If you have experienced plantar fasciitis, you know how painful and debilitating it can be! To others, it probably remains a mystery.
What is plantar fasciitis?
The bottom of the foot is covered with a tough sheet of connective tissue--the plantar fascia. Strong bands from each toe cross the bottom of the foot and merge near the heel. They provide support and shock absorption for the the foot and transmit force from the Achilles tendon to the ball of the foot during walking and running. (1) Injury, excessive tension in the calves, and overuse are among the causes of inflammation in the plantar fascia (fasciitis.) If the inflammation does not successfully resolve, tissue degeneration (fasciopathy) can result. Plantar fasciopathy can then be a chronic / recurring problem that is very hard to rehab! (2)
How is it Treated?
Treatment involves reducing any inflammation, reducing tension in the fascia, allowing any tissue damage to heal, and restoring balance within the foot. Often, rest and conservative measures like ice and stretching are enough to resolve mild cases. If conservative care is not enough, family physicians commonly recommend physical therapy, orthotics, night splinting, or corticosteroid injections for plantar fasciitis (3). For tough cases, surgery is sometimes recommended, but the long-term consequences of this can be quite serious! (1)
Stretching is also commonly recommended as ongoing self-care. While the science is limited, and it is not clear whether stretching the fascia itself or the calf muscles or both is most effective (4), stretching to lessen tension in the fascia is definitely an important part of the solution.
Can Medical Massage Help?
Yes! Medical massage can be highly effective for plantar fasciitis and should be a treatment of choice. If you have heel or foot pain that rest and self care have not remedied, please see us for a free consultation! Especially if you have fought this pain for years and are considering surgery, please give us a call. As this case study from the Science of Massage(5) shows, even long-standing pain that has resisted normal treatment can be eliminated if the underlying trigger is properly identified.
Depending on the initial cause of your symptoms (injury or overuse), your therapist will focus on the best way to alleviate pain and promote healing. Tension or adhesions in the plantar fascia itself and in the Achilles tendon will be addressed. Any muscle tension in the calf will be addressed, as will any hip or back tension suspected of irritating nerves that innervate the foot. The area probably most critical to full recovery -- where the fascia inserts into the bones of the foot -- will be checked for signs of damage. Treating these areas with deep friction can reboot the healing process and provide lasting relief.
Last but not least, we will give you homework! Self care in the form of regular stretching at home is key to beating plantar fasciitis and keeping it from coming back. So is following your doctor's advice for orthotics or other lifestyle modifications.
Plantar fasciitis is a serious problem but it does not have to keep you down for good!
(3) James D Goff, Robert Crawford, Diagnosis and treatment of plantar fasciitis, Am Fam Physician, 2011 Sep 15;84(6):676-82.