Foot Pain – (Plantar Fasciopathy aka Plantar Fasciitis)
Intense foot pain first thing in the morning? Like stepping on pins.
Plantar Fasciopathy (aka Plantar Fasciitis) is a common cause of foot pain. It is often seen in people who spend a lot of time standing– eg Police officers, nurses etc and it is equally common in active or sedentary people. The typical description is that the first few steps on getting out of bed are like stepping on drawing pins.
Anatomy of Plantar Fasciopathy
The plantar fascia is the tough connective tissue on the sole of the foot. Think of it as the bow string on an archery bow which adds tension to the arch but allows the arch some flexibility. This is exactly how the foot works and our bony arch is the body’s first line of shock absorption.
Planter fasciopathy is an overload injury to the plantar fascia. Think of the bow string starting to get a little frayed where it attaches to the bow. This is what happens in plantar fasciopathy / fasciitis.
The key point here is that the plantar fascia is weakened and needs to be strengthened. Foam rolling, stretching or orthotics don’t make your plantar fascia stronger but they may mask the symptoms if you’re lucky!
5 Top Tips for Fixing Persistent Plantar Fasciopathy / Fascitiis.
The only, evidence based, way to fix persistent plantar fasciitis is with strengthening exercises.* Unlike the string of a bow the plantar fascia is a live tissue which can regenerate. The trick is to load the tissue with exercises to strengthen it but not to overload it and make the injury worse. Here are my 5 top tips for loading plantar fascia safely.
- Do calf raises. The calf muscle is continuous into the plantar fascia therefore strengthening the calf will strengthen the plantar fascia.
- Do the exercises very slowly. Slow is the best way to keep strengthening exercises safe. Slow means you don’t have to deal with extra forces generated by momentum in the exercise.
- Feel the burn. Unless you do enough exercise to feel burn in the muscle, at least twice a week, you will not get stronger over time. (NB This is true of any strengthening exercise)
- 1 day on 2 days off. If you are pushing the muscle hard enough to feel the burn you need to give it time to recover. Every day will overload it.
- If you don’t notice an improvement within a couple of weeks or things get worse speak to a professional.
If left untreated plantar fasciopathy usually lasts a few weeks to a couple of months and then self-resolves. This has lead the internet being full of miraculous self-remedies, often based around stretching, self-massage or orthotic shoe inserts. However, the evidence on this is quite clear that the fact somebody has been stretching the heck out of their calf or torturing the sole of their foot with a frozen hockey ball is likely to be incidental to the fact that their foot pain got better because it would have anyway! This logic is particularly applicable when one understands the mechanism of the problem. If one understands the pain is essential due to a weakness that has become over loaded then the long term ‘core’ solution must be to strengthen it.
Written By Adam Richmond, Lead Osteopath at Lace Market Clinic.