Tuesday, 18 February 2014

Plantar fasciitis, reflexology and foot mobilisation



Plantar fasciitis: "Rather than being the result of inflammation, the condition more closely resembles long-standing degeneration of the plantar fascia near its attachment.” 

Statement by James Speck1 who has a master’s degree in physical therapy and a special interest in understanding injuries


Possible causes of the condition
  • Repeated strain on the fascia may cause small tears that lead to pain
  • Heel spurs, with new evidence, are unlikely to be a cause of fasciitis and seem to develop due to compression
  • Excessive pronation leads to extra weight on the fascia
  • Tissue degeneration in areas that receive poor blood supply 
Risk factors
  • Decreased ankle dorsiflexion with a normal flexibility range being 20 degrees.
  • Increased body weight (BMI) in non-athletes
The above risks lead to increased strain on the arch and increased pressure/compression on the heel. Muscles and ligaments in the arch are then unable to balance body weight.

Shoes
  • Limit the natural movement of the foot
  • Prevent/limit muscle activity
  • Hold the plantar fascia in a stretched position
  • Reduce circulation to the bottom of the feet
Shoes are generally too rigid with a toe box too high above the ground. This restricts the activity of intricate muscles in the toes. The foot forced into this rigid ‘container’ leads to
  • Strong reduction of the gripping action of smaller toe muscles
  • Prevention of the shock absorption capacity of muscles and the plantar fascia
  • Prevention of muscle contractions to support the arch
  • Possible reduction of circulation
As toes are not working as intended, it is possible that their restricted movement may lead to degeneration of either the plantar fascia or the tendons.

Walking barefoot allows all muscles to grip and stabilize the arch. When all these muscles are strong, the plantar fascia is more flexible and lengthens with the complex movements of the foot when walking and/or running.

The arch of the foot is naturally elevated to create space for the nerves and blood vessels that pass through. Arch supports found in shoes more often than not put undue pressure on this area reducing blood flow and inhibiting free muscle movement.

Conclusion one
James Speck reports that plantar fasciitis is not caused by
  • Inflammation
  • Wearing shoes that don’t have enough support
  • A tight plantar fascia
  • Running or standing a lot
It is rather caused by a combination of:
  • Heel compression where body weight is carried by the heel instead of the whole foot when standing
  • Excessive stress put on the foot due to decreased ankle flexibility, pronation and carrying too much weight
  • Rigid shoes reducing muscle activity which in turn reduce the plantar fascia’s ability to absorb shock
  • Weak foot muscles
Treatment
The aim of a treatment is to
  • Reduce compression of the heel by changing the standing position
  • Take weight off heels and spread this evenly from heel to toe
  • Wear more flexible shoes with a low heel
  • Exercise
    • Increase barefoot activity
    • Increase ankle flexibility
    • Strengthen muscles in the foot and leg
    • Stretch and massage legs and feet
In my 15 years of clinical experience2,  the following treatment techniques have proven to be successful
  • Foot mobilisation uses gentle techniques to increase flexibility in the ankle and foot and stretches muscles and tendons
  • Reflexology massages the muscles at the base of the feet loosening them up so they can stretch better. Blood flow and nerves are stimulated
  • Massage loosens and stretches muscles and tendons
Exercises to strengthen the feet
Here are a few examples of how to strengthen the complex muscles in the feet
  • Picking up small items with the toes
  • Walk on soft (beach) sand and make the feet work
  • Standing on toes, raise heels as high as possible, hold and lower slowly, repeat several times
  • Stand on the toes and walk a few steps
  • Stretch toes out like a fan, sideways and forward
  • Roll arch of the foot gently over tennis ball or golf ball, this loosens up the muscles in the arch of the foot





This video shows a great quick routine that can be performed daily: 



Conclusion twoPlantar fasciitis is the result of the wrong kind of pressure on the heel and treatment needs to concentrate on the entire foot to evenly carry body weight and to encourage a healthier function of the whole foot.


References
1. Speck, J. (2013). The real cause of plantar fasciitis. Retrieved from
     http://www.somastruct.com/cause-of-plantar-fasciitis/
2. Hilarius-Ford, A. Orthopractic foot mobilisation. Retrieved from
    http://annehilariusford.com.au/services/footmobilisation