Foot Pain and Treatment

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 can easily impact younger and extremely active people, people who spend a lot of time on their feet and people carrying heavy loads. Heavy loads may be due to obesity or can be related to an aspect of 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 really effect anybody and is common in those with a sedentary lifestyle.

Non-weight bearing foot

Even when the foot and ankle are in a non-weight bearing position, 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 heel on the right. The coiled spring shape has been used to represent 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 force to 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 when compared to the weight-bearing picture. Hence, the triangle can flex and changes shape with loading.

Weight-bearing foot

In the weight-bearing position, the plantar fascia is under 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 will then start to break or become dysfunctional if they are unable to adapt to the specific loads/requirements placed on them.  For example, bones will get thicker/stronger; muscles will gain a combination of strength, endurance and suppleness and joints structures can adapt somewhat too.  Bodily tissues will also change in situations that are 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 bodies way of attempting to protect itself against the damage caused by any given irritant. The article about Biotensegrity (see Biotensegrity and how everything is connected article covers far more detail with regard to tensional forces within the body.

Irritation of the plantar fascia can result in a thickening of the tissues. If left untreated and the condition becomes chronic then 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 bones of the foot 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 symptoms of the problem, and this may be elsewhere in the kinetic chain. It is well worth seeking professional advice before the condition becomes Chronic. There are many types of therapists that can assist with such issues, with varying degrees of training, education and relevant experience. Professional 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, again it is strongly advisable to seek a Professional Diagnosis and treatment advice 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.