Pain, near the heel, at the bottom of the foot which is worst for the first few steps in the morning and then eases is often diagnosed as Plantar Fascitiis. However, if it’s been going on for more than a few weeks and hasn’t resolved with the usual advice (arch supports, deep and painful massage to the bottom of the foot or loads of calf stretching) it’s unlikely to be a Plantar Fascitiis…. despite the protestations of many doctors, physiotherapists, osteopaths and even the great Dr Google!
Ongoing foot pain like this is most likely to be a Plantar Fasciopathy not Plantar Fasciitis. Does it sound like I’m splitting hairs? Well, is your foot pain fixed? In medicine the suffixes are important. (Remember it’s all Greek and Latin for the main purpose of confusing the proletariat!) The suffix indicates the process behind the pain. -itis indicates that inflammation is present; whereas -opathy does not. -opathy is an umbrella term which may include inflammation but may also include mechanical wear and tear without inflammation. Mechanical degradation, not inflammation is often the main problem with ongoing Plantar fascia pain. And the last thing you want to do to mechanical degradation in the plantar fascia is give it a hard time with a golf ball or squash it with an orthotic! This is all important because if we understand the root cause of the pain we can direct our treatment appropriately rather than blindly doing the same old thing.
At Lace market clinic I find best results with a 3 pronged approach.
- Soft tissue massage to reduce associated local symptoms. (but not to the painful area!)
- Strengthening exercise to deal with degenerative change of the plantar fascia
- Video Gait analysis. (Mainly for runners) If your foot pain is associated with running then a couple of tweaks to your running technique may reduce the potential for re-occurence. (NB I recommend clients are able to walk 6 miles without pain and have been pain free for 4 weeks before performing the gait analysis. This will ensure you are running normally and not compensating for the injury.