Treatment & Rehabilitation as it should be…
Treatment When You Need It!..
What Is Plantar Fascia
Our feet connect us to the earth, they are the foundation of the body to which our movement is based on, whether its running, walking or golf, its vital we look after them.
The feet themselves are quite complex in their make up, each foot is made up of 26 bones, 30 joints and more than 100 muscles, tendons and ligaments, all of which work together to provide support, balance and mobility.
All tissues in the body is surrounded by Fascia, it is a thin casing of connective tissue that covers and holds every organ, blood vessel, bone, nerve fiber and muscle in place .
Plantar pertains to the sole of the feet, the bottom surface, the plantar fascia acts like a hammock, bearing the weight of the foot, connecting your heel to your toes.
What Is Plantar Fasciitis
The fascia normally has elastic and flexible properties that permit free dynamic movement of the foot and allow it to perform supportive and shock absorbing function. Due to the high loads and pressure placed on the plantar fascia it can become painful, the nature of it being under the foot makes it difficult to manage on a day to day basis, often being very debilitating. When injured during the healing process new tissue is laid down, unfortunately this tissue (scar tissue) is less elastic with reduced suppleness, this physiological change leads to adaptive changes and mobility, as the scar tissue is stiffer with reduced flexibility.
Also when the plantar is stressed the load is transferred to the heel which can lead to pain and discomfort, at this point small heel spurs (bony protuberance) can arise where the plantar is attached. This results in pain when you weight bear over them.
It can occur suddenly but more often it develops gradually over a period of time.
What Causes Plantar Fasciitis
The cause of plantar fasciitis is not always clear, however, there are factors that are known to increase the risk of developing the condition.
If you are on your feet a lot of the time or do lots of walking, running and standing when this is not normal for you.
If you have recently started exercising on a different surface.
If you have been wearing shoes with poor cushioning or poor arch support.
If you are overweight, this puts extra strain on the heel.
If there is a sudden stretch to the sole of your foot.
If you have tight Achilles tendon and calf muscle.
What Are The Symptoms Of Plantar Fasciitis
Pain is the main symptom and can be anywhere on the underside of the heel. Pain is often worst when you take your first steps on getting up in a morning or after long periods of rest, where no weight is placed on the foot.
Gentle exercise usually helps ease the pain but being on your feet or going for a long walk often makes the pain worse.
How Do I Manage Plantar Fasciitis
What should I do in the first 72 hours after the injury?
As stated earlier normally individuals will present will a gradual build up of symptoms and if this is the case for you then this section is not relevant.
However, if your symptoms have come on suddenly then the most important initial treatment is aimed at controlling the pain and inflammation by following the principles of PRICE:
Reduce any further risk of injury, this can be altering training and exercise.
Complete rest is not advisable, but it is important that you prevent putting the plantar fascia under strain in the early stages of healing. The movements over the page should be done 10 times, within your limits of pain, 3 – 4 times per day:
There are many different ways in which ice can be applied. Whichever method you choose, it is important that you wrap it in a damp towel to prevent burning the skin. Ice should be applied for 20 to 30 minutes every two hours.
Please Note: Only use an ice pack on areas that have normal skin sensation i.e. where you can feel hot and cold.
Do not apply over an open wound.
Do not apply an ice pack to an area that has poor circulation.
During ice application check the skin every five minutes and discontinue its use if:
The area becomes white, blue or blotchy.
The area becomes excessively painful, numb or tingles.
If you have been given a tubigrip to wear, it is important this is removed if you develop any signs of poor circulation. Signs of poor circulation include pins and needles or numbness. In addition it should be removed when you go to sleep.
The ankle should be elevated above the level of the heart as much as possible, as this will help to reduce and prevent swelling.
Consuming alcohol, massaging the injured area and applying heat can all be detrimental in the early stages of healing and therefore should be avoided.
How is plantar fasciitis treated after 72 hours?
In most cases plantar fasciitis will get better by itself but it can take several months or more to go. There are a number of things that you can try to speed up your recovery and these are described below:
Rest and Exercise
Rest your foot as much as possible, avoid running, excessive walking and long periods of standing. However, do perform the specific exercises regular.
To ensure that you do not receive a skin burn please follow the advice, in the previous section, regarding the application of ice.
Wear supportive shoes and avoid going barefoot, wearing slippers, flip flops or backless shoes. Ill-fitting and worn shoes should also be avoided as they; do not support the foot, have reduced shock absorbance and may lead to increase strain on the plantar fascia.
To manage your pain it is advised that you regularly take simple painkillers which can be brought cheaply over the counter from your pharmacist. If you have allergies or conditions which prevent the use of painkilling or anti-inflammatory medication, please seek advice from your GP or a pharmacist.
When to seek further help
If after 10 days following your attendance at the soft tissue injury clinic and despite following the advice above, you are unable to weight bear and the foot remains painful, please contact the clinic.
The clinic will work to treat the condition and put in place actions to reduce the risk of re-injury.
There are three objectives to treatment and rehabilitation;
Reduced tension on the plantar
Increase resilience and load capacity
Support the foot mechanics and function
The difficulty is combining these objectives at the appropriate times,
A global approach
The body is complex, with many functional patterns and adaptive processes treating the foot in isolation is only part of the equation.
Alterations in lumbar spine, hips and knees influences how we move, this includes running. It is also worth noting neck, shoulder and mid spine function influences the lower spine, all combining to affect the efficiency of running and ultimately the load transferred through to the feet.
Treatment will consist of;
Exercises at the appropriate time will include:
Initially working specifically around the foot mechanics then integrating whole body function.
Recommendations for custom orthotics depending on gait analysis.