What is Plantar Fasciitis?
Plantar fasciitis is a unique repetitive strain injury affecting people from all walks of life: runners, walkers, even people who have to stand on hard surfaces at work especially on concrete floors.
For some, plantar fasciitis can be resolved in a matter of weeks, for others it can be one of the most stubborn and frustrating conditions out there. Part of the problem is that it is still a bit of a medical puzzle.
What are the symptoms?
Most people first notice a tightness or a pulling sensation in either the arch of the foot, the heel or both. This can quickly become a very sharp pain felt in the heel, and often much worse in the morning, or when standing up after having been sitting for a while. You might find the foot eases a bit as you walk around, especially in the early stage, but as it progresses, you might find that any weight-bearing on your feet is pretty darn horrible!
What aggravates plantar fasciitis?
The causes are not particularly straightforward. Whilst there will be some of the inflammation in the early days, plantar fasciitis is not a chronic inflammatory condition, despite what the name implies (“-itis” usually means inflammation).
It’s a bit like tendonosis crossed with some degeneration of the plantar fascia. It’s an overuse injury, and it’s common in runners (and menopausal women). Plantar fasciitis is caused by too-much repeated load on the arch of the foot leading to tissue fatigue, but biological and biomechanical factors are also involved. Not everyone who runs a lot will suffer from it.
The plantar fascia is like a web. Or to think of it another way, it’s like a bowstring (with the arch of the foot being the bow itself). Along with a few muscles it supports your foot mechanics and helps maintain the shape of the foot and allows it to be “springy” – very important for running. Too much stretch and it can stretch out and fatigue, too little and it won’t be able to absorb the forces from the ground very well; either way it won’t cope with the strain!
What’s the best way to treat plantar fasciitis?
Plantar fasciitis is a sore and incredibly frustrating condition to have. The good news is over 95% of people will recover with conservative treatment alone. This treatment will usually include a combination of manual therapy, stretching regimes, short-term use of anti-inflammatory drugs, and lifestyle/activity modification.
Surgical options that involve cutting part of the plantar fascia are generally reserved for the most severe and chronic cases. And this is why it’s important to see a professional quickly if you think you might be developing plantar fasciits. Do not wait until it becomes unbearable!
Can an osteopath help with foot problems?
Osteopaths assess the biomechanical components and the lifestyle factors that contribute to plantar fasciitis. They look at your day-to-day life, your footwear, your foot posture and stability, and your gait. The number priority one is reducing the load through the arch of your foot. An osteopath might recommend wearing a supportive shoe with good cushioning as your regular daily shoe – especially if you usually wear flat shoes, high heels or jandals.
It's common with plantar fasciitis that the issues aren't actually in the foot, but higher up, such as weakness in the hips that causes more strain on the foot.
If you’ve got a high arch, then it’s often good to get some orthotics for your shoes. Podiatrists can help you source insoles specifically made for your foot. With your footwear taken care of, you’ll probably have to make a few changes to your daily routine. This might mean taking a break from running for a while or taking the weight off your feet if you stand all day. If the pain is acute and it needs a little extra support, taping is another way to take the pressure off the medial arch.
How to Treat Plantar Fasciitis
At home, icing the sole of the foot can feel great and can help relieve the immediate soreness. Freeze a bottle filled with water and roll the sole of your foot gently over it for 15-20 minutes. Repeat as necessary.
Stretching exercises are a vital part of medium-longer term management but won’t offer the immediate relief that icing will. But this doesn’t mean you should avoid them! Stretching of the calf is recommended. And sometimes the hamstrings and other parts of the lower limb benefit from stretching.
Stubborn plantar fasciitis
Sometimes you can do everything right and still feel as if you’re getting nowhere (I did say it’s a bit of a medical puzzle!) If you’ve been managing your pain properly for 2 months or more but you still see little change, it’s worth looking at Shockwave therapy. Extra Corporeal Shockwave Therapy, to be precise. This is a relatively new form of treatment used for tendinopathy and myofascial conditions.
Shockwaves are high energy soundwaves produced underwater with a high voltage explosion and evaporation – sounds pretty cool right? The theory is that the shockwaves induce neovascularization at the bone-tendon junction and stimulate the release of growth factors to help with cell proliferation. In other words, they improve blood supply and tissue regeneration (1).
While these machines have been around since the 80s, it’s only recently that they’ve been applied to tendinopathy and myofascial issues. The evidence is still growing but is very promising.
1. Dedes, V., Stergioulas, A., Kipreos, G., Dede, A., Mitseas, A. and Panoutsopoulos, G. (2018). Effectiveness and Safety of Shockwave Therapy in Tendinopathies. Materia SocioMedica, 30(2), p.141.
Osteopath & Sports Nutritionist
Jamie is a Queenstown based osteopath treating a full range of muscular and skeletal injuries, particularly sports injuries. He has a practical and empathetic approach and experience treating chronic pain. He finds it incredibly fulfilling to educate and help his patients who have thought they would live with pain forever.
Special areas of interest: Shoulder injuries and rehabilitation, headaches and migraines, chronic pain and arthritis of the neck and joints an exercise rehabilitation.
Favourite technique: Jamie's great with his joint manipulations, cupping and applying a gentle but highly effective treatment. He also loves teaching people breathing techniques.