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Plantar fasciitis; causes and treatment

Management and Treatment of Plantar Fasciitis (heel / sole of the foot pain)

This condition is a common cause of heel pain in adults. It typically presents as significant pain with the first few steps taken after rest or first thing in the morning. It is usually self-limiting, (resolves by itself) but that depends on the cause and also the lifestyle of the sufferer, as a maintaining factor. However early intervention can help the condition to resolve sooner than is typical.

The causes of plantar fasciitis are many but tend to be related to a swift change in activity, like going from running 5km to 10km with no build up over time or going on holiday and suddenly walking barefoot or in flip-flops everyday when this is not a typical activity. It can also happen to people who spend a lot of time on their feet as part of their profession: chefs, window cleaners are two examples I have come across. Part of this picture can be related to type of shoes used. In the case of the window cleaner, spending time on the steps of a ladder in trainer-like shoes rather than solid boots was part of the problem. Weight gain can also contribute.

Examination tends to reveal a specific sore spot on the front edge of the heel, with tension in the connective tissue and the tend of the muscle that bends the big toe. The latter can mean that the foot does not travel in its ideal way when walking, leading to a slight flattening of the arch rather than creating the rigidity needed especially at toe-off (when the toes leave the ground).

In addition the movement at the ankle may be reduced either by natural stiffness in the joint or caused by tight calf muscles. When running is involved in the onset, one can also find that the muscles of the bottom (glutei) are weak at the landing phase, leading the knee to drift inwards, which alters the foot position, putting strain on the arch.

Osteopathic treatment of plantar fasciitis is multifactorial and involves both stretching and strengthening.

Hands on work will include mobilisation of the foot and ankle joints, soft tissue work to muscle and connective tissue of the whole leg and even some mobility work to the pelvis and low back.

Stretching is targeted to the big toe, the sole of the foot and the calf muscles.

Strengthening is targeted at the muscles of the sole of the foot, the calf muscles and the bottom muscles.

Intervention with an orthotic (insole) in the shoe can help the arch during the recover process. This helps support the arch so it does not drop and over-stress the tissues on the sole of the foot. It can also help with the foot position at toe off.

Ideally, if running is an issue then some time should be spend on developing the right muscular control of the whole limb, from top to bottom and even looking at running style, stride length, etc. There can even be some interventions in walking style and leg gym-work.

Exercise is still possible but ideally in a reduced or non-weight-bearing capacity like biking or swimming, Cross trainers or elliptical trainers may also be OK but it does depend on the severity of the problem and how long it has been going on.

It is difficult to say how long this condition can last as each person is different but the use of the above protocol can only help with both recovery and also prevention of recurrence.

There are surgical interventions for the really stubborn cases but these are not considered until all other conservative options have been exhausted.

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