The information here is my personal interpretation of the comments made on the podcast about plantar fasciitis mainly for my own reference and posted here for general interest. It is not intended to replace or to be a substitute for medical advice by a trained physician and healthcare practitioner.
Fasciitis implies inflammation of the fascia but what is
more likely to be happening is an -oscis.
Maybe there was an initial injury but there may be maladaptive changes
but they are not necessarily inflammatory.
Breakdown of the structural integrity of the plantar fascia. The layers are to aid transferring of the
weight through the foot and the body. Any
damage takes a long long time heal – it’s a stubborn condition. We can exercise correctly and do any number
of home remedies but no matter what you do, it will take a long time to heal.
In a conventional medical approach with this kind of foot
pain then they may recommend taping or a boot to keep the foot in a slightly
dorsiflexed position during sleep. This
may result in a slightly stronger structure when we start to walk in
morning. Cortisone injections are used
but not as anti-inflammatory. Cortisone
may melt the connective tissue to aid healing.
But the problem with that is that it weakens the plantar fascia so leave
you at the risk of rupture (& you can only have a limited number of
cortisone shots). Not necessarily a
Massage may help – not only to the foot and the intrinsic
muscles. Also need to work on the
muscles that affective the foot strike eg tibialis posterior, flexor digitorum
longus and flexor hallucis longus. The
more functional they are then the better the foot strike – won’t necessarily
solve the plantar fasciitis but may make it a little easier to live with. Be aware that as a massage therapist, you
will not solve genuine plantar fasciitis in one session; it will take weeks.
Can be caused by a traumatic incident eg foot suddenly hitting the ground but more commonly it’s a more gradual onset. Wearing shoes that always support the foot is recommended.
Condition is frequently present in active people. There are other conditions that has similar
symptoms to plantar fasciitis so just be mindful of this when someone presents
with plantar fasciitis type symptoms.
Whilst it was traditionally considered as an inflammatory
condition, the indications are that plantar fasciitis is more likely to be a
degeneration of collagen. For massage
therapists then treatment will rarely be isolated to the plantar fascia and the
whole kinetic chain may need to be addressed.
Eg lower leg biomechanics and loads on the foots. May require activity modification. Muscles that it is important to address are
the intrinsic muscles of the foot, deep compartment muscles that impact on foot
biomechanics (tibialis posterior, flexor digitorum longus and flexor hallucis
longus – whose tendons all pass down medial side of ankle). Irritation of tibialis posterior tendon on
the foot may mirror some of the pain symptoms associated with plantar
Please be aware that the plantar fascia is very thick and
dense connective tissue and any manual therapy will have negligible impact on
the plantar fascia. Any changes are more
likely to be associated with neurological impact and/or changes in the way that
the plantar fascia is loaded biomechanically.
Whilst there is some doubt about validity of a fascia trains
type model (if connective tissue is tethered along its length then how can
force be transferred?) then the sensation of pain may be affected by other
areas that are seemingly not connected.
Hence working extensively to reduce sensations elsewhere in the body may
impact on the level of pain associated with plantar fasciitis – even if it not
Be aware nerve entrapment eg in the tarsal tunnel which can
mimic plantar fasciitis pain. By
stressing the nerve by working away from the plantar fascia may be a suitable
technique to assess whether you are looking at a nerve issue or plantar
Characteristics of plantar fasciitis are that there is pain on first steps in the morning. However, if you palpate on medial side of ankle and that makes foot pain worse then more likely to be nerve issue.
Plantar fasciitis affects both athletes, weekend warriors
and sedentary people. Asks patient “What
provokes the pain? What eases the pain? What treatments have they had and what
were the affects of them?”
Performs detailed clinical assessment, asking lots of
questions and finding out such things as where does it hurt. Important to find out if it is genuinely
plantar fasciitis as there are many “experts” out there quick to give a
diagnosis. Checks out range of motion of
the ankle, does it vary side to side (not necessarily causative if there is a
difference). “Can I provoke the
sensation with light touch or stretch? If
can then often moves straight into treatment.
This involves lying on side with the arch of the affected
foot facing up and perform the traditional myofascial cross handed stretch –
one hand at calcaneus, other at the base of the meta-tarsals. How does that feel for the patient?
Likes to treat shin (anterior, posterior, medial and
lateral). Self treatment might include soft
tissue work coupled with loading; resistance and weight bearing exercises +
If pain is more at the medial aspect of the calcaneus then probably more likely to consider nerve pathways rather than fascia but there is always some degree of overlap and always wise to consider both nerve and fascia.
YouTube Plantar Fasciitis Massage Demonstrations
Please do not hesitate to contact Richard if you have any questions to any information presented on this blog.
Any information, advice, recommendations, statements or otherwise contained herein, or in any other communication made by or attributed to Richard Lane, whether oral or in writing, is not intended to replace or to be a substitute for medical advice trained by a trained physician or healthcare practitioner.