For those who have suffered, or are suffering, from a common foot condition called plantar fasciitis (or as we have mentioned before, it’s now fasciosis or fasciopathy!) you know how painful & difficult a problem it is to get on top of.
The evidence we presented in a previous newsletter in 2018 revolved around calf and foot strengthening exercises. However, more recent evidence suggests going further by progressively loading the plantar fascia with a particular type of single-leg calf raise. The key is to stress the fascia – performing these exercises bilaterally (both legs together) won’t provide enough force to stimulate a reactionary loading response. Eventually, the long term aim would be to be able to perform this exercise single-leg with added weight, as this is a level where the plantar fascia will be able to cope with the demands of many daily activities.
Also strengthening of the deeper calf muscle (soleus) is an important exercise not to be missed in the rehab program. The soleus muscle is the highest producer of force around the foot and ankle, so the stronger this muscle is the less load there is placed on the plantar fascia.
But the other big parts of the puzzle, in equal measures, are:
a) Overstriding, and
b) Early intervention
Overstriding, or having a longer than efficient step length, causes the foot to start weight-bearing further away from your centre of gravity (COG), increasing the load through the plantar fascia. It also means a longer period of time in contact with the ground. Both of these are thought to lead to the breakdown in the connective tissue which makes up the plantar fascia.
One quick tip for those who may overstride is to take quicker but shorter steps when walking or running and aim to run on the balls of your feet rather than heel-toe. For longer-term solutions, the key is strengthening the trunk and hip regions with a guided strength or Pilates program.
Early intervention is self-explanatory – beyond the two-week mark both you and we have a vastly reduced ability to make a pronounced difference quickly. Since plantar fasciopathy is a response to tissue overload where a breakdown within the connective tissue occurs, the quicker you can limit or reverse this process the better.
Effective early measures include:
- Taping of the foot: to reduce over-pronation and hence the loading of the plantar fascia, taping can be very effective to alleviate pain in the early stages. If this is found to be helpful then orthotics can be a good long term solution to reduce overpronation.
- Massage and dry needling: can be an effective way to reduce calf muscle tone and alleviate the loading of the plantar fascia. Tight calf muscles can reduce ankle range of movement which is another biomechanical issue that can lead to increased pronation and thus increased plantar fascia loading.
Medium-longer term measures include:
- Orthotics if indicated by foot posture
- Guided calf re-strengthening
- Postural, trunk and hip strengthening – working on your ‘core’ is paramount to a more efficient gait and stride
To book in for treatment with one of our physiotherapists to discuss treatment and strengthening options, please use the Book Online link or call our clinic on 9751 0400.