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Foot Pain and Treatment

Plantar Fasciitis / Fasciopathy - An MSK Therapy perspective

Foot pain treatment brisbane

Plantar Fasciitis (Plantar Fasciopathy) is one of the most common sources of heel pain and can often prove debilitating for many patients once symptoms become chronic.  The condition tends to affect middle-aged people, though it can easily impact younger and extremely active people and those who spend a lot of time on their feet or carrying heavy loads. Heavy loads may be due to obesity or related to work, such as in the military and emergency services. The condition is a commonly sports injury in an MSK Therapy clinic and often with runners. Some sports create additional demands on the tissues and structures involved in lower body mechanics. However, the condition can affect anybody and is common in those with a sedentary lifestyle.

Pain is usually felt on the underside of the foot and near the heel and is commonly sharp and stabbing. As with many conditions with an inflammatory component, symptoms tend to appear worse first thing in the morning or after rest. Typically, the pain improves with walking once one has pushed through the pain. However, symptoms then return and can prove worse after a rest period. One can see the Plantar Fascia area highlighted with a "greenish tint" in the following diagram.

Image of a Right foot with the plantar fascia highlighted in green

Image of a Right foot with the plantar fascia highlighted in green

Images produced with kind permission of from Essential Anatomy 5

(Copyright © 2018 - 2024 3D4Medical. All rights reserved.)

Foot Pain (Plantar Fasciitis)

The condition is caused by straining the plantar fascia and often the surrounding soft tissue structures of the foot (sole).  Research has also indicated the presence of myofascial trigger points in cases of plantar fasciitis. This straining of the tissues leads to the initiation of the body's inflammatory response. The body's initial reaction starts the soft tissue repair process (see article on soft tissue repair and scar tissue) while helping to protect (cushion) the damaged tissues. However, once damage and inflammation have occurred, it is relatively easy to create further irritation/inflammation. The combination of the presence of myofascial trigger points and inflammation can then result in myofascial pain.

The author is well aware of the problems that plantar fasciitis can cause and as somebody who has experienced it. As a runner and musculoskeletal professional, the author is acutely aware that unresolved trauma can lead to such issues later. As with several other lower extremity injuries, it is easy to aggravate plantar fasciitis and so can become chronically painful and debilitating, resulting in Persistent Pain.

The plantar fascia plays a critical role in arch support, which can have a direct impact on other joints and soft tissues elsewhere in the "Kinetic Chain". In brief, the kinetic chain is a biomechanical concept that logically suggests that one joint structure will affect other joints within the chain.

The kinetic chain and foot pain-

The kinetic chain consists of a number of related joints and structures including:-

Ankle joints, knee joints, hip joints, lumbar spine, thoracic spine and cervical spine.

One can further divide functional joint structures into mobility and/or stability sections. Many joint structures and associated tissues within the kinetic chain have multiple roles or functions. These tissues also operate similarly to suspension and shock absorption or damping systems. For example, cartilage and menisci within the knee provide a form of shock absorption function, amongst other things.

The feet are particularly complicated joint structures and consist of 26 bones, 33 joints and around 100 muscles, tendons and ligaments. Much like the rest of the body, the feet also contain another structural and functional component, fascia, which transcends multiple aspects of the kinetic chain. The foot plays a critical role in the human body's suspension system. As already mentioned, the feet are incredibly complicated. Hence, the following explanations and diagrams simplify everything for the reader. In essence, a simple triangle can help remove a great deal of the foot mechanics complexity, though there is much more to the foot. The following diagram shows a side profile of the right foot and helps demonstrate the structures' triangular nature. One can see the Plantar Fascia area highlighted with a "greenish tint" in the following diagram.

Image demonstrating the triangular nature of the foot

Image demonstrating the triangular nature of the foot

Images produced with kind permission of from Essential Anatomy 5

(Copyright © 2018 - 2024 3D4Medical. All rights reserved.)

Non-weight bearing foot

Even when the foot and ankle are non-weight-bearing, tendons, muscles, ligaments and fascia still apply forces to the structures. The blue, coiled type spring section on the sole of the diagram highlights the plantar fascia, with the toes on the left and the heel on the right. The coiled spring shape represents the somewhat elastic nature of the plantar fascia. In a non-weight bearing position, the plantar fascia has a level of tension, and the forefoot and rearfoot are slightly closer together than in weight bearing. The Achilles Tendon also produces a force on the plantar surface of the foot due to the connection points of the tendon and the plantar fascia. The midpoint of the triangle in the non-weight-bearing diagram is relatively high compared to the weight-bearing picture. Hence, the triangle can flex and change shape with loading.

