Arch Nemesis - By Nicola Grice, RMT

July 3, 2013

Photo Courtesy of: http://www.laserstim.net/

 

As a long distance runner, I can reel off quite the plethora of injuries that are common to those of us who like to slip on our running shoes and head out for miles and miles…and miles, just because we have this sadistic enjoyment to do so.

 

One of the most common and chronic foot injuries, particularly to a runner, is Plantar Faciitis. The most common train of thought is that it is a kind of tendonitis but instead of a tendon it’s the plantar fascia of the foot that’s inflamed and/or degenerating/torn that leads to the most common cause of heel pain.

 

This fascia is the thick, fibrous band of connective tissue on the sole of the foot that supports the foot’s arch. It runs from the ball of the foot to the heel, stretching to its limit when the foot is on the ground and supporting your full body weight. When placed under excessive stress, the plantar fascia stretches too far and tears, and has been traditionally believed to result in inflammation. This is now believed to be incorrect due to the absence of inflammatory cells within the fascia. The cause of pain is now thought to be degeneration of the collagen fibres close to the attachment to the calcaneus (heel bone). In fact the more recent research states plantar fasciitis is better compared to tendinopathy (when the tendon becomes painful or torn) or tendinosis (chronic degeneration without inflammation), because the tissue is often not actually inflamed or at least not for long but instead it shows signs of collagen degeneration. More recent research declares plantar fasciitis as a degenerative fasciosis without inflammation, not a fasciitis.

 

Phew! With all that said, it is still not truly well understood scientifically or biomechanically.

 

Regardless of all this, it is a painfully frustrating injury because it has the habit of healing slowly and reoccurring frequently. The effects of the stress can build up gradually or be the result of a sudden occurrence. Plantar fasciitis is not the same thing as heel spurs and flat feet, but they are related and often confused.

 

Common causes and/or risk factors of plantar fasciitis include:

  • Flat feet (Pes planus/fallen arches);

  • High arches (Pes cavus);

  • Tight calf muscles;

  • Tight hamstrings;

  • Overpronation or oversupination

  • Sudden increase in activity;

  • Switching running surfaces – especially from a softer surface to a harder one

  • Increased weight gain, either from obesity or pregnancy;

  • Poorly fitting footwear.

 

Plantar fasciitis can be unilateral or bilateral. Symptoms of plantar fasciitis ranges from mild to severe. The pain is commonly felt on the bottom of the foot, where the fascia attaches to the heel. It is most severe in the mornings when you get of bed because the fascia is in a shortened position at rest, and when you stand up, the sudden stretch and load of your body weight pulls on the attachment. Many people also find stair climbing painful and the pre-swing phase of the gait cycle (the medical term to describe human locomotion, or the way that we walk).

 

 

 

 

 

Photo courtesy of: http://www.clinicalgaitanalysis.com

 

Symptoms can linger for months at a time, with pain increasing and decreasing in an unpredictable pattern. Often, discomfort may nearly disappear for several weeks, only to re-emerge full-blown after a single workout or change in activity. The pain may even temporarily ‘fade’ as you walk only to intensify again two or three hours later with continued activity.

 

Whilst plantar fasciitis can be treated, it does not resolve quickly. It pays to review each of the factors and try to prevent its onset. Good basic treatments include:

  • Stretching your arch before getting out of bed;

  • Stretching your calves and hamstrings before going for a run;

  • Reducing mileage and adding cross training to your schedule;

  • Contrast bathing for your feet (as long as there is no acute inflammation) using both cold and heat.

 

If these symptoms seem familiar to you, come and see a Tonume Integrated Health massage therapist for an assessment. You may find relief in just a few treatments. We are a clinic dedicated to the health of the community through massage therapy, naturopathic medicine and chiropractic care. We are located on the Drive in Vancouver, BC. 

 

 

References:

Clinical Massage Therapy: Understanding, Assessing and Treating Over 70 Conditions. Rattray F, Ludwig, L. (2000) Talus.

 

The pathomechanics of plantar fasciitis. Wearing SC, Smeathers JE, Urry SR, Hennig EM, Hills AP. Sports Med. 2006; 36(7):585-611.

Plantar fasciitis: a degenerative process (fasciosis) without inflammation. Lemont H, Ammirati KM, Usen N. J Am Podiatr Med Assoc. 2003 May-Jun;93(3):234-7.

http://www.healingfeet.com/blog/foot-care/all-about-oversupination

http://www.tendinosis.org/index.shtml

 

 

 

 

 

 

 

 

 

 

Photo courtesy of: http://www.clinicalgaitanalysis.com

 

Symptoms can linger for months at a time, with pain increasing and decreasing in an unpredictable pattern. Often, discomfort may nearly disappear for several weeks, only to re-emerge full-blown after a single workout or change in activity. The pain may even temporarily ‘fade’ as you walk only to intensify again two or three hours later with continued activity.

 

Whilst plantar fasciitis can be treated, it does not resolve quickly. It pays to review each of the factors and try to prevent its onset. Good basic treatments include:

  • Stretching your arch before getting out of bed;

  • Stretching your calves and hamstrings before going for a run;

  • Reducing mileage and adding cross training to your schedule;

  • Contrast bathing for your feet (as long as there is no acute inflammation) using both cold and heat.

 

If these symptoms seem familiar to you, come and see a Tonume Integrated Health massage therapist for an assessment. You may find relief in just a few treatments. We are a clinic dedicated to the health of the community through massage therapy, naturopathic medicine and chiropractic care. We are located on the Drive in Vancouver, BC. 

 

 

References:

Clinical Massage Therapy: Understanding, Assessing and Treating Over 70 Conditions. Rattray F, Ludwig, L. (2000) Talus.

 

The pathomechanics of plantar fasciitis. Wearing SC, Smeathers JE, Urry SR, Hennig EM, Hills AP. Sports Med. 2006; 36(7):585-611.

Plantar fasciitis: a degenerative process (fasciosis) without inflammation. Lemont H, Ammirati KM, Usen N. J Am Podiatr Med Assoc. 2003 May-Jun;93(3):234-7.

http://www.healingfeet.com/blog/foot-care/all-about-oversupination

http://www.tendinosis.org/index.shtml

 

 

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