Pain can range from being slightly uncomfortable to very painful, depending on the extent of the condition. Many people describe the condition as feeling as if needles are piercing through the bottom of the foot. Often times people try stretching the area conventionally or length-wise, by placing their foot at an angle and using a wall, for example, to try to lengthen the bottom of the foot.
This type of stretching is very limited as it only impacts the healthy, elastic fibers that are capable of stretching. The fibers that are chronically contracted and tight do not respond to this method very well and need a more direct, multi-dimensional approach.
Most people we see use conventional stretching and ball-rolling on a regular basis without sufficient relief, so something is obviously being missed. At Delos Therapy, we have had considerable success treating and eliminating plantar fasciitis , especially for our clients who are marathon runners. The reason our therapy is effective is that we focus on stretching the muscles and fascia in and around the area using precise pressure, which we believe is the most effective way to stretch bound-up tissue.
Working through a treatment plan with us will re-structure the muscles of the foot and calf into a healthy and pliable muscular state, which will result in the relief of pain and stiffness. Delos Therapy also can loosen these muscles as a preventative measure. Our loosening technique enhances athletic performance by allowing the muscles of the feet and calves to be recruited so they can perform runs more efficiently and with less effort.
When pain and discomfort become unbearable, they are the result of weeks, months, and even years of repetitive motion that led to the chronic tightening of the plantar fascia. Resolving this issue takes some time, so we recommend immediate treatment.
In degeneration the tendon structure changes and there is change in the collagen which makes up the tendon. For more on this read staging of tendinopathy. Scott Wearing is widely published in plantar fasciitis research. He suggests in his excellent paper that there is similarity between the response of plantar fascia and tendon. This could mean that plantar fasciitis also goes through stages along a similar continuum.
All that jargon aside where does it leave us with managing plantar fasciitis? Degenerative change usually happens after prolonged overloading. In the reactive stage treatment will largely centre around reducing load on the plantar fascia. This can be achieved by reducing activities that increase pain such as walking barefoot and running.
Taping the fascia can also help. Stretching the Achilles is widely recommended for plantar fasciitis but it might be best avoided in the reactive stage as it places greater stress on the fascia. With more chronic degenerate plantar fasciitis load management is still key but can involve a gradual increase in load on the plantar fascia. Strengthening calf muscles and tibialis posterior may also help these muscles to manage load associated with impact during running to prevent recurrence.
Again if we take the lead from tendinopathy management we have some guidance in terms of pain and exercise. Research on achilles tendinopathy by Silbernagel found that people could continue sport as long as they aimed to keep their pain below 5 out of 10 where 0 is no pain and 10 is worst pain you can imagine and pain had reduced by the next morning.
You could certainly apply this concept to plantar fasciitis. Indeed, many runners continue to run with their symptoms. When we consider the stress on a tendon or the plantar fascia with often think of tensile load which places a stretching force on the tissue. Until fairly recently compression has been overlooked but Cook and Purdam highlight the importance of compressive load.
However according to Wearing compressive load has not been fully examined in plantar fasciitis. Perhaps future research will shed light on this. What is the Windlass Mechanism of The Foot? A number of factors will play a part in loading — your training type, volume and intensity will have a role as will footwear and training surface. There can be a connection between barefoot running and plantar fasciitis as this promotes forefoot striking and increases load on the calf complex.
This can help you identify a cause to your plantar fasciitis and potential solutions. Several risk factors have been identified in plantar fasciitis and generally these link to increase load on the fascia;.
Addressing these factors will likely reduce load on the plantar fasciitis allowing the tissue to heal. Stretching the calf muscles has been a cornerstone of plantar fasciitis rehabilitation for years.
Many articles in the literature recommend it alongside traditional exercises like rolling your foot over a frozen bottle of water. Despite its popularity there is a sparsity of quality evidence supporting calf stretches for plantar fasciitis. The theory is that a tight achilles increases load on the fascia so we stretch it to reduce load.
The problem is there is some debate whether stretching will actually achieve this. A big question too is why stretch a condition that is usually aggravated by tensile load? Cole et al. That said I do feel achilles stretches have a role in more chronic cases where you are aiming to gradually increase load on the fascia. There is some evidence that stretching the plantar fascia itself may be more effective — DiGiovanni et al. Their follow up study DiGiovanni et al.
Many aspects of plantar fasciopathy have not been extensively studied. My thoughts here come from the perspective of a reasoned way of managing a condition heavily linked to overload with many similarities to tendinopathy. However, without a sound evidence base this can only really be theory and opinion in relation to plantar fasciopathy. Indeed while there are similarities to tendinopathy which has been used as a framework to guide some of these ideas there are differences too.
The use of isometric and eccentric exercise has become a key factor in managing tendinopathy, this is difficult to achieve with plantar fascia. It can be helpful to think of plantar fasciopathy as a response to excess load. This can be an acute response that will settle with temporary reduction in load or a more chronic response that requires a gradual re-introduction to loading. There are similarities with tendinopathy that might help guide us in some respects but this approach is not evidence-based.
In the Cochrane Collaboration did a systematic review of interventions for treating plantar heel pain. The work, by Crawford and Thompson reported,. They updated the review in but it was later withdrawn as it was substantially out of date! This highlights a big gap in the research for this common and complex condition. Plantar fasciopathy is not the only potential cause of heel pain and is frequently misdiagnosed. Weak core muscles, tight hip flexors and back problems can also play a part, as these issues can lead to changes in your stride.
While it is possible to continue running after developing this condition, doing so can delay healing and cause further damage. Marathoners are generally advised to take a break from running — or at least cut down — until the area heals, which can take as long as several months. Wearing the proper running shoes to adequately support and cushion the feet is essential, and, in some cases, it can be beneficial to wear custom orthotics, such as shoe inserts or heel cups.
Are you a runner who suffers from foot or heel pain? Contact us today for a comprehensive evaluation of your feet and legs to determine if plantar fasciitis may be a problem for you.
Triumph Blvd. Lehi, UT Symptoms of Plantar Fasciitis Swelling and irritation along the arch of the foot are typically the first signs of damage to the plantar fascia.
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