With the beautiful summer we are having here in Vancouver the streets are full with avid runners keeping in shape and perhaps preparing for the next 5K 10K or marathon of the season. I have had the opportunity to work with several runners many of them who are presenting with plantar fasciitis, which is a condition that can ruin any runner’s season. It is very important to recognize symptoms so that they can be treated.
Plantar Fasciitis is typically characterized by pain on the bottom of the foot with normal heel to toe walking/running, pain during the first few steps of the day and sometimes referred pain to the top of the foot, achilles tendon and in the ankle joint. After a warm up the pain usually subsides a little. So what can be done for someone experiencing these symptoms?
Seeing a Massage Therapist and Physiotherapist is very effective in assessing and treating the condition. There are several soft tissue techniques, joint mobilizations, stretches, strengthening exercises and self-care measures that can be used and taught by therapists.
Dynamic and passive release techniques
- The client will point their effected foot and crunch their toes as much as they can.
- The therapist will palpate for a restriction in the plantar fascia and then provide sustained point specific pressure to the restriction.
- The client will then slowly start to relax the foot and pull the foot and toes back towards themselves as much as they can with the pressure from the therapists maintained.
- This process will be repeated at a different restriction.
This treatment is fairly aggressive and can be very painful. A gentler approach would be to use the same process but instead of the patient actively performing the movements their therapist can point the clients foot and perform the actions for them.
Joint mobilization of big toe.
- The therapist will stabilize the 1st metatarsal (Big Toe at the joint) with one hand.
- With the other hand the therapist grasps the Big Toe just above the nail and distracts the joint by pulling directly outward from the joint in a straight line.
- With the toe distracted the therapists glides the distracted toe at a 90 degree angle towards the clients head.
This treatment will help with improving big toe extension which is often very painful with plantar fasciitis.
Kinesiolgy tape is a newer modality becoming very popular with athletes. It has been effective with many conditions, plantar fasciitis being one of them.
- Start by having the injured foot pointed back to the nose (dorsiflexed).
- Anchor a strip of tape to the back of the heel and with no stretch fan out the strip across the plantar fascia.
- A second strip anchored at the top of the foot, stretched and wrapped around mid foot to support the arch.
Ball / Water bottle rolling
A tennis ball, lacrosse ball or frozen water bottle can be placed under the foot. I find frozen bottle works best since the ice helps manage the pain while rolling. The client will slowly roll the bottle back and forth along the plantar fascia breaking up restriction and lengthening the tissue. They can choose to sit or stand depending on how aggressive they want to roll.
The plantar fascia can easily be stretched using a belt while lying down on the back. The middle of the belt should be placed at the toes while having both ends in hand. Pulling the belt to pull the toes back will stretch the fascia.
It is also very important to stretch the calves, the outer muscle ‘gastrocnemius’ and deeper muscle ‘soleus’. The gastrocnemius is shown to the left with the soleus stretch shown on the right. By lengthening the calf muscles there will be less tension pulling upward on the heel, which allows the plantar fascia to relax.