Weight-bearing foot

In the weight-bearing position, the plantar fascia experiences more tension, and the forefoot and rear foot are slightly further apart. The shape of the triangle changes due to the weight-bearing load, and in effect, the midpoint of the triangle becomes lower or closer to the ground.

As is the case with many tissues within the body tissues will adapt Soft Tissue Adaptation to the forces placed on them, up to a point (Wolff's law, Davis's Law). Tissues break or become dysfunctional if they cannot adapt to the specific loads/requirements.  For example, bones will get thicker/stronger; muscles will gain a combination of strength, endurance and suppleness, and joint structures can adapt somewhat, too.  Bodily tissues will also change in situations causing tissue irritation, such as when wearing ill-fitting shoes.  Ill-fitting shoes often lead to blisters, blackened toenails, and, over time, calluses, bunions, etc. These changes are the body's attempt to protect itself against the damage caused by any irritant. The article about Biotensegrity (see Biotensegrity and how everything is connected article covers far more detail concerning tensional forces within the body.

Irritation of the plantar fascia can result in a thickening of the tissues. If left untreated, the condition becomes chronic, and the body can often lay down additional bone deposits as a result of chronic irritation to the aponeurosis. The long-term irritation to the tissues of aponeurosis results in excessive tension within these structures as they become shortened. The bone deposits or "heel spurs" can form as the body attempts to protect the foot bones from the thickened and inflamed plantar fascia matrix. Bone spurs typically then result in increased pain and further tissue degeneration.

As with many conditions, it is essential to identify the reason for the symptoms of the problem, which may be elsewhere in the kinetic chain. It is well worth seeking professional advice before the condition becomes Chronic. Many types of therapists can assist with such issues, and they can have varying degrees of training, education, and relevant experience. Professionals may include, Sports Medicine Doctors, GP's, Chiropractors, Myotherapists, Physiotherapists, Osteopaths, Podiatrists and Soft Tissue therapists (Sports Massage and Remedial Massage) etc. There are some self-help options, including Trigger Point Therapy (foam roller style), Gentle Stretching of the Plantar Fascia and lower leg muscles, self-administered over-the-counter ibuprofen or paracetamol, icing the plantar fascia, and even wearing heel lifts. However, seeking professional help and treatment advice is strongly advisable before embarking on any form of self-treatment. See the article on Finding a good, ethical Musculoskeletal health professional - An MSK Therapy perspective which covers the types of characteristics and behaviours one would expect with a patient-centred practitioner.

The article was written by Terry Davis MChiro, BSc (Hons), Adv. Dip. Rem. Massag., Cert. WHS.

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About the Author

As of December 31st 2020, the author chose to leave the Chiropractic profession due to a planned move back to Australia, where his training and education are not recognised. Terry no longer works as a Chiropractor and works as a Myotherapist in Morningside, Brisbane. He developed an early interest in soft tissue therapy techniques and advanced myofascial release methods in 2006 for treating various conditions. Terry's interests in human performance and trauma have naturally led to him developing a specialism in treating work and sports-related musculoskeletal injuries and Chronic Pain symptoms.

The author possesses an unusual background for somebody who trained in the McTimoney Chiropractic technique. His education, training, and practical experience span over two decades and relate to health's physical and mental aspects. He also needed to push his body and mind to the limits of physical and psychological endurance as part of his time serving in Britain's elite military forces. His education includes a bachelor of science degree in Business Management, with a specialisation in psychology and mental health in the workplace, an Integrated Masters in Chiropractic, MChiro and a multitude of soft-tissue therapy qualifications (see the about section for more details). His soft tissue qualifications range from certificate level right through to a BTEC Level 5 Advanced Diploma in Clinical Sports and Remedial Massage Therapy. He has also taught as a senior course coach at the Advanced Diploma level (Myotherapy / Musculoskeletal Therapy) in Australia, both theoretical and practical aspects, including advanced Myofascial Release Techniques and has certification in training and assessment. Terry will have taught many of the first students to train as Myotherapists in Brisbane. Terry's combination of knowledge through education, training, elite military service, and personal injury history has paid dividends for the patients he sees and has treated over the last 16 years. Terry is still extremely active and enjoys distance running, kayaking, mountain biking and endurance-type activities.