Plantar Fasciitis

Plantar Fasciitis is a painful condition, affecting the area between the heel and the arch of the foot. The pain is typically worse in the morning, or after periods of inactivity.

What is plantar fasciitis?

The causes of plantar fasciitis are not well understood. You will find that people will suggest it is an inflammatory process of the myofascia, the fascia that runs from the heel (the calcaneal) to the forefoot. Others will say it is a degenerative process. It is associated with repetitive or ballistic exercises, and being overweight.

It can take time to emerge. The degeneration can occur over time if, for example, you are running multiple miles a week. That degeneration will set in over years, which in turn can lead to inflammation. This may build for some time and then eventually it causes pain

What are the symptoms of plantar fasciitis?

Plantar fasciitis is characterised by pain from the calcaneal spur (the point of the heel), straight down into the mid foot. Most people will feel a deep pain at the heel or arch in the morning, or when they have not been moving for a while.

What happens when plantar fasciitis gets worse?

Initially, it may be possible to “walk off” the pain. As the condition becomes chronic, the pain takes longer to fade. Where initially the pain may start to fade after a short period of activity, such as a few steps, chronic plantar fasciitis may not fade. It may also spread further towards the front of the foot.

Can you get plantar fasciitis in both feet?

Plantar fasciitis can occur bi-laterally, but generally it will just be in one foot. There could be a number of things that contribute to that. The biomechanics of the hips and knees play a role in how effectively the foot is being used.

Other factors that may be relevant include:

Which foot is dominant;
The shoes that you are wearing; and
Over-pronation of the foot

How does plantar fasciitis occur?

The achilles tendon wraps under the calcaneal, so can have an impact on plantar fasciitis. Likewise, imbalances through the calf muscles, including the gastrocnemius, the soleus muscle, the tibialis muscles, tibialis anterior, may have an impact on the emergence of plantar fasciitis. As these are overworking or underworking, it can lead extra stress through the plantar fascia.

Who is most at risk from plantar fasciitis?

Plantar fasciitis is very common in runners because running is very linear. The repetitive strain, from repeatedly pounding the ground, may lead to pain. Several factors contribute to this, such as gait, how much pressure you are putting through feet, and any imbalances. It also occurs in high impact, ballistic sports, such as basketball.

However, it also frequently occurs in non-sports people who are inactive, such as middle aged women and those who are overweight. There is no scientific evidence that suggests why.

Kube Medical | Plantar Fasciitis foot rolling

What happens if you ignore plantar fasciitis?

Early treatment is ideal for resolving plantar fasciitis. After the first two weeks of plantar facia pain, the issue starts to become sub-acute or chronic and it's so much harder to get on top of it. There is also the risk that degenerative changes will occur, which cannot be treated. Ideally we would want to have it at least examined to determine what is going on before this happens.

How to manage plantar fasciitis at home

Rest: Like tendinitis and tendinopathy, the more a plantar fasciitis sufferer uses their foot, the worse it will get. Rest is therefore important. While it is unrealistic that people would stop walking altogether, this should be limited as far as is possible. The way people moved should also be adapted to avoid putting excessive force through the area.
Ice: Icing the area helps reduce the inflammation and ease pain. This should be done regularly throughout the day.
Massage: This can help break up the adhesions that occur within the plantar fascia and also ease the pain. Massage also stimulates blood flow and promotes healing.
Stretching: As there is a relationship between the plantar fascia and the calf muscles, gentle calf and shin stretches can help ease the symptoms.

Icing and massage can be combined. We can use certain techniques like a patty roller, a concave device which you store in the freezer. Every half hour, especially if you are sitting at a desk throughout the day, roll the foot backwards and forwards over the roller for a couple of minutes at a time. If you don't have access to one of those, use a plastic bottle filled with water. Once it is frozen, use to as a roller for your foot. That soft tissue technique will start to break things up, loosen up plantar fascia and start to help.

How can plantar fasciitis be treated by a chiropractor?

In terms of treating the immediate symptoms of plantar fasciitis, massage, soft tissue release and stretching would be used to ease the pain. Shockwave Therapy has also been shown to have some success in reducing plantar fascia pain.

A chiropractor would likely look more broadly than the site of the pain, and would aim to address musculoskeletal imbalances throughout the body that may be contributing to the patient’s foot pain.