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Those dreaded first steps, the quick hobble that eventually smoothes out to some semblance of a heel-toe gait as the pain starts to ease. Plantar Fasciitis is the name you probably recognise. More formally we call it Plantar Heel Pain, but we're essentially talking about the same problem.
So how many bouts have you had? Does it eventually settle down with a good rest, only to flare up as soon as you try to start walking, running or playing sport again?
Here's a few things you might not know yet:
The Plantar Fascia is a broad sheet of fibrous connective tissue that originates from the undersurface of the heel bone, and extends forward, attaching to the bases of the toes (the 5th toe receives a separate, “lateral band”). It acts as a sort of winch, to help maintain the arches and turn the foot into a stiff lever, when we need to efficiently push off that foot, as in walking and running.
Plantar Heel Pain is a load problem. What does that mean? Whilst it doesn't actively move us the way that muscles do, it still functions under the load of our body weight, plus any gravitational forces applied to our body. So first up, anything that increases the load on the Plantar Fascia can potentially cause strain to the tissue.
Load problems can arise from the obvious, like weight gain and increased activity. But that doesn't explain why not everybody who gains weight, or increases their physical activity, develops Plantar Heel Pain. So what else is happening to cause it? Or stop it from recovering completely?
The Plantar Fascia has a tear.
This can usually be confirmed by a diagnostic ultrasound. In the clinic, taping the foot can be a useful way to determine if an ultrasound is warranted; pain that doesn't improve significantly with taping is suspicious for a tear.
Scans or clinical testing have ruled out a tear, suggesting a muscle dysfunction problem.
The muscles that predominantly act on and influence the Plantar Fascia are the calf muscles. In fact, the Plantar Fascia is a continuation of the connective tissue that attaches the calf muscles to the heel bone. The calf muscles lift us onto our toes (plantarflexion), help maintain our upright posture in standing, and are the first line of shock absorption when our feet hit the ground. They even act as a pump on our leg veins, to help return blood to the heart! They're a busy, hard working group. And the harder they work, the more tension they apply to their neighbouring tissue. This is why calf muscle tightness is closely linked with Plantar Heel Pain.
So what can we do about this?
1. We can, of course, try a number of hands-on treatments to help relieve the pain. But that probably isn't news to you. Every single patient I've treated with Plantar Heel Pain has rattled off every manual therapy technique they've received in the past. It undoubtedly gave them a degree of relief at the time, but it's rarely been a long term solution on its own. However….there's a difference between massaging a site of pain, and releasing the tension in a muscle that's creating the pain. So let's not throw the baby out with the bathwater.
2. We can figure out what might be causing the excess tension that's putting strain on the Plantar Fascia. Is the calf muscle dealing with more load than it should? What isn’t taking its share of the load?
3. We can retrain the muscles that haven't been firing. This will reduce the load on the overworked calf muscles, and therefore the tension and strain around the Plantar Fascia. The best chance of success here is with using a Graded Exposure Rehabilitation Plan. Graded Exposure is a way of reintroducing activity at a pace that doesn't flare up symptoms, but steadily progresses you toward your end goal. It doesn't allow for short cuts, but when done properly, it builds a meaningful and long term recovery.
So if you're done with the constant relapses of Plantar Heel Pain, and you're looking for a more permanent solution, book an appointment and take the first steps towards happy, pain-free feet!
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