• Murray Kovesy

Plantar Fasciitis | Heel That Foot Pain

Updated: Jan 9


Plantar Fasciitis or 'jogger's heel' is a chronic condition affecting the fascia of the sole of the foot.

It typically causes sharp pain underneath the foot in the plantar fascia which is a thick fibrous band of connective tissue similar to a tendon and ligament. The plantar fascia attaches from the calcaneus or heel bone and extends into the arch of the foot and the toes. Plantar fasciitis is often seen in high impact sports like running but also prevalent in middle aged woman.


What Is Plantar Fasciits?


Plantar Fasciitis characteristically presents pain in the morning with the first step or after resting and taking your first step under the heel or in the arch of your foot. Quite often your symptoms will be worst with the first steps you take in the morning and improves with activity, as it warms up. The prevalence in the general population is estimated to range from 3.6% to 7%, (2. 3.) whereas plantar fasciitis may account for as much as 8% of all running related injuries. (4,5.)


The past conventional definitions of Planar Fasciitis has been described as being inflammatory in nature but recent studies show there is little to no inflammatory involvement. Plantar fasciitis was considered and treated as a chronic inflammation, now it is seen as a complex of degenerative changes. The “itis” suffixes in tendinitis and fasciitis means “inflammation,” but in the case of Plantar Fasciits the tissue is rarely inflamed like we have be told in conventional texts. Instead, the plantar fascia shows signs of collagen degeneration and disorganisation. In 2003, Lemont et al looked at 50 cases and found so little inflammation that they declared that plantar fasciitis “is a degenerative fasciosis without inflammation, not a fasciitis.” (1. ) Meaning it would be better to use the suffix of opathy (diseased) or osis (condition).



What Are The Causes and Risk Factors of Plantar Fasciitis?


Plantar Fasciits is often a combination of risk factors that cause the symptoms so for the best treatment with Myotherapy and Remedial Sports Massage all these factors need to be taken into account for a speedy recovery. Plantar fasciits can be caused by many factors which includes;

  • Obesity

  • Pes planus (flat feet)

  • Pes cavus (high-arched feet)

  • Shortened Achilles tendon

  • Overpronation (inward roll)

  • Limited ankle dorsiflexion

  • Weak intrinsic muscles of the foot

  • Weak plantar flexor muscles

  • Poor biomechanics or alignment

  • Deconditioning

  • Hard surface

  • Walking barefoot

  • Prolonged weight bearing

  • Inadequate stretching

  • Poor footwear (6.)



Activity: One of the biggest factors causing Plantar Fascitiis are sports that place excessive stress on the heel and attached tissue. Sports like running or involving jumping like aerobics or ballet can cause it. If you have chronic tight calf muscles, stiff ankle joint or previous ankle injury while you exercise this makes it more prone to develop the injury


Weight: The more weight you carry around the more strain on the plantar fascia preventing it from recovering.


On your feet: Work which requires you to be on your feet standing or walking for long periods particularly on hard surfaces is a key aggravating factor seen in jobs like factory workers, waitress and security guards.


Footwear: Old or poor supportive shoes overtime stress and load through the Plantar Fascia.


Your foot structure: Having flat feet, high foot arches, foot pronation or a tight achilles tendon can all change the shock absorption ability increasing the load and strain of the plantar fascia.


Weak Intrinsic Foot Muscles and poor foot control: Muscle fatigue, weakness and poor control can overload your plantar fascia and cause injury.


Reduced Ankle Mobility (Dorsiflexion) and great toe mobility can increase the loading of the Plantar Fascia.


The presence of a calcaneal spur (heel spur) can lead to increased risk of developing Plantar fasciitis and can be confirmed by X-Ray.

How to Fix Plantar Fasciits?


Massage and Myotherapy

Getting your calves and achilles released helps to improve ankle mobility and biomechanics of the foot. A Myotherapist or Remedial Massage Therapist can provide specifically targeted massage of the lower leg, ankle and foot helps to improve the function of the plantarfascia to absorb and disperse force with weight bearing exercise.

