Plantar fasciitis is one of the most common causes of heel pain in both sedentary and athletic people. It is estimated that approximately 1 in 10 people experience heel pain at some point in their lives. Plantar fasciitis presents with pain and tenderness at the inner aspect of the bottom of the foot (heel) which can extend into the arch. The insertion of the plantar fascia and the calcaneus (heel bone) is known as the fascial enthesis. This area is typically painful and stiff when taking the first few steps in the morning or after being seated for long periods of time.
Plantar fasciitis is thought to result from chronic overload from lifestyle or exercise. Injury to the plantar fascia can be acute or chronic in nature. While acute tears of the plantar fascia can occur in runners, the majority of cases are due to progressive and chronic overload and stress. Current research suggests that plantar fasciitis is more correctly termed fasciosis or fasciopathy because of the chronicity of the disease and the evidence of degeneration rather than inflammation. For the purpose of familiarity I will refer to the condition as plantar fasciitis for the remainder of this blog post and stay clear of using the term plantar fasciopathy or fasciosis. Here are the top 4 steps for managing plantar fasciitis.
1. Get a Diagnosis:
It’s important to have your foot pain diagnosed by a manual therapist prior to starting any treatment. Plantar fasciitis can cause heel pain but so can a lot of other conditions. If you assume you have a condition and try to self-treat you may prolong healing or make things worse in the long run. Plantar fasciitis is a stubborn condition which makes early diagnosis and correct treatment that much more important. The internet is a great way to share information but nothing can take the place of an expert. If your car breaks down or your tooth starts to hurt you will go to a mechanic or a dentist and follow their instructions. It should be no different if you have aches and pains in your muscles or joints. A chiropractor will be able to make a diagnosis, and provide the correct treatment and exercises.
Plantar fasciitis occurs when we overload the area where the plantar fascia inserts onto our heel. This overload typically occurs over a long period of time. This means that the plantar fascia at the bottom of the foot was not prepared (strong enough) to handle the demands you placed on it. This could mean long barefoot walks on the beach during your Hawaii vacation or a new job (i.e.: waitressing) that keeps you running around on your feet for 8 hours a day.
Whatever the cause, in the initial stages of plantar fasciitis, it’s important to unload the plantar fascia and give it a chance to rest. Depending on the irritability of the tissue, this may mean different things for different people. It’s important to experiment with activity and modify as needed. Resting is important, however complete inactivity is typically not advised. If you have pain with running but not walking then a period of rest from running is advisable. If you have pain with any weight bearing activity, starting a low impact activity such as swimming or biking may be a good short-term exercise strategy. Some additional ways to unload the tissues include: taping, gel heel inserts, cushioned shoes or orthotics. Your chiropractor can discuss the need for these based on your foot structure and mechanics.
3. Get Treatment:
Treatment will also vary based on the individual. As discussed above the plantar fascia can be injured when we ask too much of our feet in any given moment or over a longer periods of time. The plantar fascia may also be stressed by soft-tissue tension and poor joint mobility. Tension in the calves and hamstrings along with limited ankle joint mobility are risk factors for developing plantar fasciitis. Treatment at Mountain Health & Performance may include myofascial release, instrument assisted soft-tissue work or cupping to help release tension in the calves and hamstrings. Various ankle and foot adjustments and mobilizations (slow joint stretching) are also helpful for getting the ankle and foot moving optimally.