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Plantar fasciitis 

I've been having quite a few patients presenting to me with plantar fascitis. What is it and how can it be treated by an Osteopath?

 

The plantar fascia is a thick band of connective tissue found on the bottom of foot which helps the foot to flexibly bear the weight of the body. It stretches between the heel and the ball of the foot spreading more widely at the front than it at the back.

 

Plantar fasciitis is a very painful condition in which the area of plantar fascia which attaches to the calcaneus (heel bone) becomes inflammed and painful. It is most commonly associated with biomechanical changes which may not be in the affected foot or even on the same side of the body. For example, if you exercise on very hard surfaces, are overweight, or are suddenly doing more intense, dynamic exercise, these biomechanical problems are more likely to result in plantar fascitis. Extra force and strain is put through the foot and the abnormal forces pull on the plantar fascia attachments causing the pain. Chronic pain often indicates that wear and tear or degeneration has occurred or that the foot is over-pronating (the arch on the inner border of the foot is collapsing). The pain is most often felt once the person weight bears, for example getting up after sitting and, in more active people, is often worse with increased activity.

 

Depending on the cause of the plantar fasciitis, treatment usually involves a combination of rest, ice, anti-inflammatory medication, stretches, rolling a tennis ball under the foot and taping or splinting the foot. Osteopathically, diagnosis and treatment includes an assessment of the bio-mechanics of the lower limb, pelvis and the low back, joint mobilisations of the low back, hip(s), ankle, mid-foot and toes, massage of the calf muscles and plantar fascia and advice on exercises and stretches as appropriate. Sometimes, in long-standing cases, the emphasis on treatment needs to move away from the foot to the hips or low back as they can sometimes be the origin of the problem.

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