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Fixing Your Feet: Plantar Fasciitis

It's been cited that as much as 10% of the population will experience Plantar Fasciitis during their lifetime - 10%! And within what population do we see an even higher percentage? Amongst you runners out there. Plantar Fasciitis, or perhaps more correctly Plantar Fasciopathy (it just doesn't sound as catchy), is something I see very regularly as an Osteopath.

What is plantar fasciitis?

Plantar fasciitis is inflammation, or more correctly, degeneration and thickening of the fascia at the base of the foot where it inserts at the heel bone. Common symptoms patients complain of are heel pain with the first few steps in the morning, pain with walking after sitting down or resting for a while, and pain that is often worse whilst barefoot on hard surfaces. Occurence of plantar fasciitis is shown to be higher in people that run, people with a higher BMI and people that spend long periods of time on their feet either standing or walking.

Why should you get a proper diagnosis?

It is important to get your foot pain diagnosed properly as there are so many other things that can be responsible for pain in the foot (I should know!!) and the faster you get diagnosed, the faster you can crack on with the right treatment and rehab. So, what sorts of things can also give us foot pain?

- Tendonitis / tendonosis

- Nerve impingement/ irritation

- Impingement

- Bursitis

- Fracture/ Stress fracture

- Benign or malignant tumours (rare)

..and these are to name a few. It's so important to get diagnosed by a healthcare professional such as an Osteopath, as they can often quickly tell you what exactly is responsible for your pain and if in doubt, can refer you for investigations such as MRI's and xrays. An important part of an osteopath's job is to then figure out why the plantar fasciitis has developed in the first place - if that dysfunctional pattern that led to the plantar fascia being overloaded to the point of failure has not been corrected/ altered, then the pain will keep returning. This is why simply resting and rolling out the fascia regularly can help in the short term, but as soon as you return to your normal sport or activity the pain often comes straight back, because technically nothing has changed.

Initial stages - getting pain under control

So in the early stages the most important thing is for us is to get pain levels under control, at this point it's often necessary to do that dreaded 'R' word.. REST. Depending really on pain severity and what we have concluded the main aggravator of your pain is, the amount of rest someone needs can vary significantly but it is pretty unrealistic to expect any relief without some level of activity modification. For many this does not mean you have to put your feet up and do nothing for several weeks, but merely adjusting your current routine temporarily, so don't panic!

Next, osteopathic treatment and rehab exercises can start to work on offloading structures that are shortened and overworked. Treatment will likely involve targeted massage and myofascial release techniques, mobilising and possibly manipulating joints of the foot and ankle, and perhaps kinesiotaping to help offload the plantar fascia. Your osteopath can also give you advice on things like footwear and orthotics.

Getting to the root of the problem

Osteopathic treatment and rehab exercises can now begin to resolve any biomechanical imbalances that were identified during your assessment. We have to take into account how the rest of your body impacts how you load your plantar fascia.

Unfortunately, as wonderful as the internet is (google gives me 550,000 results for 'plantar fasciitis' in 0.38 seconds), youtube cannot tell you that your bad ankle strain from 2 years ago has left you with ankle instability and calf weakness, or that your hip on that side is weak causing a valgus strain through the knee and pronation at the ankle, or that perhaps your hips and hamstrings are tight leading to more loading through your forefoot. Point is, we all have different bodies that are tight or weak or strong in different areas.. our bodies are unique and also how we use them is completely unique to us - some of us sit all day and some of us are always on our feet, some of us are aiming for a 10k or ultra or not running at all, some of us wear heels for work or live in flip flops! Because of this huge individual variation, there is unfortunately no one size fits all solution for plantar fasciitis - there may be some overlap with methods and exercises but your treatment and rehab really has to be specific to YOUR body.

Returning to sport or normal daily activity

The final stages of treatment are usually about trying to get my patients back to whatever it is they want to do pain free. By this point often patients are able to do most of their rehab at home and don't need to rely on lots of treatments, but it is important that you continue to work closely with your Osteopath to determine the right stage to re-introduce certain activities, as it is often a fine balance required between exercises that are loading the plantar fascia and a controlled, graded return to activity.

Thanks for reading, please feel free to share with your friends!


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