|Dynamic Chiropractic – January 29, 2007, Vol. 25, Issue 03|
By Daniel Batchelor, DC
Plantar fasciitis (PF) is a common cause of heel pain in adults. The PF is a fibrous band that holds the arch in your foot, much like the guy wires of a suspension bridge. When it overstretches, the patient will experience pain in the arch or heel, or both.The disorder usually presents itself with arch/heel pain that is severe during the first few steps taken in the morning. Symptoms usually resolve more quickly when the interval between the onset of symptoms and the onset of treatment is shorter. Many treatment options exist, including physiotherapy, rest, special taping, stretching, strengthening, change of shoes, arch supports, orthotics and night splints. Surgical intervention is an extremely rare necessity for those suffering from PF.
Over the past 26 years, I have successfully treated hundreds of patients for plantar fasciitis and heel spurs. Recent advances involving pulsed ultrasound, along with galvanic current to gradually reduce the sharpness of the spur, are very effective. In addition to reducing the cause of the pain, it's also important to address the rehabilitation of the area to prevent future episodes of pain.
One of the most aggravating symptoms of PF is the pain experienced when first stepping out of bed in the morning. One very effective device that helps to improve PF pain is the night splint. Just before going to bed, you strap the special brace to your foot. It places your foot into a dorsiflexed position. This allows your plantar fascia to gradually lengthen. It is the tight PF band that causes a great amount of pain. If the PF continues to be tight, a spur eventually will occur. This is why it's important to reduce the chronic tightness of the PF. After wearing the brace for a few days, most patients state that their initial morning steps, which used to be painful, are pain-free. Wearing the brace every night for a total of six weeks will allow your PF to adapt to its new length.
Pulsed ultrasound is a type of physiotherapy that breaks up the sharpness of the low-density calcium spur. I have used this method with excellent results. Remember, only the sharpness of the spur needs to be dulled. One person might have a huge, dull spur and feel no pain, while another person with a tiny, sharp spur can have severe pain and swelling. Some patients state that this small, sharp spur feels like a piece of ground glass under the heel. Pre- and post-X-rays determine the results.
The patient with chronic PF usually is put on a program of cross-training for two to four weeks. Kayaking, biking, swimming, etc., are excellent activities to take the stress off the PF.
Overuse is the most common cause of plantar fasciitis in athletes. A history of weight-bearing activities is common, especially those involving running, which causes microtrauma to the plantar fascia and exceeds the body's capacity to recover. Plantar fasciitis also occurs in elderly adults. In these patients, the problem usually is more biomechanical, often related to poor intrinsic muscle strength and compounded by a decrease in the body's healing capacity.
On examination, the patient usually has a point of maximal tenderness at the front bottom region of the calcaneus/heel bone. The patient also might have pain along the arch/mid plantar fascia. The pain might be exacerbated by passive dorsiflexion of the toes or by having the patient stand on the tips of the toes.
It's equally important to correct the problems that place individuals at risk for plantar fasciitis, such as increased amount of weight-bearing activity, increased intensity of activity, walking/running on hard surfaces and wearing worn shoes. Early recognition and treatment usually lead to a shorter course of treatment, as well as increased probability of success with conservative treatment measures.
Stretching and Strengthening
Stretching and strengthening programs play an important role in the treatment of plantar fasciitis and can correct functional risk factors such as tightness of the gastrocsoleus complex and weakness of the intrinsic foot muscles. Increasing flexibility of the calf muscles is particularly important. Frequently used stretching techniques include wall stretches.
Strengthening programs should focus on intrinsic muscles of the foot. Exercises used include towel curls and toe taps. Exercises such as picking up marbles and coins with the toes also are useful. To do a towel curl, the patient sits with the foot flat on the end of a towel placed on a smooth surface. Keeping the heel on the floor, the patient pulls the towel toward the body by curling it with the toes. To do toe-taps, all of the toes are lifted off the floor and, keeping the heel on the floor and the outside four toes in the air, the big toe is tapped to the floor repetitively. Next, the process is reversed and the outside four toes are repetitively tapped to the floor while keeping the big toe in the air. Rolling the foot over a soup can or a roller pin also can help to loosen the PF.
Orthotics also might be necessary to correct any biomechanical imbalances in the foot. If the patient wishes to train without pain, there are a number of factors that must be addressed. During examination, I determine the cause and correction of PF pain and devise a specific rehab program to prevent it from occurring in the future.
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