Plantar Fasciitis, incurable or easy fix?

plantar fasciitis

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.

plantar fascia percentages

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 ultrasound

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.

pronation

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.

plantar insoles

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.

Running, good or bad for you?

 

Last weeks blog discussed arthritis and I mentioned the commonly held belief that running causes knee and hip arthritis may not actually be true. Studies have shown that compared to non-runners those who run regularly generally have a lower level of knee and hip osteoarthritis. But running can still cause many injuries including shin splints, achilles tendonitis, ITB syndrome, patellar tendonitis and glute medius tendonitis to name a few. Being physically under prepared for running is a key reason for this. Meaning that if you are running way more distance or way faster than you are used to running or you are too heavy for the amount of running you are doing then you will get overuse injuries like the ones mentioned above.

So what if you want to use running to lose weight? Well start sensibly with a mix of walking and running so you can build up your fitness slowly over many months. For example look for objects on your route that you can target like lamp-posts to run to and then walk until the next one and repeat. Don’t make big increases in your mileage, if you’ve signed up for a marathon but never run more than 5 miles a week before don’t try and go for long runs straight away, build your distances up slowly using examples like the couch to 5k program offered by the NHS.

The next important aspect whether you are elite, overweight, a beginner or anyone else you will also need to have good “core” stability to reduce the chances of overuse injuries from poor biomechanics when running. You need good rotational stability in your trunk muscles to reduce any twisting in your spine when running so you don’t run like phoebe from friends! Exercises such as rolling patterns, planks & bird-dogs will improve your rotational stability. You will also need good hip stability to stop your knee from dropping inwards each time you land, this is where the oft mentioned glute medius muscle comes into play and you can use exercises like side lying clams, monster walks, 1 legged squats and hip aeroplanes to strengthen these muscles.

If we look even further down the chain of muscles used for running then your ankle will also need some lateral stability to maintain a good foot arch so exercises such as toe scrunches, 1 leg balance, calf raises and hip aeroplanes (yes I mentioned this one twice for a reason :-)) will help to reduce inward movement of the knee the same way lateral hip exercises will. For these muscles to have an easier time of it good mobility of your feet, ankles, hips and pelvis (sacro-iliac joints) will allow for full, unimpeded running motion that does not need to be compensated for. Therefore it will also be good to do foot, calf, hamstring, quad, glute, inner thigh and lower back stretches regularly and/or have regular chiropractic to help maintain your mobility.

The other factor I wanted to go into a little bit of detail about in this post is the choice of running technique itself. The two main options are forefoot running and heel strike, referring to the part of your foot that makes contact with the ground first when running. Heel strikes are more economical in ultra long distance running (longer than marathon) but will increase the forces transmitted through your bones on each step. This leaves you more at risk of ankle, knee, hip and low back joint pain but is easier on your muscles. It is also a slower technique so if you are trying to run fast you should definitely be striking with the forefoot first.

Forefoot running as mentioned above is the predominant technique of sprinters, middle distance runners and some long distance runners as it allows you to use the powerful spring mechanism of your foot, achilles calf complex to rebound off the floor with each stride. This does reduce the load on your joints but means your muscles & tendons are taking over and so their injury risk becomes higher.

SSC

This means things like achilles tendonitis, calf strains, hamstring strains and plantar fasciitis become more common although most of these can be avoided with the things described in the paragraphs above like sensible time, distance and speed for your current fitness, good mobility, good core stability, good technique and regular chiropractic treatment.

So most of you will be best with forefoot running. A few might benefit from heel striking instead but all will benefit from having a body that can cope with the demands of running in the first place so be honest with yourself do you need to put more miles in, more speed or first concentrate on mobility/stability exercises whilst slowly increasing your running load. Core stability won’t make you a faster runner in the short term but if you get injured less then the consistency of regular training not interrupted by injury will make you a better runner in the long term.

If you would like to learn more about this and get any of your niggling running injuries fixed then call 07710791434 or book online via this website. Exminster Sports Injuries and Chiropractic Clinic are also teaming up with Essential Chiropractic Torquay at the Exmoor ultra marathon series next Sunday 27th September to offer pre race advice and rocktaping, so if you’re there and you want to know more come over and say hello and pick up some discount vouchers for clinical assessment/treatment.