The podiatrists here at APC are currently seeing many people complaining of foot pain. Most are referring to this as plantar fasciitis. This is the case with the store staff to, with customers hoping that a new pair of shoes solve the problem. Yet, in a number of cases the pain they are experiencing is not plantar fasciitis. Colin Papworth, APC Podiatrist, takes us through the Plantar Fascia and fasciitis.
Plantar fasciitis is a term often used to describe a pain in the foot. It is so often misdiagnosed, which in turn can lead to an ineffective treatment plan.
Foot pain can be debilitating, stop us from running, or any weight bearing for that matter. So, a correct diagnosis is imperative, as is an effective treatment plan that not only deals with the pain and injury itself, yet also deals with the cause. We recently had a situation whereby what was thought to be platar faciitis was a much more serious DVT!
Assessment to confirm a correct diagnosis is critical!
Pain from plantar faciitis is most commonly considered to be the point at which the planar fascia meets the heel pain. Pain originating from elsewhere within the foot is likely to be something else. Either way there are a range of treatments that can help.
What is the Plantar Fascia?
The plantar fascia is a big thick band of strong tissue that comes from the toes and metatarsal heads which narrows down to the inside edge on the bottom of the heel bone.
It has two jobs to do when we are moving – jumping, walking or running.
Its first job is to help support the foot when we stand on our feet. It takes the load from our body weight pushing down onto the foot It almost acts like a tie bar between the heel and forefoot to stop the foot from completely dropping through the arch. Our foot arch needs to drop and the foot has to become mobile to work as a shock absorber and adapt to the ground we are standing on.
Its second job is to help the foot become stable as we move into the push off phase of our movement. As the big toe joint bends this movement tightens the plantar fascia around the big toe joint and causes the arch to lift and become more stable.
So all in all its a pretty important structure of the foot.
What Causes Plantar Fasciitis?
Plantar fasciitis can often occur for a number of reasons.
The most common cause of Plantar Fasciitis is a ‘repetitive strain’ injury
1) The most common is a ‘repetitive strain’ injury – that is when the structure has been subject to a continual or ongoing overload. This could be caused by a case of ‘to much to soon’.
2) Sometimes the big toe isn’t bending properly and the arch doesn’t lift correctly as we move into the push off phase of the gait cycle.
3) Sudden trauma such as a big leap that puts excess strain through the plantar fascia.
4) The arch is unable to drop enough so tension and strain builds.
A classic symptom of plantar fasciitis is pain when first standing up and not wanting to put the heel down. Often this can ease with movement yet will quickly return. In addition the calf can become sore and tight as a result. It can all be very painful and uncomfortable.
Self Help…
The first thing to do is de-load. That is to reduce what you are doing. So cutting back for 5 or so days can be very beneficial, especially during the very early stages. Walking instead of running, perhaps a run – walk – run will be the way to go. Remember to build back up slowly.
There are also a number of stretches that can help, which will often depend on the severity of the problem. Calf stretches are a good place to start. This should be done two or three times a day.
Another good idea is to ensure your running or walking shoes are not wearing out. If so get them replaced.
Getting Help…
If you are still experiencing pain and it is still the in the first month of pain then getting a massage (soft tissue therapy) would be the way to go. Seeing either Oliver or Issy here at APC will also ensure you are given a number of self help ideas that you can complete at home.
For anything that is longer term (more chronic), beyond 8-weeks, then we would recommend that you see one of the Podiatrists, either Abbie or Colin. You will now need a thorough assessment to identify what is going on and how to treat not just the pain, but what is happening. Also, it is likely you will need help with any compensation that may by now be causing or about to start creating a whole new set of problems.
Treatment…
This can vary by person to person and will dependent upon severity and for how long it has been left unchecked.
Manual therapy of the foot can help relieve pressure to start getting structures moving again in the way that they should. This can also include Ankle and Foot Mobilisation. This would be coupled with a discussion about getting moving in a controlled and effective way. This is often referred to as a ‘Loading Program’.
A footwear check is also a good idea and bringing all your shoes along to your appointment is a good idea. Not just your running and walking shoe, bring things like your work boots with you.
Orthoses or insoles can also help. These can be really helpful with de-loading the structures of the foot and to encourage improving movement patterns.
As you move through your treatment a gait check (walking or running style) can be beneficial to ensure this is not contributing to the injury. From there changes can be made to help prevent this from happening again.
As with all these things if other factors are considered to be impacting on the cause, or prevention, you may be referred to others for a more bespoke treatment plan.
Summary
So a pain in the foot may or may not be plantar fasciitis. Yet, leaving it unchecked can cause more pain and disruption to training or daily life.
If this is still within the first 4-weeks of discomfort and you can still move around freely or training lightly then we would suggest you see Issy or Oliver (soft tissue therapy) for treatment.
If it is beyond the 4 weeks then you should see either Abbie or Colin (Podiatry) for an assessment and treatment.
That said, if you are just of a mind that you really want to get to the bottom of things then podiatry would be the way forward.
This article was compiled and written by Colin Papworth, Podiatrist MRCPod
Colin, is a Specialist in Walking and Running, Assessment and Treatment injuries to the foot and lower leg. He is also able to analysis movement, walking and running gait and to show you how this can be improved to help avoid future injuries.
