Plantar fasciitis is a painful and often chronic condition of the foot, so-called because the soft tissue in the arch of your foot is called the planter fascia. Planter, meaning the underside of the foot, and fascia meaning the connective-tissue that fills the spaces around the tendons muscles and bones in your foot. This becomes irritated and inflamed and is the ‘itis’ part. Generally in medicine anything that has become irritated and inflamed or swollen is given the ending –‘itis’ with other examples being tonsillitis or appendicitis.
There are several factors that may lead to plantar fasciitis in one or both of your feet, but ultimately you will have strong or even disabling pain in the arch of your feet or in the heel, or more rarely in the ball of your foot. The pain tends to be worse after stillness, so mornings are often the worst time with people describing those first steps to the bathroom as “like walking on broken glass” or “agony”. After a few minutes, and up to half an hour of movement, the pain subsides, but if you do too much it returns.
18 months of pain
In bad cases, plantar fasciitis or heel spurs (the two are generally one and the same), can go on for years, and the longer it goes on the harder it is to resolve. A dancer who he came to me for treatment of this condition had been suffering for 18 months, she had seen several therapists with no improvement. It was incredibly painful and her career was affected. She was also booked to have surgery to decompress the fascia in her feet.
My approach to plantar fasciitis and Heel spur issues is to consider the condition of the tissues in the foot, and the potential causes of the condition. This approach is generally very successful and approximately 12 sessions over 3 months working with the dancer resolved her problem, she cancelled the surgery, and two years later her feet remain healthy despite dancing as much as ever. This is quite a long treatment time by my standards, but her symptoms were chronic and long standing.
So I will outline the most common causative factors, then the self-help procedures that you can do at home, and if your problem is too chronic to resolve by yourself the most likely approach to treatment that I will employee to resolve the problem.
In my opinion, this is a condition that is more often than not easily resolved with the correct approach and self treatment. It’s a shame that so many people will needlessly suffer for long periods before receiving the correct treatment.
Firstly let's consider the problem itself, the planter fascia in the arch of the foot. Whilst stealing the name for this condition the planter fascia is just part of an incredibly complex arrangement of muscles and joints that comprise the aches of our feet. I believe that the muscle function here is of primary importance and all the factors involved in allowing healthy muscle function need to be considered.
Lower leg muscles
For instance the arch of the foot needs to be maintained and it is reasonable to assume that the muscles in the arch of the foot are responsible for maintaining this, and they are to some extent, but a huge portion of the job goes to the so-called stirrup muscles. This Stirrup is made up of both the tibialis anterior muscle which runs down the front of the shin bone, and the peroneal muscles which run down the outside of the lower leg. Both of these muscles attach to the bones inside the arch giving considerable support to it. There is also a muscle on the back of their shin bone called the tibialis posterior which also lends some support to the arch. If any of these three muscles fails to do its job properly the foot arch muscles become strained and irritated leading to cramping and stress on their attachments, particularly the heel which at its worst can become distorted into a wedge which is known as a heel spur.
Treatment often involves being told to strengthen the muscles in your foot by perhaps curling a towel up with your toes on a slippery floor. Or you are told to stretch them by pulling the toes back. I feel these are both bad ideas. As far as I am concerned what we have with plantar fasciitis is dysfunctional muscles in the arch of the foot causing irritation, to themselves, the tissues around them, and to the places on the bone where the muscles attach. This leads to mild swelling, congestion and possible adhesion between adjacent tissues. This along with identifying and treating causative factors, is what we need to deal with.
If you follow the common advice about stretching, consider this, get hold of a supermarket carrier bag and stretch it, go on, stretch it hard. Now take a look at it, does it spring back? Does it look ruined? Use this as an analogy for what happens to your tendons and ligaments when you stretch them, as well as considering that spasmed muscles generally respond to stretching by spasming even more, especially once you have cooled down. There may even be micro damage to the tendons and ligaments in the arch, imagine a frayed damaged rope, would you tug at both ends in order to repair it?
If you consider strengthening, consider why on earth your muscles could be weak! Does your granny have plantar fasciitis? No? Maybe she has stronger foot muscles than you?! (see Stretching and strengthening)
The truth is, if you separate the adhesions, stimulate the muscles to regain their natural strength by removing obstacles to that process, and restore the ability of the other muscles that help support the foot, the problem will resolve itself. When you come for treatment I will consider and treat all factors that may relate to your pain. This could include poor hip rotation, low back and pelvic imbalance or weight shift, lower leg muscle dysfunction and issues with the connective tissue or facia that runs from the ball of the foot around the heel and up the back of the leg.
Sometimes orthotics (insoles with arch supports for inside your shoe) may help, but mostly they don't, and I feel they quickly create a dependence and properly weaken the arch supporting muscles, potentially making the problem worse if you dare to go without them. They may sometimes be appropriate to give the muscles in the arch a chance to rest while they heal. This needs to be managed carefully.
So for self treatment, begin this process by using a tennis ball to massage the arch of your foot. Don't roll or press on tender heel spurs, just into the arch of the foot. Explore the whole arch, rolling a little more deeply into the tender areas if you can stand it. Generally optimal times are a firm five minutes massage on each foot two times per week equally spaced, and possibly a light workout for two or three minutes on each Foot just before you go to sleep. When you can use the tennis ball firmly with minimal pain, you need to go to a golf ball sized hard rubber ball, not a golf ball as this is too intense.
You may also want to consider using a Strassberg Sock, this does not stretch the tissues so much as stop them contracting overnight. This can be amazingly helpful when combined with ball rolling on the foot. (amazon link)