Written by Melissa Gibbins
We had a huge response to our Facebook livestream on plantarfasciopathy the other day which has prompted me to write this quick blog.
It seems that many of you are suffering from the persistent heel pain associated with the condition. You know the type I’m talking about, it almost makes you scream to put your foot down in the morning and you cross the room looking like you’re walking on hot coals. All whilst your family or (or pets) look on in wonder and confusion. They don’t understand because you didn’t actually injure yourself and often in 10 or 15 minutes, you’re walking around as though nothing has happened, until the next time you sit down, and the process repeats itself. This is a story I hear all too often in my consultations, people come in and say:
A tendinopathy such as plantarfasciopathy (plantarfasciitis is less accurate as itis’ implies inflammation which is often not present) is most often brought on by an abusive activity. Tendons are thick and robust connective tissue that connects muscle to bone, they are designed to deal with high and repetitive loading. Occasionally, the load may be excessive or too frequent and the tendon becomes stressed. When a tendon is stressed the cells repairing it change the basic structure of the tendon, this means it no longer tolerates the same loads as it previously could.
When I’m treating someone with these symptoms, I start the consult talking to the patient about things that may have led to their onset of symptoms. It might not seem like much at the time, maybe you went away on holidays and forgot to pack your orthotics, or went bushwalking in thongs, maybe you suddenly increased your shifts at work meaning more time on your feet or added hills to your training regime. Without doubt there is often an ‘ah ha’ moment in the consult where people will remember their preceding cause.
So now that we͛ve identified it, what are we going to do?
As a physiotherapist treating this condition, it is my role to have a look at everything you do in a day that results in loading of the plantarfascia. I’ll look at your feet and ankle, I͛ll talk to you about your footwear or orthotics, I ll ask about your employment, hobbies and training regimes (or lack of).
Essentially what I͛m trying to work out is, how am I going to unload the foot to assist with your pain relief. Quite often it’s the suggestion of a change in footwear (i.e. wearing joggers instead of thongs, yes even first thing in the morning!) as well as a change in training regime or other activity as appropriate.
In addition, I would look at what else is happening in your lower limb, do you have flat feet or high arches, is your ankle stiff from a previous injury, I will assess all the way up to your back just to rule out any additional cause or contributing factor. I do this because no two people are the same, where one person may get a tendinopathy from running on hills, another may have an onset when walking following an ankle sprain. For this reason, a full assessment is key. A one size fits all approach will not work!
Okay, so we͛ve worked out how to unload the area. This is where it gets interesting, because whilst I’m assisting you to unload I’m also instructing you to re-load the area. Whilst you work on removing the provocative activity, I’m m going to prescribe you specialised exercises involving slow and controlled loading to promote healing of the tendon. This is done by applying the right stimulus to the cells producing the tendon. In the case of plantarfasciopathy this ͞right stimulus is the often a modified version of the single leg heel raise, however for to stress the plantarfascia the toes are on a towel.
The basic formula for the exercise is to go up into the heel raise over 3 seconds, hold at the top for 3 seconds and slowly lower down over 3 seconds. This exercise is then repeated approximately 12 times, 3 times per day. The number of repetitions is then altered progressively, whilst load is increased to have a training effect on the tendon.
In addition to loading there are a range physiotherapy tools that can assist in your initial pain relief. These may include: compression socks, night splints, soft tissue massage and/or dry needling. Although these elements are known to decrease pain, they do not specifically address the tendon pathology. This is quiet often why plantarfasciopathy remains recalcitrant to treatment.
So now, you have the basic formula for how to treat a plantarfasciopathy. I will recommend that you always seek advice from a physiotherapist prior to commencing a regime such as the one described above. If you’d d like to have a physiotherapist assess and treat you plantarfasciopathy please don͛t hesitate to contact Wellness Embodied on 0488 588 470.
