Image source: http://bodyinmotionchiropractic.com
- Do you have heel pain that feels like you are standing on glass with your first few steps in the morning or after arising from sitting?
- Does it feel better when you are wearing soft shoes and worse when walking barefoot on hard surfaces?
- Does your heel ache after a long day of standing and walking?
You may be experiencing plantar fasciitis, which we now correctly refer to as plantar fasciopathy.
This heel pain is widely known as plantar fasciitis (‘itis’ – inflammation) as previously health professionals thought that the pain was caused by significant inflammation of the tendon at its’ attachment to the bone.
Latest research has proven that although there may be an initial inflammatory component the main problem is due to changes within the makeup of the Achilles tendon and plantar fascia complex.
A change within the structure of the Achilles tendon and plantar fascia complex is the source of pain in plantar fasciitis (fasciopathy).
Fascia and Tendons transfer forces from the muscles to the bone to allow us to move. So when you run or jump, the plantar fascia transmits the forces of the calf muscles to allow push off while stabilising the ankle joint (9 x body weight when running). Sometimes in life there is a change in activity or ‘load’ on the lower limbs which affects the load through the tendons eliciting a significant change.
There can be a spike in training (such as ramping up running for a marathon in 2 months time) or a relative unload through sickness, extended holiday or even a change to low load activity such as swimming from running. Sometimes the change might be due to different footwear (from boots in winter to thongs in summer) or a change of job that requires prolonged standing all day.
Whatever the reason for the change in load the pain will come on 4-6 weeks later.
What we know:
- Tendons & Fascia don’t like to be compressed (avoid hard surfaces/footwear, rolling spikey balls or ice bottles underfoot)
- Tendons & Fascia are best not to be stretched (avoid calf stretches)
- Tendons & Fascia respond to gradual loading
- Anti-inflammatory medication doesn’t fix anything
- Orthotics don’t really help
To treat Plantar Fasciitis (Fasciopathy) physiotherapy will:
- Take a thorough history from you to determine what change has occurred affecting the loading capacity of the plantar fascia
- Discuss load management and decide what sports/activities will need to be modified in the short term
- Discuss how to modify habits in your life that are aggravating the heel pain
- Develop a graduated, specific strengthening program of the achillies/plantar fascia complex
- Commence with pain relieving exercises
- Move to early strengthening exercises
- Progress to heavy loading
- Introduce impact exercises
- Return to previous exercise
Pain relieving exercise is the 1st stage of treatment, holding the position of a heel raise.
Once pain has settled, move onto weights, fascia and tendon need heavy weights to stimulate the tissue to adapt and get stronger.
Then progression to plyometric (bounce) exercises.
Gradually load, guided by pain, to return to your exercise. It can take 3-6 months to get to this point, but by specific exercise you will strengthen your plantar fascia.
If you have been walking on glass first thing in the morning and your heel pain is now affecting your ability to exercise, you probably have plantar fasciitis, which is now correctly termed plantar fasciopathy. Physiotherapy directed specific fascia and tendon exercises will allow you to get back to your favourite activities. Doing nothing will change nothing. You need to reload gradually and get back to ‘Moving to Better Health’ with Active Solutions Physiotherapy.
