SIMPLE WAYS TO RELIEVE PLANTAR FASCIA PAIN

By: Mark Z. Jamantoc, PT

About the Author

PLANTAR FASCIA PAIN

     According to Physiopedia.com, There are many different sources of pain in the plantar heel besides the plantar fascia, and therefore the term "plantar heel pain" serves best to include a broader perspective when discussing this and related pathology. The average plantar heel pain episode lasts longer than 6 months and it affects up to 10-15% of the population. However, approximately 90% of cases are treated successfully with conservative care. 

     I have seen cases range from pain on the heel (which is by far the most common area of pain) to the midfoot area, the bottom of the big toe, and on the lateral part of the foot. I am not going to deny that this condition is extremely hard to treat and because of the multitude of anatomical structures in the foot, it is almost impossible to isolate the symptom ONLY to Plantar Fasciitis. This condition also takes some time to heal and may persist for a very long time. Physical Therapy can help speed up the process and we can teach you SELF-TREATMENT techniques that can help you recover faster and save money on office visits.

     As with anything, what I have here is a quick compilation of quick easy stuff to do to see if they help your symptoms and if your pain persists, always consider seeking professional help by seeing your local Physical Therapist or Doctor. In the US alone, this condition constitutes about 2 million patient visits per year and accounts for over 40% of Podiatry visits.

WOMEN VERSUS MEN? 

Middle aged women, and younger men - predominantly runners are more predisposed.

WHO ARE AT RISK?

According to Physiopedia, there are many risk factors which contribute to plantar heel pain including but not limited to: 

• HIGH ARCHES or even FLAT FEET.
• Impact/weight bearing activities such as prolonged standing, running, etc
• Improper shoe fit
• Elevated BMI
• Diabetes Mellitus (and/or other metabolic conditions)

SOME POINTS TO CONSIDER BASED ON THE LATEST STUDIES OUT THERE:

• Plantar fasciitis is the most common cause of heel pain and exact cause is unclear, ranging from repetitive microtrauma among runners to poor training errors, and ill-fitting shoes. According to BRUCE WILK, PT, OCS, the most common cause of running injuries is training errors.
• Keep in mind that Heel Pain may occur in other systemic conditions like Rheumatoid Arthritis, Ankylosing Spondylitis, Reiters Syndrome, among others. Also remember that heel pain has been caused by the following too:
• Stress Fracture on the heel
• Bone Bruise
• Tarsal Tunnel Syndrome
• Sever's Disease

• LIMITED ANKLE DORSIFLEXION and HIGH BODY MASS INDEX should be considered as risk factors of Plantar Fasciitis according to JOSPT
• Manual Therapy procedures (PERFORMED BY YOUR PHYSICAL THERAPIST) like Talocrural joint posterior glide, subtalar joint lateral glide, anterior and posterior glides of the tarsometatarsal joint, subtalar joint distraction manipulation, soft tissue mobilization near potential nerve entrapment sites and passive neural mobilization techniques. 

5 WAYS TO QUICKLY TREAT YOUR PLANTAR FASCIITIS

1. THE ALMIGHTY ICE. While this really isn't a big surprise, it is astounding how many people ignore the benefits of icing. Freeze a bottled water and roll your foot over it while you are sitting down for about 5-10 minutes, especially if the pain is brand new (say, you ran today). It almost feels like an icy massage! Most people take some time to get used to it but as soon as you start it, you will thank me later! You may also freeze water in dixie cups and use that to ice your foot.

2. STRETCHING. Calf muscle or plantar fascia specific stretching has been shown to relieve symptoms short term (between 2-4 months) and improved calf flexibility. Do this 2-3 times a day using SUSTAINED (3 minutes) or INTERMITTENT (20 seconds) - studies have shown that either one produces the same effect.

3. SHOE INSERTS (ORTHOTICS). These can be custom-made by your podiatrist or physical therapist (can range between $250-300/foot) or can be bought over the counter (about $40-60 for a pair). I really like using the Superfeet brand because it comes in a variety of firmness and it is customizable by cutting the edges. In fact, I own several of them and insert them in a variety of shoes for support. Studies published in the Journal of Orthoepedic and Sports Physical Therapy have shown that wearing these will actually help symptoms for up to 3 months.

Brian Heiderscheit, who is physical therapist that mainly treats runners in UW Madison, states that shoe orthotics can give some relief for up to 6 months. But after that, there is no other significant improvement. It was further reported that even after 6 months, certain patients continued to wear them just for prophylactic purposes. I, myself, am not really against that but I believe in strengthening the small muscles of the foot too so that you will not be as dependent to the shoe inserts. If you were truly medically diagnosed with collapsed arches and have a very severe Flat Foot deformity and if buying the over-the-counter orthotic does not seem to help, make sure to consult with your doctor or therapist regarding use of these orthotics. 

4. SELF-MASSAGE. Using a tennis ball, two taped tennis balls (as shown in pics), golf ball, or lacrosse ball, massage the bottom of your feet, making sure all the parts of the bottom are reach: inside, outside, front and heel, for at least 1-2 minutes a day. Some of my patients have bought some of those fancy foot massagers, but I do not really see the need to spend so much money on massagers whenn you can purchase tennis balls for $3. Use this technique BEFORE and AFTER you RUN or WORKOUT. It will make the world of difference.

 

     This one I have mainly discovered myself as I worked with some marathon runners who were having deep calf pain. I started adding MEDIAL LEG MASSAGE and it literally improved their symptoms by 80% after 1 visit. HOW TO DO THIS: Find the shin bone on your lower leg and go immediately inside of it, you will feel some tenderness there (note that this area is very tender in many many people, so don't push too hard). Softly massage up and down on the area starting from the upper leg going down to the inside of your ankle (medial malleolus area). 

5. STRENGTHEN AND CONDITION YOUR LEG. Two things I like to teach my patients in conditioning the foot:

• Eccentric heel lowering exercise: These have been shown to treat (and prevent) Achilles tendinitis, calf strain, and heel pain. Since your calf muscles end on the heel area, it only makes sense to include them in your strengthening program. Also make sure to include Heel raises in a variety of position (I know it may look weird doing it): foot toeing in, foot neutral and foot toeing out. It helps condition all the parts of the gastroc-soleus complex.

• Mobilize the intrinsic muscles of the foot (small muscles of the foot) by doing towel crunches on the floor (note that this will be extremely difficult over carpeted floors). Try doing these for 10 times every other day. Other therapists have suggested tracing alphabets with the foot (from A to Z).

Just remember that if your symptoms do not get better, be sure to consult with a Physical Therapist.