{"id":634,"date":"2019-03-18T04:43:21","date_gmt":"2019-03-18T04:43:21","guid":{"rendered":"https:\/\/www.richardlanemassage.com.au\/blog\/?p=634"},"modified":"2019-03-18T04:43:24","modified_gmt":"2019-03-18T04:43:24","slug":"plantar-fasciitis-and-massage","status":"publish","type":"post","link":"https:\/\/www.richardlanemassage.com.au\/blog\/plantar-fasciitis-and-massage\/","title":{"rendered":"Plantar Fasciitis and Massage"},"content":{"rendered":"\n
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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.<\/p>\n\n\n\n

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Fasciitis implies inflammation of the fascia but what is\nmore likely to be happening is an -oscis. \nMaybe there was an initial injury but there may be maladaptive changes\nbut they are not necessarily inflammatory. \nBreakdown of the structural integrity of the plantar fascia.  The layers are to aid transferring of the\nweight through the foot and the body.  Any\ndamage takes a long long time heal \u2013 it\u2019s a stubborn condition.  We can exercise correctly and do any number\nof home remedies but no matter what you do, it will take a long time to heal.<\/p>\n\n\n\n

In a conventional medical approach with this kind of foot\npain then they may recommend taping or a boot to keep the foot in a slightly\ndorsiflexed position during sleep.  This\nmay result in a slightly stronger structure when we start to walk in\nmorning.   Cortisone injections are used\nbut not as anti-inflammatory.  Cortisone\nmay melt the connective tissue to aid healing. \nBut the problem with that is that it weakens the plantar fascia so leave\nyou at the risk of rupture (& you can only have a limited number of\ncortisone shots).  Not necessarily a\npermanent solution.<\/p>\n\n\n\n

Massage may help \u2013 not only to the foot and the intrinsic\nmuscles.  Also need to work on the\nmuscles that affective the foot strike eg tibialis posterior, flexor digitorum\nlongus and flexor hallucis longus.  The\nmore functional they are then the better the foot strike \u2013 won\u2019t necessarily\nsolve the plantar fasciitis but may make it a little easier to live with.  Be aware that as a massage therapist, you\nwill not solve genuine plantar fasciitis in one session; it will take weeks.<\/p>\n\n\n\n

Can be caused by a traumatic incident eg foot suddenly hitting the ground but more commonly it\u2019s a more gradual onset.\u00a0 Wearing shoes that always support the foot is recommended.<\/p>\n\n\n\n

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Condition is frequently present in active people.  There are other conditions that has similar\nsymptoms to plantar fasciitis so just be mindful of this when someone presents\nwith plantar fasciitis type symptoms. <\/p>\n\n\n\n

Whilst it was traditionally considered as an inflammatory\ncondition, the indications are that plantar fasciitis is more likely to be a\ndegeneration of collagen.  For massage\ntherapists then treatment will rarely be isolated to the plantar fascia and the\nwhole kinetic chain may need to be addressed. \nEg lower leg biomechanics and loads on the foots.  May require activity modification.  Muscles that it is important to address are\nthe intrinsic muscles of the foot, deep compartment muscles that impact on foot\nbiomechanics (tibialis posterior, flexor digitorum longus and flexor hallucis\nlongus \u2013 whose tendons all pass down medial side of ankle).   Irritation of tibialis posterior tendon on\nthe foot may mirror some of the pain symptoms associated with plantar\nfasciitis.<\/p>\n\n\n\n

Please be aware that the plantar fascia is very thick and\ndense connective tissue and any manual therapy will have negligible impact on\nthe plantar fascia.  Any changes are more\nlikely to be associated with neurological impact and\/or changes in the way that\nthe plantar fascia is loaded biomechanically. \n<\/p>\n\n\n\n

Whilst there is some doubt about validity of a fascia trains\ntype model (if connective tissue is tethered along its length then how can\nforce be transferred?) then the sensation of pain may be affected by other\nareas that are seemingly not connected. \nHence working extensively to reduce sensations elsewhere in the body may\nimpact on the level of pain associated with plantar fasciitis \u2013 even if it not\nmechanical.<\/p>\n\n\n\n

Be aware nerve entrapment eg in the tarsal tunnel which can\nmimic plantar fasciitis pain.  By\nstressing the nerve by working away from the plantar fascia may be a suitable\ntechnique to assess whether you are looking at a nerve issue or plantar\nfasciitis.<\/p>\n\n\n\n

Characteristics of plantar fasciitis are that there is pain on first steps in the morning.\u00a0 However, if you palpate on medial side of ankle and that makes foot pain worse then more likely to be nerve issue. <\/p>\n\n\n\n

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Plantar fasciitis affects both athletes, weekend warriors\nand sedentary people.  Asks patient \u201cWhat\nprovokes the pain? What eases the pain? What treatments have they had and what\nwere the affects of them?\u201d  <\/p>\n\n\n\n

Performs detailed clinical assessment, asking lots of\nquestions and finding out such things as where does it hurt.  Important to find out if it is genuinely\nplantar fasciitis as there are many \u201cexperts\u201d out there quick to give a\ndiagnosis.  Checks out range of motion of\nthe ankle, does it vary side to side (not necessarily causative if there is a\ndifference).  \u201cCan I provoke the\nsensation with light touch or stretch?  If\ncan then often moves straight into treatment.<\/p>\n\n\n\n

This involves lying on side with the arch of the affected\nfoot facing up and perform the traditional myofascial cross handed stretch \u2013\none hand at calcaneus, other at the base of the meta-tarsals.  How does that feel for the patient?  <\/p>\n\n\n\n

Likes to treat shin (anterior, posterior, medial and\nlateral).  Self treatment might include soft\ntissue work coupled with loading; resistance and weight bearing exercises +\nmovement exercises.  <\/p>\n\n\n\n

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.<\/p>\n\n\n\n

YouTube Plantar Fasciitis Massage Demonstrations<\/strong><\/p>\n\n\n\n

Massage Sloth<\/em><\/p>\n\n\n\n