The plantar fascia is a double layered fibrous tissue on the plantar (sole) side of your foot. It attaches to the calcaneus, the heel bone, and then fans forward to attach to the base of all the toes. This attachment means that the plantar fascia helps to maintain the integrity of the arch of the feet, and also functions to transmit force from the ground, as we walk, stand, or play, to the bones muscles and ligaments of the foot, ankle, lower leg, knee etc (the foot bone is connected to the shin bone after all!). And, what goes up, must come down as well, so as force is transmitted from the surfaces we walk/run/play on up the body, so too, what happens from above, affects the tissues below. As such, the causes of plantar fasciitis can be many and varied and may include knee, ankle and hip injuries or compensations above, muscle hypertonia (tight calves and hamstrings for example), as well as direct trauma (compression or over-stretching) of the plantar fascia itself – including poorly fitted shoes or repetitive injuries.
The other factor which really comes in to play with foot problems, and plantar fasciitis is included under this umbrella, is the modern ailment of jamming our very sensory feet in to sense dulling shoes. There are 26 bones in each foot, and more than 100 muscles, tendons and ligaments, and this structure of the foot is really for informing us, our body/brain, about the terrain that it is covering. Tight and immobile feet and toes contribute greatly to increased load on the plantar fascia, which in turn increases the likelihood if irritation and inflammation.
Non-surgical treatment
You firstly want to identify any causative factors, which could be any of the following:
- Poor lower limb and lumbo-pelvic mechanics such as flat feet, knock knees and weak glutes
- Being overweight (increases the load/strain on the plantar fascia)
- Poor footwear (unsupportive or lacking shock absorption), especially if working on feet all day.
- Tightness in the lower limb muscles, especially the calf and plantar fascia itself
- Stiffness in the ankle joint and surrounding foot joints, especially the big toe.
Effective treatment of plantar fasciitis should take all these factors in to account, but primarily, non-surgical treatment of the plantar fascia should include stretching of the calves, hamstrings and plantar fascia, the use of ice when acute, say a frozen water bottle rolled in the arch of the foot, working on balance and proprioception of the foot and ankle (try brushing your teeth while standing on one leg!) as well as massage of the plantar fascia with a massage ball/tennis ball/ golf ball and articulation of the bones of the feet and toes.
Treatment options include:
- Manual therapy such as osteopathy, providing soft tissue massage to the lower limb, mobilising joint restrictions in the lower limb and instruction on strength and stretch measures to improve glute and core strength, flexibility in the ankle and arch integrity. They may also strap/tape the arch to assist in arch support in the short term, and to determine whether orthotics may be indicated. (Referral to a podiatrist may be required).
- Certain medications such as NSAID’s (anti-inflammatories) may assist in reducing inflammation and provide a degree of symptomatic relief. (Long term use is not recommended however, as it may only act like a band-aid, and not get to the cause of the problem)
- Assessment from a podiatrist may reveal an underlying mechanical issue that may require a supportive orthotic device, or they may provide advice on appropriate footwear.
What are some exercises tennis players and golfers can do to prevent plantar fasciitis?
Exercises with a particular focus on stretching the calf and icing the plantar fascia/arch post exercise, and in between bouts of exercise rolling the arch with the frozen lime (or water bottle).
By osteopaths Clare Greig and Chris Reeves