Plantar Fasciitis/Joggers Heel or as we should really call it, Chronic Plantar Heel Pain is a pretty common issue affecting around 10% of the population. Despite it being a relatively common issue the treatment of this issue is often less than effective, this is mostly due to clinicians focusing on attempting to reduce inflammation as their primary treatment. Science is now telling us that inflammation is not the real problem here, but in fact the symptoms seem to derive from a thickening or stiffening of the plantar fascia. So what is the plantar fascia and how do we go out fixing that painful foot!
The Plantar Fascia is a fibrous and relatively thick soft tissue structure on the underside of the foot running from the underside of the heel to the ball of the foot. Its a bit like a sheet of thick rubber under tension, when we walk or run it absorbs energy as it stretches during our foot landing on the ground, and releases it like a spring when we push off the foot, providing around 10% of our propulsion. It has a strong sensory feedback directly to our brain to help with balance, however, this means when it becomes painful boy do we know about it!
Current evidence suggests that the main reason why our Plantar Fascia becomes painful is due to a mixture of rapid increase in the amount of load beyond levels which these tissues are used to (e.g. suddenly deciding to take up running again after a year off and overdid the training) or due to biomechanical issues which would best simplified, loading the Plantar Fascia too quickly.
To describe this in a little more detail lets look at the example of running. The majority of runners land on our heel or midfoot and roll through the foot to push off the tip of the big toe, its a rocker motion that allows gradual loading of the plantar fascia (imagine your foot is like the underside of a boat). However, if we change our running style to instead land on the ball of the foot, the plantar fascia is now loaded very swiftly with around 2.5 times our body weight. Whilst some runners have been running in this style most of their lives, if we alternate to this style in a manner that it has not been steadily trained into doing over a period of years we end up with the plantar fascial pain symptoms. Whilst sometimes a drastic change to tissue loading forces is to blame, there are a lot of other factors which influence the speed of loading such as calf tightness and shortening of the muscles which bends the big toe.
What happens next? Well due to this sudden increase of load or speed of load the Plantar Fascia becomes sensitised, essentially the brain becomes vigilant of what is going on in the underside of your foot in order to stop you from causing more stress to these tissues. If we can find a way to reduce our loading of these tissues quickly, then we can stop the problem in its tracks and these tissues return to normal. However if we continue to repeat this trauma then the muscles which stabilise the foot will tighten in response to pain, which often amplifies the problem of the loading speed, the plantar fascia will thicken and become more rigid, this then progresses into bony changes occurring to the Plantar Fascia where it attaches to the underside of the heel sometimes forming bony outcrops known as heel spurs.
Our main aims of Physiotherapy are to investigate your specific issue thoroughly, in order to find the route cause of your symptoms. Once we know why, then we can look to modify the aggravating factors, in a broad variety of ways including but not limited to adjusting training schedules, modifying running technique, strength and conditioning, offloading the plantar fascia, balance and control exercises and footwear adjustments.
If you suspect this could be your problem or perhaps you have other types of foot and lower limb pain currently, then you can book your own appointment to see one of the team HERE.
Kind regards from,
The Shawe Physio Team