent the condition.
Treatment for plantar fasciitis includes correcting the person’s walking style and addressing poor exercising and stretching habits, as well as treating the tissue itself.
One option is ultra sound: the tissue type making up the plantar fascia absorbs ultra sound well, unlike muscle, which does not.
Manual techniques, such as aggressive massage and friction, will increase local blood flow to encourage healing.
While not life threatening, the foot pain caused by plantar fasciitis can compromise one’s quality of life. However, the good news is that this condition is preventable. Through care, common sense and the advice of capable professionals, plantar fasciitis can be cured – and even better – prevented!
Jonathan Maister, Bach Soc Sci Dip, SIM, RMT, CAT(C), SMT(C), is a Canadian trained Athletic Therapist, Massage Therapist and Sport Massage Therapist. He is in private practice in the Markham area, and has lectured on Sport Massage and Sport Medicine topics across Canada. firstname.lastname@example.org; Tel: 905.477.8900.