Crisis Plan Series
Plantar fasciitis
Plantar fasciitis (inflammation of the ligament of the sole of the foot) especially at its heal attachment is one stubborn condition to treat. Although the source of injury, the foot, is easily accessible, it is very resistant to treatment. It is best to begin treatment immediately after an acute injury or flare up. The usual R.I.C.E. (rest, ice, compression, elevation) techniques apply. If treated early and if the patient follows instruction well, good recovery is sure. Unfortunately, the cause of most plantar fasciitis is often chronic (long-standing) and multiple such as flat feet or high arch, wearing shoes with hard and non-supportive insoles for work or sports, tight plantar fascia (the ligament of the sole of the foot) and other ligaments and muscles in the foot, tight calf muscles, stiffness in one or more of the joints in the ankle and foot, poor gait etc.. The knee, hip and even the back may have to be checked to hunt for possible aggravating factors in some difficult cases. Poor neural (nerve) mobility such as tight tibial nerve at the back of the lower leg is not an uncommon cause or aggravating factor.
Since the pathology is chronic (long-standing) inflammation of the unhealed tear or the residual scarring, frequent ice as often as 5 to 10 minutes an hour may help. Rest from weight bearing is important to prevent further irritation. If not, soft silicone insole helps to reduce direct pressure to the spot. A Podiatrist referral is often indicated for further advice on foot wears and tailor-made insole fitted to restore best possible ankle and foot alignment. Deep friction massage helps to remove swelling and break scarring. Frequent Plantar fascia stretching to reduce tightness is crucial in its recovery. Other foot and calf muscles and neural stretches should also be performed as often as possible. General foot and ankle mobility exercises in all directions help to reduce stiffness and improve circulation. Foot intrinsic (deep and small) muscle strengthening exercises help to support the foot arches. Specific joint mobilizations especially to the subtalar (ankle) joint often helps as it is not uncommon for a subtalar joint injury to refer pain to the plantar fascia area.
It is fortunate that most of these treatments could be taught to the patient. If the patient performs enough self-treatment, prognosis could still be good. If all treatment methods have been exhausted, a local injection could be a good treatment of choice. Whatever it takes, one should try the best to prevent development of a bone spur that has been proven to be even more difficult to treat!
Luck LI
Musculoskeletal Physiotherapist
Since the pathology is chronic (long-standing) inflammation of the unhealed tear or the residual scarring, frequent ice as often as 5 to 10 minutes an hour may help. Rest from weight bearing is important to prevent further irritation. If not, soft silicone insole helps to reduce direct pressure to the spot. A Podiatrist referral is often indicated for further advice on foot wears and tailor-made insole fitted to restore best possible ankle and foot alignment. Deep friction massage helps to remove swelling and break scarring. Frequent Plantar fascia stretching to reduce tightness is crucial in its recovery. Other foot and calf muscles and neural stretches should also be performed as often as possible. General foot and ankle mobility exercises in all directions help to reduce stiffness and improve circulation. Foot intrinsic (deep and small) muscle strengthening exercises help to support the foot arches. Specific joint mobilizations especially to the subtalar (ankle) joint often helps as it is not uncommon for a subtalar joint injury to refer pain to the plantar fascia area.
It is fortunate that most of these treatments could be taught to the patient. If the patient performs enough self-treatment, prognosis could still be good. If all treatment methods have been exhausted, a local injection could be a good treatment of choice. Whatever it takes, one should try the best to prevent development of a bone spur that has been proven to be even more difficult to treat!
Luck LI
Musculoskeletal Physiotherapist