Sufficient rest is a fundamental in successful recovery from heel pain, as it often originates from lifestyle factors over time without enough recovery from sporting activities and poor foot wear.

Footware either old or supportive shoes like heels need to be looked at as it is a major contributing factor leading to Plantar Faciitis and heel pain. This is very important to address early on for the successful treatment and rehabilitation of this injury.

Stretches and exercises are prescribed which if done properly can heavily reduce the recovery time reducing pain of the plantarfasia that help reduce the tightness. Proper stretching and exercises can help heal and foot pain by stretching the plantar fascia, Achilles tendon and strengthening the calves to help improve the stability of the ankle and heel.


The use of a spikey massage ball rolling on the sole of the foot can relieve and reduce pain instantly. Starting out slowly and not putting all your weight through initially and gradually applying more weight as pain reduces.

Performing a calf and arch stretch using a towel is very effective stretch for plantarfascia release. Doing this stretch every night before sleep and before the first step in the morning is the most effective time to do this stretch. Pull back on foot for 30 seconds 3 times with 30 seconds of rest in between.



What is the Plantar Fascia Function?

As the plantar fascia attaches from the heel to the toes it limits the the over flattening of the arch of the foot. When this function is compromised it can be over stretched causing pain and dysfunction. The plantar fascia also acts as an active sensory structure providing the brain with proprioceptive feedback about the position of the ankle and foot.


Assessment and Treatment of Plantar Fasciitis

At Motion Myotherapy Northcote our highly trained Myotherpists and Remedial Massage Therapists will help diagnose, take history notes and perform a physical assessment and treat the condition. Your Myotherapist or Remedial Massage Therapist may refer you for an X-Ray to help identify a heel spur if needed.


Having a thorough assessment our practitioners can provide you with the cause of your symptoms and create a treatment plan to not only resolve and reduce your pain and symptoms, but address the cause to prevent it from reoccurring in the future.


Treatment of Plantar Fasciitis


Myotherapy and Remedial Massage: Treatment strategies and techniques that your Myotherapist or Remedial Massage health practitioner may utilise Soft Tissue Massage, Trigger point releases, Dry Needling, ankle joint, mid-foot and toe mobilisations.


Taping: can provide relief in the acute pain stage for the short-term treatment of plantar heel pain. The aim of taping is to support the arch of the foot, improve foot posture and reduce stress on the foot and lower limb during activity.


Custom Foot Orthoses:

If needed a podiatrist may recommend a custom foot orthoses to assist your symptoms and improve your foot and lower limb biomechanics. They have been shown to be effective in both the short-term and long-term treatment of pain. Improvements in function, foot-related quality of life, and a better compliance suggest that a foot orthosis is a good choice for initial treatment plantar fasciitis.


Strength Training:

The benefit of high load strength training in the recovery phase can help with Plantar Fasciitis. A progressive program of high-load strength training, performed every second day can have better outcomes than plantar specific stretching aiding in a quicker reduction in pain and improvement in function. High-load strength training guided by your Myotherapist consists of single leg heel-raises with a towel inserted under the toes to further activate the Plantar Fascia.

The exercises are performed every second day for three months. Every heel-rise consisted of a three second concentric phase (going up) and a three second eccentric phase (coming down) with a 2 second isometric phase (pause at the top of the exercise). This exercise will be specifically prescribed by your Myotherapist and will include a specific number of sets, repetitions and load.


Conclusion:

  • Don't ignore early signs of heel and foot pain as Plantar Fascitiis can be chronic and debilitating with everyday activities. Avoid weights bearing activities that are aggravating symptoms.

  • Book in for treatment for Myotherapy and Remedial Massage to first identify the problem and then treat the problem accordingly.

  • Get proper footware with arch support and limit wearing heels.

  • Start stretching slowly early on to prevent it turning into a chronic condition.


Author: Murray Kovesy

BHSc - Clinical Myotherapist


Find out more about Myotherapy and Remedial Massage Melbourne at Motion Myotherapy Northcote.






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