I had a call yesterday about helping with the heel pain of her plantar fasciitis. I sometimes suffer from plantar fasciitis myself, and it is a very common condition seen in both my Bracknell and Shepherd’s bush area osteopathy clinics. A holistic osteopathic approach to the heel pain of plantar fasciitis can be very successful in helping the pain and preventing it from happening again.
What is the plantar fascia?
The plantar fascia is a band of thick connective tissue that aids the foot in flexibly bearing the weight of the body while you move. It stretches between the part of the heel closest to the middle of the foot and ends of the bones that end up forming your toes (metatarsals). The front of the plantar fascia is spread more widely than it is at the back, which is why the pain is usually felt at the heel.
What is plantar fasciitis?
Plantar fasciitis is a very painful condition that most often affects where the plantar fascia of the foot inserts into the calcaneus (heel bone). It is called an ‘itis’ because it is often an inflammation of that area that causes the pain. Chronic pain in that area may signify that there is a degenerative or ‘wear and tear’ process happening at that location.
Many people will have pain that is more intense after not weight bearing for a while (ie, sitting at a desk and then getting up) but in more active people the the pain is often worse with increased activity.
What causes plantar fasciitis?
Biomechanical causes are the most common causes for plantar fascia pain, and are likely to have been there for a long time. These biomechanical factors are not always on the foot or even on the same side of the body, and they may very with each person. If you are overweight or exercise on very hard surfaces or are suddenly doing more dynamic, pounding types of exercise you are more at risk to making these biomechanical problems show up as plantar fasciitis. Whatever the particular issue is, excess force and strain is placed through the plantar fascia, which will then pull with abnormal force on its attachments. It is usually the smaller attachment feels more strain – which causes the associated heel pain. The most common ’cause’ is described as being a foot that overpronates but that may not be sufficient information to give a full assessment or try to define a treatment. Costly orthotics may not be needed if you can find someone to address some of the other contributing factors.
How is plantar fasciitis treated?
How the foot pain of plantar fasciitis gets treated depends a lot on what the root cause is. Typical approaches usually include
- tennis ball under the foot
- taping for support
These things can help reduce discomfort but often more integrated approaches will provide a greater benefit over the longer term.
If the problem is one with foot anatomy, and the foot and toe joints don’t move well passively, an osteopath can take a manual therapy approach that includes the use of joint mobilisations in the ankle, midfoot and toes to improve passive movement. However, this may not be enough, especially in longstanding cases of plantar fasciitis, or in cases where the problem is not in the foot at all. Movement patterns adapt to pain and are affected by any biomechanical issues further up the leg – in particular problems with hip extension or internal rotation. Healthy spinal rotation is also important during gait as it affects the movement of the hips and lower limb.
In addition to passive techniques, I always use weight-bearing movement-based approaches to treatment that challenge the body to correct some of the movement patterns that may be contributing to the pain. These are simple movements and home-based exercises that can be adapted to the individual and require no fancy equipment or gym membership! I’ll be writing more on all the various treatment approaches soon.
Remember! If in doubt, get it checked out
One important thing to remember is that plantar fasciitis is not the only cause of heel pain. Podiatrist research estimates that up to 20% of people with heel pain in the region of the plantar fascia insertion have a ‘Baxter’s Entrapment’ of the lateral plantar nerve that passes just through that area. A proper history and assessment are needed to determine the cause of your heel pain, especially if your heel pain is chronic. You could have a chronic plantar fasciitis that is causing swelling and creating a secondary Baxter’s entrapment! And, you could have another heel pain cause altogether. Other causes of heel pain can include nerve entrapments, tendinopathies in the foot and ankle, and the consequences of certain systemic diseases that affect the muscuolskeletal system such as ankylosing spondylitis. This is why you should always get fully assessed.
In any case being seen earlier is better than being seen later.