Plantar Fasciitis can make you really miserable – it stops you from walking or moving normally. It can take a long time to stop / solve. It is usually associated with gait changes – brought on my your shoes / foot posture, extra loading on the foot mechanics or an injury.
The pain is typically around or under the heel. It can be especially noticeable at the front of the underside of the heel – where the fascia goes from being bony to softer tissue – as it is due to over-stretching and inflammation in the thickened ligament-type tissue of the fascia, which goes from the heel, along the sole of the foot to the base of each toe.
It is often worse in the morning when the sole had not been moved and stretched much with walking, and due to the fascia shortening a little over night.
Osteopathically, I often find that it is associated with
- calf pain and increased muscle tightness
- heel pain around the Achilles tendon
- a mal-aligned ankle joint (Tibio-talar)
- overall tendon tightness
- A displacement of the upper fibula joint articulation just under the tibial plateau by the knee
- an inability to fully dorsi-flex your foot – bring your toes upwards towards your knee
- a noticeably shorter leg length on one side
- unusual gait patterns or use – can be related to your foot wear eg military boots
- is more susceptible in the leading foot when walking
- low back spinal issues
I should add that not all of these are associated with every clients’ symptoms – but they are found quite often. This is why a personalised, unique-to-you Osteopathic consultation is so important. Your plantar fasciitis is not the same as anyone else’s!
Other factors which can play a part are pregnancy – when the weight distribution changes quickly over time and the ligaments get more lax. Obesity will aggravate the situation (in 70% of individuals this is a significant risk factor) and poorly fitting shoes.
Treatment with an Osteopath will involve looking at ALL of these factors and more – some of which may originate from far away from the feet! By normalising the structural components and helping the blood supply and lymph drainage (which is notably poor in tendons and ligaments – hence anti-inflammatories are also not especially effective for many people) we can get a better working environment for the foot.
Frequently known as “Jogger’s foot” as it is such a common problem, along with shin splints, which are a related symptom one of the main basic treatments is to rest and stay off weight-bearing for a while. Sometimes a heel lift so that the ankle and foot do not have to be at such an acute angle helps initially and can be normalised over time later.
Often it is a short-lived problem – with many cases “spontaneously” resolving over about a year – but obviously everyone doesn’t want to wait that long! Nor should they have to.
Icing the effected area is also recommended although in my experience it doesn’t make that much difference. It’s raison d’etre is for reduce the inflammatory processes – but the tendons are very deep to the sole! Sometimes alternate hot and cold treatment works better.
Directly applied anti-inflammatories can help – sometimes called non-steroidal anti-inflammatories (NSAID’s) – spays, gels, creams etc. These are NOT the same as muscle relaxants though.
Occasionally wearing a splint at night will help as they support the foot posture.
Wearing orthopaedic shoes (ditch the high heels!) can work wonders. Better shock absorption and foot support, plus keeping the foot in better alignment will all help. They can be expensive though – but think how much you wear a shoe?! I can advise you further on what to wear and what to look for.
There are various, toe, foot and calf stretching exercises which you can be given. Although painful to do, over time they really help. Especially important to do first thing in the morning.
Following on from these localised exercises are stretching exercises for the whole body – as everything is connected to everything else! The feet are really not an “island”!
Orthotics – these are shoe inserts which change the way the foot mechanics work. They are an effective, adjustable and inexpensive short term solution for many. I can advise and provide them or see a chiropodist / orthotic specialist who is good with managing foot dynamics and further up the body at the same time.
There is also the possibility of having a steroid injection locally into the sole of the foot – to try to resolve deep inflammatory reactions! These are painful to undertake, not successful if the Consultant misses the exact spot and may not work even if they do. As a result I rarely recommend that you get referred by your GP to an Orthopaedic Surgeon.
If you wish to make an appointment to get your plantar fasciitis / heel / foot pain looked at by an expert and in detail – make an appointment to see Gayle Palmer D.O. right away!
You can book directly online here:
Do NOT put up with this horrible symptom – it takes time to resolve in the same way that they take time to develop… “hoping” that it will “Go away!” is rarely the answer.
If this has helped you understand about it better – please comment on the post below. Thank you.
© Gayle Palmer / Living Elements Clinic
Here is the accompanying video for you, and after that – the transcript.
PLEASE forward it on to others who may be helped. Thank you.
The long awaited video on PLANTAR FASCIITIS.That's a pain in the sole of the foot, most commonly!Blogpost on website..
Posted by Living Elements Clinic on Monday, 30 September 2019
PLANTAR FASCIITIS – the transcript
By Gayle Palmer
Good morning. This is Gayle Palmer from the Living Elements Clinic in Sidlesham and I am an Osteopath. Today’s video is about Plantar Fasciitis.
