Many of you will have heard of the term “plantar fasciitis” and some will be familiar with stiffness around the heel first thing in the morning or after exercise or running. Plantar fasciitis tends to be the most common cause of heel pain and so to follow is a brief explanation of what it is but more importantly what we can do to get rid of the pain and get moving.
The plantar fascia (basically the tissue of the sole of your foot) is a flat band of soft tissue that connects the toes and the heel bone together and the achilles tendon feeds into the plantar fascia as it come down the back of the ankle around the heel. It supports the arch in your foot.
When the plantar fascia becomes too tight, or short, it can pull against your heel bone causing inflammation and pain, so your heel will end up hurting whenever you walk or run. You can get the condition in one foot or both feet.
What causes plantar fasciitis?
Repeated over-activity and too much demand placed on it causes micro tears and shortening to the plantar fascia, which is the body's normal healing process, but if the plantar fascia doesn't have time to recover and heal in between use then there is continuous inflammation, pain, excessive nervous system sensitivity and changes to its normal function. There is also increasing evidence that plantar fasciitis is due to collagen degeneration in the fascial tissue. Collagen is the main structural protein of the body’s connective tissues (which are our bone, tendons, ligaments, cartilage).
Causes could be:
- a change in footwear i.e. sometimes changing our shoes in the summer from supported to flat shoes, flip flops or possibly wearing worn out shoes
- Increased activity levels i.e. ramping up your walking or running too much too soon.
- Postural issues, flat feet or perhaps compensations from the knee or hips causing excess pressure
- Impact to the heel i.e. stepping on something, jumping and causing an injury
How to manage and get rid?
The plantar fascia helps to contract the sole of your foot and the achilles tendon connects the muscles at the back of the leg (gluts, hamstrings, calves) to the heel and foot so this is where REHAB needs to be focused.
Massage and soft tissue treatment can be extremely effective in helping overcome the pain and limitations of plantar fasciitis. Focusing on the plantar surface of the foot, ankle and foot joint mobility and combined with massage, release and stretching techniques to the lower and upper leg and possibly to the glutes too.
You can also help yourself with some Rehab ideas:
- Rest - if you are experiencing sharp/acute pain then you need to reduce your activity and avoid hard surfaces, wear good cushioned shoes and sometimes it helps to wear a shoe with a small heel (not flat) or a heel insert to shorten the achilles tendon and calf muscles. If your pain is from walking or running induced then rest, and make sure you are comfortable walking before recommencing, or at least reduce your activity
- Ice is helpful too if your pain is acute. Place your foot on some wrapped ice for 5 mins and you can do this 3- 5 times a day.
- Importantly exercise and movement is good and if you pain is manageable then here are some Rehab Exercises to try first of all:
- Big toes stretch and wiggle - sit with one ankle resting on your knee and with your hands stretch the sole of your foot, wiggle the toes and massage the foot whilst wiggling the toes, particularly the big toe too.
- Roll a tennis size ball (or slightly smaller) on the soul of the foot - you can do this at any time seated or standing for 3 - 5mins.
- Ankle mobility - take the ankle slowly round all in a circle, pull the toes back, point the foot and toes and tip the foot from side to side, trying to trying to exaggerate all possible angles of the foot and ankle. You can do this actively and also passively using your hands to assist.
- Calf stretches, to start with:
- Lean into a wall or worktop and extend one leg straight behind you and feel a stretch potentially through the foot, calf and/or hamstring, hold for 30 secs
- In the same position now behind the opposite leg at the knee and try to take your knee over your toes, this is a stretch for the deeper calf muscles, hold for 30 secs
- Short foot exercise - seated, first of all (you can progress to standing) with a foot flat on the ground, try to crunch your toes back forwards your heel (shortening the foot) - this uses the smaller intrinsic muscles of the foot
It is necessary to progress from these initial stretch and mobility exercises to strengthen the foot/calf muscles to better tolerate the load created by walking and especially running. It may also be necessary to consider gait and/or footwear changes.
Shockwave Therapy (which I don’t offer, see footnote 1 below) has also been found to have positive effects too and possibly visiting a podiatrist for orthotics.
This is an introduction to heel pain and how you can start to take control and manage it. If you have any questions on the above and would like to book an appointment for treatment, please call or email me.