This is a condition that occurs due to overuse and stress placed on the plantar fascia. This is a type of connective tissue located on the bottom of the foot that connects your heel bone to your toes. The overuse causes microtearing in the fascia where it attaches at the heel resulting in inflammation. If the inflammation becomes chronic, adhesions begin to form. The healing process is often slow as the plantar fascia has a poor blood supply.
Causes of PF
There are a variety of different causes/predisposing factors of PF and including the following:
Overuse due to poor training or a rapid increase in training
Running on hard surfaces
Dancing i.e. ballet
Standing for long periods of time
Short and tight calf muscles
Improper footwear i.e worn out, not enough arch support, too stiff
Weight gain, pregnancy
Poor biomechanics i.e. excessive pronation of the foot, or excessive external rotation of the hip while walking
Individuals between the ages of 35-60
Symptoms of PF range from mild to severe and there is usually no history of injury or trauma. The pain is often of slow onset and located at the bottom of the foot most often at the heel.
Pain may feel like a bruise, sharp stabbing, deep throbbing, or a dull ache
Initial acute inflammation (heat, pain, swelling, redness), this can become chronic
Pain occurs within the first few steps after non-weight bearing i.e. first few steps out of bed in the morning
Symptoms are the worst during what is called the Pre-swing phase, or toe-off phase of walking. This is when your toes are bent when you are about to swing your leg forward into a step
Pain climbing stairs
Pain usually lessens after 30-45min of activity, however it will then intensify after 2-3hrs with continued activity
Pain is often relieved by rest
How is PF Determined?
A massage therapist cannot diagnose your condition since they are not medical doctors, but they can perform special orthopedic tests to determine whether it is likely that PF is the cause of your foot pain.
The massage therapist will likely perform a postural observation and gait assessment to look for signs of poor biomechanics that were discussed earlier. In addition to this the therapist will also palpate the area where the plantar fascia attaches to determine if there are signs of inflammation. Further, range of motion testing will be done to see if /where there is any tenderness. Also, the therapist will be looking for any shortened muscles that may be contributing to the problem. Lastly, other conditions will be ruled out that could be the cause of your heel pain, such as a contusion, stress fracture, and tarsal tunnel syndrome.
Treatment of PF
Massage therapy can be very beneficial in treating this condition, especially in combination with physiotherapy. The focus of the treatment depends on what stage the PF is in, acute, or chronic. If the PF is in the acute stage, the focus of the treatment will be on decreasing the inflammation. This is done with ice and therapeutic ultrasound. The ultrasound helps control and decrease the inflammation but also speeds up the healing process. Decreasing the inflammation is important to relieve symptoms as well as to decrease the formation adhesions. Also, during the acute stage both legs will be worked on, as they are often sore as a result of compensation or contributing to the problem.
If the PF is in the chronic stage, the focus will be on breaking down any adhesions that may have formed in the plantar fascia. Breaking down the adhesions is important because once formed the adhesions decrease range of motion and are weaker than healthy tissue, therefore making the area more prone to re-injury. The adhesions are broken up with a technique called frictions. This technique can be quite uncomfortable but the therapist will always work within your pain tolerance. Therapeutic ultrasound may also be used and is less invasive. As in the acute stage the legs are also treated. Treatment for this condition is generally recommended for 2x/week for 2 weeks, followed by 1x/week for 8 weeks. The resolution of this condition is heavily dependent on finding the root cause of the problem and eliminating it.
If you choose to have the PF treated medically, it is often treated with non-steroidal anti-inflammatories (NSAIDS), or corticosteroid injections, as well as the recommendation of rest.
In addition to your massage therapy treatments it is important to continue your care at home to help improve your condition.
The therapist will often recommend the following:
Ice 3-4x/day for 10min at a time, also ice after activity that causes pain
*For this you can freeze a water bottle and then roll it on the bottom of the foot. This ices and provides a self massage
Pick up pen/towels with toes, this will help to strengthen the foot muscles
Stretch calf muscles/plantar fascia
Wear proper foot wear
Rest from aggravating activities such as running and switch to non weight bearing i.e. swimming
Wearing night splints to keep your calf muscles and fascia from shortening overnight.
Below are some videos that are helpful to use for your homecare routine.