What is Plantar Fasciitis I hear you say?
Well, it is a really painful, somewhat debilitating condition which causes pain on the sole of the foot and around the heel most typically. It can stop you walking properly because you are unable to use the movement in the sole of your foot and your foot mechanics properly. The plantar fascia is an area of really thickened tendon and ligament which goes from inside the heel of the heel and attaches to the bone at the back of the foot and then goes forward along the sole of the foot deep in the base of the foot to all of the toes. It causes inflammation and it has an excellent nerve supply but poor blood supply so it is very good at producing inflammation, but not so good at healing because it’s blood supply is less well attributed.
It can result in lots of day to day changes which is not good when you want to walk and is often called a “Jogger’s heel” because it is often brought on by extra stress and pressure as you are weight bearing.
It can be aggravated by a whole range of things:
- Poorly fitting shoes or boots, so see it quite often in the military;
- if you increased your work load substantially – so you gone from being fairly sedentary to suddenly taken up five mile jobs to get fit and that will cause problems for you often.
- For me, there are few things that I see typically in practice which occur along with the plantar fasciitis. You get a lot more muscular tension in the calf muscles, the gastrocnemius and soleus, and also around the Achilles tendon which is a tendon which attaches to the back of the heel and that can be exquistely the tendon as well. I find this often a malalignment in the tibio-talar joint which is the joint between the tibia, the long bone in the leg and the talus which is the first articulation and it accurate like this. So, this here is the tibia, this is the talus and that is the ankle movement that you are getting. You often find this malalignment in that articulation which then stresses the rest of the foot dynamics.
That, along with that, there is often the problem with the fibular attachments and the fibula is the knuckle bone on the outside of your ankle. Either right down the bottom of the foot or further up by knee.
You cannot fully dorsiflex the foot. It already goes so far and that is not necessarily restricted by pain. It is actually a physical restriction.
It is much more common, I find in whichever foot to lead off from. So, if you are right footed, you tend to lead off on your right foot. So, it is more like occurring in that foot. As that is your leading foot. So, that is an interesting foot, isn’t it?
Although I said all of that, those are the findings that I have most commonly.
The thing about plantar fasciitis is that it is individual in every single person. There is no one solution that will solve it for everybody.
It tends to be relatively self-implementing, last a year or so perhaps and there are various factors that definitely make it worst.
So, pregnancy, because you ended up with an increase amount of fluid around the area.
Obesity, you got more weight bearing,
Direct trauma, so jumping, shoes, that sort of thing and postural differences. So, if you have a short leg on one side, your weight bears differently.
If you have spinal problems further up, that can then affect the posture in your legs and feet, and that will increase the likelihood of having problems.
All sorts of things can make a difference.
Icing, although I found that not very effective because the tissues are really deep into the foot and it is
fairly temporary but lots of people recommend it or a variety of hot and cold compresses can make a difference.
Directly applying anti-inflammatories can make a difference with gels, creams. In extremis, I have had patients who have had steroid injections from the orthopedic consultant. I genuinely do not know if they make that much difference to be fair. The injection has to be extremely so specific, you missed it by a tiny amount and it does not make any difference and they tend to wear off as well. So, I think over time, a conservative treatment makes the same amount of differences as having an injection although it you probably feels a bit more traumatic so you might feel a bit better as a result with the placebo effect.
Wearing properly fitting orthopedic shoes makes an enormous difference. I know flip flops and other supportive shoes definitely aggravate it. Getting shoes that fit comfortably around the heel can help.
Sometimes, wearing orthotics will also make a difference. Those are inserts that you put into the foot which changes the shape of the arch or how your rotation is in your ankle, that can often make a difference and I have those here in the clinic. Sometimes wearing a splint at night to help support the foot helps. Definitely in the early stage, not having really flat shoes because when your foot at that time go, you cannot do that dorsiflex enough so the risk is not the same. You are stretching out those solar structures. If you have a slightly raise heel, then it’s not getting stretched quite so far. So, sometimes wearing shoes with a slight heel makes a difference and then over time, as things resolve, you can lower the heel and start working better on the flat.
There are all sorts of exercises that you can be given, but particularly working around the calf and the ankle area, sometimes they make a difference, sometimes they do not. But osteopathic treatment definitely helps.
If you or friend have plantar fasciitis, and you wanted to be looked up by an expert who is used to do with this horrible problem, because it really can bright your life, then give us a call at the Living Elements Clinic, you can go to the website, www.livingelements.co.uk and I also written a blog about this, so if you want to find out more, have a look at the blog on the website. Thanks very much. Take care for now. Bye-bye.