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

PMS and the debilitating PMDD

The Age, 2 February 2014

“It can leave sufferers bedridden, unable to work and suicidal. But should extreme premenstrual syndrome be categorised as a mental disorder? By Amy Molloy.

"WHEN THAT TIME COMES AROUND, I CAN'T CONTROL MY BEHAVIOUR OR MY EMOTIONS."

This is the opening of an article in The Age about how PMS, in this case better described as premenstrual dysphoric disorder (PMDD), can seriously affect women every month to the point where they cannot function. The faculty of medicine, nursing and health sciences at Monash University reports that 90% of women experience at least one symptom during their menstrual cycle, from feeling uncomfortable to gaining weight. A small percentage, 3 to 9%, experience debilitating symptoms where they cannot control their lives. This brings about a host of symptoms such as not being able to control behaviour, feeling worthless, useless and a terrible person. Last year PMDD was recognized in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.1

Research conducted in India concluded in 2009 that 54% of women with suicidal tendencies were menstruating at the time against 6.75% in the control group.1

The danger of having PMDD classified as a mental disorder is over-prescription and the use of antidepressants. The other danger is that lifestyle is overlooked such as diet and the use of beauty products.

Diet and lifestyle
As with any hormonal imbalance such as fertility issues, conception, it is recommended to look at one’s diet. It is advisable to reduce the intake of sugar, caffeine and alcohol and drink enough water. It is recommended to include healthy fats, such as avocado, coconut oil and olive oil (not heated), in the diet as hormones are made from fats and proteins and they need fuel1.

Beauty products
Moisturizers and other products applied to our skin penetrate the skin and enter into the muscle tissue and blood stream. Some of the components effect the functioning of our body and as Fertility specialist Nat Kringoudis mentions, they may contain toxins that mimic oestrogen and cause a hormone imbalance1. Check out the ingredients in your beauty products, soaps and shampoos; the skin is our largest organ and is permeable. Today there are many brands available that use natural ingredients.

The role of reflexology
Stress needs to be reduced and this is where Reflexology excels. It is also a great tool to balance hormones in the body. I don’t personally know anyone who suffers from PMDD so have not worked with anyone presenting with these symptoms. I have however worked with women with strong PMS symptoms as well as with menopausal women. My experience shows that reflexology lightens symptoms to the point where women no longer have extreme symptoms experienced before having reflexology. One menopausal woman was changing her bedding at least once every night if not twice due to extreme sweating. After a couple of treatments, this was no longer the case. She also felt better during the day with lasting improvement.

Conclusion
Research done by Dr Terry Oleson, Psychobiologist, and Bill Flocco, Reflexologist, supports that reflexology is effective in the treatment of PMS2 and I would suggest that, together with medical treatment, reflexology could offer support to those women who have been diagnosed with PMDD.


References
1. Molloy, A. (2014). Women’s trouble: Should extreme premenstrual syndrome be categorised as a mental disorder? The Age. Retrieved from http://www.theage.com.au/lifestyle/womens-trouble-20140128-31knc.html
2. Oleson, T & Flocco, B. (1993). Randomized Controlled Study of Premenstrual Symptoms Treated with Ear, Hand, and Foot Reflexology. Obstetrics and Gynecology, 1993;82(6): 906-11. Retrieved from http://www.reflexology-research.com/index.php/what-is-reflexology/reflexology-information/reflexology-research/a-z-list-reflexology-research-abstracts-update/pre-menstrual-syndrome

DISCLAIMER: Please note this article does not replace medical advice. Please consult with your medical doctor, naturopath and/or Chinese doctor if there are any health concerns.