Posted on 8th October 2016 by Fiona
We are seeing and hearing from an increasing number of people who are suffering with quite debilitating pain on the sole of their foot. This common complaint is often the result of a condition known as Plantar Fasciitis.
Interestingly, over the last week I’ve met 8 people hobbling about with this painful foot condition and not one of these people were aware of what physio could do for plantar fasciitis.
So today’s blog is to educate you about plantar fasciitis and help you banish it for good.
What is Plantar Fasciitis?
Fascia is connective tissue which is found all over the body in various forms for different functions. It’s most common forms are sheaths surrounding muscles and ligaments to compartmentalise and protect these tissues or thickened fascial bands or sheets in certain areas of the body.
The plantar fascia is a thickened sheet of fascia on the sole of the feet, running from the inside base of the heel bone and fanning out into the base of the toes. It’s elasticity gives us a spring in our step when walking or running.
Plantar fasciitis is an overuse injury to the fascial sheet on the sole of the foot.
Causes of Plantar Fasciitis
The main cause of plantar fasciitis is caused by
the plantar fascia being put under excessive stretch for prolonged periods of time. This can happen for example when your foot arches are too flat, so that as you push off when you’re walking or running the fascia excessively overloaded and stretched. Over time microtrauma, injury and pain result.
The foot can also be termed the “rubbish bin” of the body, where asymmetries further up the body can result in compensations in the foot. The body will compensate up to a point, but due to the excessive forces during the propulsion as you move that go through your feet, the foot may adapt by stiffening up and thickening of the plantar fascia. So sometimes, it can be something going on further up the body that may put too much stress on your foot, that will in turn cause this problem.
Plantar fasciitis is normally felt as a pain on the bottom of your foot, sometimes going into your heel.
Unfortunately plantar fasciitis is often confused with another foot problem called calcaneal bursitis heel pain). Without a thorough examination, most plantar foot problems are diagnosed as plantar fasciitis.
So a quick test you can do yourself to indicate whether your foot pain is plantar fasciitis or not is to see which is more painful; walking on your tip toes or your heels.
If it is painful to walk a few steps on your heels, you may have an element of calcanea bursitis. If it’s more painful too walk on tip toes (stretching plantar fascia), it’s likely you havre plantar fasciitis.
Why is it so painful 1st thing in the morning or after I’ve been sat for a while and then get up?
Plantar fasciitis is usually painful after a period of rest. The reason being is that when you’re sat for a while or asleep in bed, the fascia is off loaded and re-tightens. When you get back up on your feet, you are re-stretching the tight, painful fascia. It may ease a little as you start to move around as it effectively ‘warms up’ and stretches.
What can affect recovery?
There are many factors that will affect the speed of recovery. Seeing an expert Physiotherapist who has a wide range of experience treating lower limb overuse injuries is vital to identify all the factors and work towards removing or modifying the triggers unique to you.
The most common triggers for foot problems such as plantar fasciitis are:
Biomechanics It’s crucial to assess whether your foot and leg biomechanics (e.g. flattened arches, knocked knees etc.) are contributing to your injury and may need correcting. Here at goPhysio, our Physio’s can do this quite easily as part of your initial session by combining their physical assessment findings with performing a computerised foot screen using our cutting edge Gaitscan system.
Training Patterns and Intensity If a runner or keen walker has the condition, it’s vital to look at the historical loading of the fascia and modify their training schedule to a level that allows the condition to heal. Without breaking the cycle, the tissues won’t be able to recover. However, we like to keep people doing what they love, so rather than advise complete rest, we try wherever possible, to modify your activity or suggest alternatives in the short term that will promote recovery.
Lower Limb Stability Often muscle imbalances further up your body in your knee, hip or pelvis, will have an impact on the foot. As part of your recovery we will always address these elements too to help prevent re-occurrences.
Age Research suggests that older people experience more severe and more prolonged episodes of inflammation and pain. So, if you’re 40 years plus and enjoy an active lifestyle, your pain is unlikely to settle with just rest. It will be easily aggravated when you resume normal activities, as the cause and actual injury hasn’t been addressed.
Footwear Unsupportive, flat, old, worn out shoes or trainers can both contribute to causing plantar fasciitis and will inevitably prolong the condition.
At goPhysio, with a condition like plantar fasciitis, we always treat the condition as part of the bigger picture. Not only will we treat your foot itself, but we will look from the foot upwards and from the hip downwards, ensuring we leave you with no issues that will contribute to a re-occurrence.
Having identified all the factors unique to your condition, we will then address and correct them in parallel with hands-on physiotherapy treatments and education. It’s crucial to manually release the tight thickened plantar fascia with a variety of release techniques. You will also be provided with a bespoke home exercise programme for you to self treat at home and speed up your recovery in-between physio sessions.
We can also asses you to find out if you’d benefit from orthotics. In most cases of plantar fasciitis there is a biomechanics component that needs addressing. This can be achieved with orthotics. As outlined above, fattened arches will lower your body’s ability to cope with loading either from day-to-day actives or sport. At goPhysio we use a technologically advanced system called Gaitscan, which uses computer scanning to analyse your moving foot Combined with a physical assessment, the physio can identify if you’d benefit from wearing orthotics and subsequently discuss the range of options available to you to get you back on your feet a quickly.
If you think you may be suffering with plantar fasciitis or you have foot pain and aren’t sure what exactly it is, just give us a call on 023 8025 3317 or book an initial physiotherapy appointment online.
We can also offer you a free computerised foot analysis to see whether you’d benefit from orthotics. These analyses are completely free with no obligation. Call and quote Free Gaitscan to take advantage of this offer and find out whether orthotics could help you.
Posted on 30th June 2016 by Fiona
R.I.C.E. or P.R.I.C.E. principles are well known ways to help treat an acute soft tissue injury, such as a sprain, strain or bruise, in the early days. The acronym stands for rest, ice, compression, elevation.
However, what’s not so widely known is that in recent years, the R. (Rest) element has been replaced with O.L. (Optimal Loading).
Why the change?
Some rest initially can be beneficial, immediately after suffering an injury, but only for a very short period of time. What research shows is that early mobilisation (loading) stresses tissues in the correct manner for full recovery, whereas rest can actually impair optimal recovery of soft tissue injuries. Too much rest and you’ll quickly develop joint stiffness and muscle weakness.
Some injuries may require some ‘Protection’ such as using crutches for a few days, just to take the weight off a severe ankle injury, or a splint or brace for a wrist, ankle or knee. This will help to unload the injury enough to avoid further aggravation but still allow tissue stress to help with healing. But use of such protection should be minimised as inevitably you won’t be loading the area if it’s totally protected.
The hard part of this is correctly identify what exactly constitutes ‘Optimal Loading’, as it is different for different tissues and body parts. You can often use common sense, don’t be afraid to move and use the injured area within your own limits of pain. A mild pain is to be expected but anything more and you’re probably doing too much. You need to make sure that you keep progressing what you are doing, as this will help your injury heal better and longer term help prevent re-injury.
This is where seeking help from a Physio is great. A physiotherapist will combine their knowledge of the stages of healing with what you should and shouldn’t be doing to ‘load’ your healing tissues. They will give you a tailored and progressive exercise programme to make sure the healing tissues are given the optimal chance of long term recovery.
As with any injury, always seek medical advice if you are worried or concerned or want to get it checked out before starting any self directed management.
Some of the research: