Plantar fasciitis – a pain in the heel

plantar fasciitis

There’s a facebook group that I’m a member of that’s all about hiking and bushwalking in Australia.  All sorts of things are discussed, questions asked… places, packs, sleeping bags, boots…

Recently the topic of plantar fasciitis was raised, and what boots did people recommend for those hikers who suffer it.

Various brands of boots were suggested, as per the poster’s request.

All sorts of suggestions were also given for how to help the plantar fasciitis.  Many focussed on the problem area of the foot.  Wear orthotics.  Strap your feet before hiking.  Roll the bottom of your foot on a ball.  Ice packs on the bottom of your feet.  Someone was even getting sucrose injections !??!

The problem with these suggestions is that it only addresses the symptom, not the cause.

A few others on the forum recognised that and started weighing with some different suggestions.  They recognised that it’s a whole-body problem, understanding a need to rectify the cause, which is likely not in the foot.  Yoga was suggested by many, and some down the path of regular stretching routines.  Others suggested gait analysis.  One interested person even tracked me down from my comments – from personal Facebook to my website !

It’s typical of many conversations.  There’s the spot where it hurts, and the area causing the problem.  They’re generally not the same place.

 

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plantar fasciitis foot

Plantar fasciitis

As part of the conversation, some (lucky) people had never heard of plantar fasciitis.  Pretty good explanations followed.

Fascia is connective tissue that runs throughout the body, covering muscles and form into tendons and ligaments.  Anything with “-itis” means inflammation – fasciitis is inflammation of the fascia.  The plantar surface of the foot is the sole.  So, plantar fasciitis is inflammation of the connective tissue of the sole of the foot…

The plantar fascia is thick fibrous connective tissue, running under the foot from heel to toes.  It functions as a type of shock absorber to the foot when moving, walking or running.  However, it’s quite rigid.  If too much traction is put on the plantar fascia, “trauma” such as an accident or “over-doing it” may result in micro-tears of the fascia.  These micro-tears result in inflammation and pain.

Inflammation is the body’s natural way of trying to protect itself.  When injury occurs, the body responds.  Blood flow is increased to the injured area (the heel, in this instance), sending cells to start a healing process that may continue for days, weeks, months… provided there is not continued re-injury.

If the plantar fascia is subject to repetitive stress, the plantar fascia may become non-inflamed but degenerated – the result of ongoing untreated plantar fasciitis.  The correct term for this injury is plantar fasciosis.  However, those who have experienced this type of chronic injury usually find it referred to as plantar fasciitis…

Some may also develop a heel spur if plantar fasciitis injuries continue.  The body deposits calcium near the heel in an attempt to repair detached fibres in the heel.  Many who have heel spurs don’t feel pain from them, however they are a sign that the problem has been present for an extended time.

 

plantar fasciitis heel painWhat does plantar fasciitis feel like ?

Plantar fasciitis usually causes pain in the heel of the foot.  For some, it may be felt in the arch area or other parts of the sole of the foot, although heel pain is most common location.  The heel may also have mild swelling.

The pain tends to be worse in the mornings or after resting.  The first few steps out of bed can feel intense, like a knife sticking into the bottom of the foot, but improves with activity as feet warm up.  For many, pain may also be felt after long periods of standing or starting to move after being seated for a time.

For those doing sport, the heel pain usually makes itself known after exercise, but not normally during.

If the plantar fasciitis has gone untreated for an extended time, then heel pain may also be felt at the end of the day.

Although plantar fasciitis can affect both feet, it is more common to feel it in only one foot at any one time.

 

plantar fasciitis cause risk

What causes plantar fasciitis ?

Plantar fasciitis is most commonly seen in people with poor foot biomechanics that put stress on the plantar fascia.  Flat feet, weak foot arches and over-pronation are common causes due to over-stretching of the plantar fascia.

Common risk factors include:

Activity

Sports such as running, walking or dance that place stress on the heel bone and attached tissue increase the risk of plantar fasciitis, especially if the intensity of exercise is increased.  While it may seem counter-intuitive to some, plantar fasciitis is associated more with those who tend to toe-run, rather than heel-running style.  This is due to commonly seen tight calf muscles or ankle problems that limits ankle movement.

Extended standing or on-feet

Activities or jobs that require a lot of walking or standing on hard surfaces can lead to stress and fatigue of foot muscles.

Weight and pregnancy

Additional weight, even through latter stages of pregnancy, increases strain and stress on plantar fascia.

Flat feet, over-pronation

Arches are the foot’s shock absorber.  With lack of arch, or arches that are weak and/or over-pronate, additional strain is placed on the plantar fascia, which absorbs the force.

Shoes with poor support

Shoes that provide no support put strain on the plantar fascia.  Despite being fashionable, ballet flats, converse sneakers and thongs/flip-flops are not good for feet.  All these shoes are thin-soles and provide no arch support.  Thongs/flip-flops also alter walking patterns, further changing foot biomechanics.  High heels can also encourage the achilles tendon to shorten, adding additional strain on heel tissue.  Note also that sports shoes do not provide support forever…

 

bowen therapy knee

Bowen Therapy

Bowen Therapy is a very gentle form of bodywork.  Small, gentle, precise moves are made on muscles, tendons, ligaments and nerves, triggering the body to begin a healing process.  The treatment initiates changes in the body that may continue for up to a week.

Bowen influences the body through the connective tissue known as fascia.  Fascia plays a major role in muscle coordination, postural alignment, and overall structural and functional integrity.

A Bowen treatment aims to help the body as a whole – helping bring the body back into balance, while also addressing the injury/pain site.  Posture and compensatory patterns are also assessed, to ensure the problem has a higher chance of staying resolved.

 

bowen therapy plantar fasciitis

Helping Plantar Fasciitis

Many on the hiking facebook forum were on the right track.  Ice packs or rolling the sole of the foot on a ball will indeed give relief to the symptoms, but not resolve the problem.  Stretching and/or yoga are fantastic for maintaining good posture and gait, but may take a long time to achieve resolution.

With foot mechanics being the primary cause of plantar fasciitis, helping the foot back into alignment is a key goal of any treatment.

That’s where Bowen helps plantar fasciitis – between the ice for the symptoms, and the stretching for maintenance.  Bowen helps bring the entire body into balance.  When the pelvis, legs and feet are helped back into alignment, gait is improved, and the plantar fascia is not re-injured.

Feet are often the victim of a culprit elsewhere in the body.  Pelvic misalignment through impact of the lumbar spine, short hip flexors or tight hamstrings may all play a part in how legs move.  Knee and ankle alignment further influences how the feet land, and the amount of strain felt by the sole and the arch.

 

Of the many I’ve helped with plantar fasciitis, all have felt clear improvements, albeit with various speeds of recovery.

I recall one almost bragging about how thick and damaged his plantar fascia was, according to the ultrasound technician.  “The worst they’ve ever seen !” I was told.  A single treatment to help balance the pelvis, not even touching his feet, had him feeling a significant reduction in pain.  “What can you do for my shoulder ?” was the response the following week.

Resolution in a single treatment is not the norm however, especially if the plantar fasciitis (or, probably more correctly, plantar fasciosis) has been a problem for a while.  Many need a few treatments with time and exercises to help the body learn and maintain a new posture.  Walking that “feels different” with the change to alignment and gait, needs to start to “feel normal”, so the feet can remain pain free.

 

 

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sportEX journals via Visualhunt CC BY-ND

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Daniel Max via Visualhunt.com CC BY