Like treading on hot coals !
" Painful feet affect the whole person. Discuss. "
This was one of our essay titles for our degree and oh boy, is it true ! I think any parent who creeping across their sleeping childs room has trodden on a Lego brick at 3am will testify to just how sensitive our feet are - it's seems odd that something that takes such a battering in our daily life should be so sensitive, yet that sensitivity is important when it comes to the function of our feet and allowing them to carry us through life whether that be a ballet dancer en pointe or a builder walking across a rocky building site. Plantar fasciitis or, if we're being technical, plantar fasciopathy is a common cause of foot pain and can be a real b****r to treat ( not to put it too lightly ! ) .
What is Plantar Fasciitis ?
The plantar fascia is a broad, tough band of tissue that runs from the underside of the heel bone along the sole of the foot to the base of the toes. It's job is to support the long inside arch of the foot giving us a strong yet flexible arch to distribute our weight as we stand, walk and run. It acts a little bit like a spring, storing energy and releasing it rapidly to help propel us forwards and upwards. But with repeated load and tension the tissue of the fascia can become irritated and sore producing that characteristic sharp, stabbing type pain under teh foot. Short of using crutches the foot is almost impossible to rest so the constant loading of the tissue just compounds the problem making it difficult to heal.
What are the causes of Plantar Fasciitis ?
Age - more common in 40-60 age group
Menopause - decreases in oestrogen cause changes in the collagen in all of our tissues including the plantar fascia
Sudden increases or changes in activity levels / load / pattern / footwear
Weight gain ( pregnancy, obesity )
Poor biomechanics - stiffness in foot and ankle changing the mechanics of the foot
Weakness in foot & ankle muscles
What can you do about it ?
Get a proper assessment !
Plantar fascia is not the only cause of pain in the foot so it's important to get a proper assessment to confirm that your diagnosis is correct and then identify the cause. As you can see from the list above there are many causes of plantar fasciitis so you don't want to be barking up the wrong tree and wasting your time with strengthening when the problem is stiffness in the ankles.
1. Specific Exercises
A combination of stretching and strengthening exercises are best help plantar fasciits. Just to be clear these exercises stretch the muscles NOT the fascia. Remember the fascia has a supportive role and isn't meant to be stretchy, indeed it being overstretched is often what has caused the problems in the first place ! Hanging your heels off the bottom step will just stretch an already sore plantar fascia and probably make the symptoms worse, A controlled supported stretch is better.
2. Activity modification
If you have a sore blister after your shoes have rubbed it raw would you carry on wearing the same pair of shoes rubbing against the same sore spot and not allowing the tissues to heal ? Of course not, it would be madness ! You would wear different shoes to take the
' load ' off the sore spot and giving the tissues a break. Plantar fasciits is no different, support and offload the sore tissue by avoiding those aggrevating activites and giving the tisue a break in the acute phase. As it heals then the load neeeds to be gradually introduced and that's really where your therapist comes into their own.
Again this comes down to offloading the tissues and taping can be very useful as both pain relief and support. Now there is not a piece of tape manufactured that will physically prop up 55kg, taping works really by encouraging the body's own muscles to do the job that they should be doing anyway - supporting the architecture of the foot - a process called proprioception. Pain can disrupt this system and needs to be carefully rehabbed afterwards, however it's often neglected and can be the reason why re-injury occurs further down the line.
4. Ice massage
Ice can be really symptomatic and soothing for plantar fasciitis, increasing the circulation if the ice is applied for long enough. Ice bottles are commonly used by runners by freezing a plastic water bottle and then rolling the foot across it to provide both ice and pressure to the area. I rather like freezing golf balls rather than a bottle - less mess as they don't leak and the smaller size means it's easier to get them into those awkward little spots on the foot.
5. Choice of footwear
There is no doubt that some footwear is more supportive than others - you can read what I think about flipflops in our other blog but I think it's fair to say that they are not the plantar fasciitis' patients friend - but other than that there is no need to splash out on horrifically expensive trainers. A slight chunky heel is often a good idea as the foot can struggle to go very flat and a more cushioned sole can be helpful in the early acute stages. There are many silcone cushions and pads on the market to help cushion the acutely sore tissues but ironically once the initial phase has passed a very soft, squishy sole may cause more problems than it solves. Rather like walking on a shifting sandy beach, the softness of the sole actually makes the muscular and ligamentous support system work much harder which can be problematic if they are not up to the job.
So in summary ....
Get an assessment - is it ACTUALLY plantar fasciitis ?
Support the tissues whilst they are sore to allow the irritation to settle.
Review your footwear & exercise programme.
Rehabilitation / ongoing exercise programme to load the tissues properly and build up endurance & strength
As ever if you are unsure and want to chat things through with us then please do give us a call or book an appointment online - we are happy to chat and give guidance in terms of what might be best for you.