Plantar Fasciitis, it’s one of the most common symptoms we treat as Physiotherapists and Pilates instructors. It is also one of the most common symptoms patients complain about not being able to fix, despite having seen “every health professional known to man.” We want to shine the light on why your plantar fasciitis treatment hasn’t worked to date, and give you the solution!
It all starts off with understanding that the Plantar Fasciitis pain you might be experiencing is so often caused by something completely different to your neighbour! Same symptoms… different cause!
To understand Plantar Fasciitis let’s first start with some anatomy…
What is the role of the Plantar Fascia?
The plantar fascia is the long, strong band of connective tissue that runs from the bottom of your heel bone along the sole of your feet to the base of your toes. Its role is to protect the sole of your feet from injury as well as supporting/ stabilising your arch. Tension in the Plantar Fascia is a good thing, it should be created during “push-off” stage of walking (this is known as the “windlass mechanism”) as well as flattening of the arches (for example when you descend into a squat). It is this tension that helps to stabilise the foot and allow the ground reaction forces to be transmitted up through the rest of the body.
However, you can have too much of a good thing. If you put too much tension through the Plantar Fascia it can cause inflammation of the fascia and just like anything in the body, this excessive tension is often caused by activities that involve repetitive tension.
The repetitive tension may be external in nature, such as inappropriate foot ware or a sudden increase in activity (for eg: going on a long hike without doing the appropriate physical training). It can also be caused from poor loading of the plantar fascia in normal day to day activities, for example poor foot biomechanics, such that even a few simple steps done incorrectly day after day week after week result in excessive tension through the Plantar Fascia.
What is Plantar Fasciitis?
We diagnose this increase in tension and inflammation as ‘Plantar Fasciitis’ once the inflammatory pain becomes acute near the heel, where the plantar fascia inserts into the heel bone. This overuse can be from a variety of factors.
What does treatment look like?
The first stage of treatment for plantar fasciitis is to address the inflammation in the plantar fascia. Depending on the severity of the inflammation, this can be through ice or anti-inflammatory medication (such as NSAID or corticosteroid injections). Once Inflammation is addressed, treatment should focus on what is straining plantar fascia in the first place (such as inappropriate foot wear, or if you are walking in a sub-optimal movement pattern).
Often, there are abnormalities in the feet such as Pes Cavus and heel spurs that are the root cause leading to sub-optimal foot biomechanics and excessive strain on the plantar fascia. If this is the case, it is often helpful to use interventions such as orthotics and taping while the inflammation is settling. These interventions will act as a temporary bandage to the situation to help hold the foot into an optimal position and protect the plantar fascia from further irritation during the initial stages of rehabilitation.
Once the inflammation has subsided, the focus of treatment should shift to whole body mechanics and gaining a clear understanding of what caused the non-optimal biomechanics in the foot in the first place. At BPS we do this through a method of Physiotherapy know as ConnectTherapy (you can read more about this approach here).
Where does treatment go wrong?
Remember when we said, ‘the focus of treatment should shift to whole body mechanics’. That is basically where all treatments go wrong. In 90% of cases this crucial step is missed. Sometimes it’s missed because the treating practitioner doesn’t assess whole body mechanics. Sometimes its missed because the patient doesn’t complete the full treatment protocol.
Either way, this step doesn’t get done. So in effect, the inflammation in the plantar facia starts to build up again and before you know it, you’re back to experiencing the debilitating heel pain with your first few steps every morning.
The solution? Ensure that once you have done the work of addressing the inflammation with ice, NSAID’s, CSI, Taping, Bracing or other interventions, that you immediately start focusing on addressing the true biomechanical issue! It is only once this is addressed that you will truly be free from plantar fasciitis for good!