Ugh! Plantar Fasciitis. One of my least favorite injuries to see coming in my doors as a therapist. Encouraged yet?
Plantar Fasciitis is a tough injury to deal with and overcome. I look at individuals with plantar foot pain near the heel is two categories: acute or chronic. Management is somewhat dependent on which category you fall into. The biggest difference is that if it is acute (short-term … let’s say <6 weeks old), you want to do everything in your power to stop it from getting worse right now! I’ll outline a few recommendations below. If it is chronic, there are some recommendations for things that might help depending on you as an individual. It often seems that each individual has a pretty specific response to all the possible interventions. Again, I’ll outline some recommendations below.
Plantar Fasciitis – What is it?
It is basically an irritation of the soft tissue along the bottom side of your foot. In particular, the heel is often involved. Fascial tissue is a thick tissue that is somewhat a middle ground between ligaments (firm, lacking mobility, meant to hold in place) and muscle (pliable, mobile, meant to move). In the foot, it is a thick tissue that covers primarily the toe flexors (curling). In a true “acute plantar fasciitis”, there is swelling in that heel area that can often be managed and certain techniques that can help it. In a “chronic plantar fasciitis” it gets trickier because I don’t really feel like we in the medical community know exactly what is going on …
There are multiple theories as to what is happening in Plantar Fasciitis, and I’m not too convinced of any of them. The traditional you will hear about is that there is scar tissue and restrictions built up in the tissue along with tightness. This theory leads to recommendations of stretching and of typically painful massage treatments on the bottom of the foot. I’ve used (and currently use) techniques based on this theory and have had some success … other times, it doesn’t seem to help much. Another theory is that the pain is related to a movement pattern fault. Basically, this theoretical standpoint would be that there is a strength or mobility issue somewhere likely in the foot, ankle, knee, hip, or back that is causing things to move differently than designed or placing more onus on the foot to handle the workload. This results in foot pain that could be related to any myriad of other things going on. I tend to gravitate toward this theoretical standpoint, but it is pretty wide open to interpretation.
Ultimately, I use the term Plantar Fasciopathy or Plantar Fascial Syndrome. Any time you hear -opathy or syndrome, you can basically assume that we in the medical field are saying “I don’t know”. I have some ideas to what is going on, but ultimately would not settle on any one thing being the ultimate definition.
So that’s what it is … kind of.