So I was going to calm the blog writing down to monthly but this week just gone I had a couple of patients in suffering from plantar fasciitis. One of them has been suffering for over 12 months and the accepted natural course of the condition without treatment is up to and sometimes longer than 18 months. With treatment it shouldn’t last any longer than 4-6 weeks so why are so many people walking around for months or even years suffering from this painful, debilitating, easily treatable condition?
Firstly the NHS lacks the necessary resources to treat plantar fasciitis so unfortunately if you have just gone to your GP you have likely been told it will go away on its own after around 18 months. If you’re lucky you might have been referred to an NHS physio. Unfortunately this is when you will then realise they also are limited in what they can do for you. You will receive some stretches and maybe some ice advice which are part of the correct treatment protocol but they will not be allowed to give you the required number of treatments (which involves massage, manipulation/mobilisation and exercises) to get the problem sorted.
Secondly there still seems to be some confusion as to how best to treat plantar fasciitis. Some therapists seem keen to use extracorporeal shockwave therapy. This is essentially high powered ultrasound designed to break up the fascia/tendons in your heel area so that they heal in the correct alignment and hey presto no more plantar fasciitis. Unfortunately several years of research on this controversial treatment have shown it doesn’t work very often as the tissues rarely heal the way you want them to as the biomechanical problems causing them in the first place have not been fixed first. Also it is basically burning your soft tissues so people are left with lots of painful burns on their feet. It should only be a last resort for the 10% of people who don’t respond to manual therapy and exercise before they try surgery.
Plantar fasciitis is not as complicated as it sounds. Basically the connective tissue (fascia), tendons and muscles under the arch of the foot have been repetitively strained over a long period of time by poor walking and/or running biomechanics. The most common reason is hyperpronation of the feet. This could be due to several reasons including weak foot arch muscles, weak glute stabilising muscles, excessively turned out feet/hips or just excessive distances walked/ran without a rest, particularly in inappropriate footwear and on undulating terrain. The latter is especially true in the armed forces.
Therefore to get better you need to firstly find out what the biomechanical problems leading to it are and get exercises to help correct those (and in some cases insoles/kinesiotaping). Secondly you will need several massage/manipulation sessions over a few weeks to loosen up the various muscles that are excessively pulling on the plantar fascia, please note this is also true for shin splints. Thirdly you need to regularly ice the foot and stretch the calf muscles to give your body the best chance at healing the damage that has built up in the plantar fascia. In most cases this should take less than 6 weeks.
So if you have been suffering unnecessarily from plantar fasciitis for weeks, months or even years and you want to get it sorted as soon as possible seek out a suitably qualified manual therapist near you. Obviously I’m bias and would say chiropractors should be the first choice due to their superior training in diagnosis, manipulation & biomechanics whilst still having no worse training than anyone else in massage, exercises and stretching but in all honesty any manual therapist who understands the biomechanics of plantar fasciitis and can loosen up the right muscles and give you the right exercises will get you sorted.
If you live near enough to Exminster I can sort it for you at Exminster Sports Injuries and Chiropractic Clinic, call 0771079434 to make an appointment or book online. As long as you follow the exercise/ice advice no more than 6-8 treatments should be required to get you literally back on your feet.