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There is nothing like an engaging title to get a reader interested. Today's blog is all about plantar fasciitis (PF).
What is PF?
PF is an issue with the sole of the foot that cause pain and lots of it! Fascia is connective tissue that joins, meshes, sticks and holds us together. All cells are connected together by fascia and if we didn’t have any we would look very odd. Our muscular shape forms because of the way fascia surrounds the muscle bellies like a sausage skin. So if we had no fascia holding us together the we would look like a melted mess, drooping and sagging! The sole of the foot has a thick and incredibly tough piece of fascia connecting the bones of the foot a bit like a suspension bridge. It's when this plantar fascia gets irritated or injured that it starts causing problems. Sometimes the fascia can have micro tears, scar tissue build up and inflammation causing moderate to severe pain.
What causes PF?
We know that being on your feet too much, obesity and sudden increases in exercise may cause PF but also on the flip side a sedentary lifestyle with little exercise, can also be a contributing factor. Heel spurs may be a contributing factor and mechanical factors such as flattened feet are still up for debate.
What are the signs and symptoms?
PF is usually a gradual process that can affect both feet in 1/3 of people. Pain is usually sharp especially with the first few steps getting out of bed in the morning. When non weight bearing it is more of a dull ache, some people report a burning sensation, tingling and numbness. In rarer cases the fascia can rupture. Look out for clicking sounds, discolouration and swelling in that area.
How is it Diagnosed?
It's pretty easy to diagnose PF with a few manual tests. There are though, cross overs between different conditions like heal spurs, fat pad syndrome, calcaneal stress fracture, bursitis, tarsal tunnel syndrome and nerve issues arising from the spine. If we can not make a definitive diagnosis during assessment then a diagnostic ultrasound is the next step, then X ray, then MRI. Blood tests may also be used to check for anything systemic like ankylosing spondylitis.
How can PF be treated and how can Chiropractic in Cardiff help?
Currently there is no gold standard but by using multi-modal techniques, it is often dramatically helped and prevented from reoccurring in the future.
The best steps in order:
1. Loading: Research is showing that progressively loading the PF helps stimulate collagen production [1]. We are not talking about throwing a 100kg barbell on your back but slowly stressing the PF within the patients pain tolerance. Click here for more info
2. Self care.
Ice Ice Ice! It’s boring, no one wants to do it, it’s cold and a chore! This may be true but it is essential you do this 3x a day for 20 minutes at a time, everyday. It’s a free way to reduce pain and the inflammation that is causing your pain. A great thing to do is fill up a water bottle, freeze it and roll your foot over the bottle for a few minutes. Make sure to not get ice burns by wrapping ice packs in a thin towel.
Rest: Rest where possible, take a load off, we were not designed to be standing for up to 12 hours a day every day.
Diet: Some foods have anti-inflammatory properties which are also very healthy, please read this page to educate yourself http://articles.mercola.com/sites/articles/archive/2015/02/02/anti-inflammatory-foods-herbs-spices.aspx
Pads: Try sticking a thick plaster on the points that is most painful and see if this reduces pain while standing, if it increases pain take it off again.
Lose some weight. If this is going to help then you will also get the other health benefits of losing some extra weight.
Pain gel: Worth a try even if it does only give temporary relief.
Swimming: If you are wanting to be more active without pain, swimming is a good alternative to running, squatting or anything that involves being on your feet longer than necessary.
3. Chiropractic care in Cardiff: Combinations of foot manipulation, massage, dry needling, sports tape and human touch has good effects in most people along with the advice we can give. Sometimes correcting ongoing back issues have helped PF.
4. Shockwave therapy: This can help around 70% of people get the long term pain relief they are after. Originally used for breaking down kidney stones it has been developed for musculoskeletal issues. Sending high pulsed acoustic waves into the fascia it promotes the healing process of many issues including PF. Treatments are only 5 minutes long and in most cases only need 3 sessions.
5. Injections: We are heading to the last resorts now, with any kind of treatment there are always risks with medication. For some people injections give short term effects but the side effects can out-way the benefits. Still when people feel like they have tried everything else then it is really the only other option.
6. Surgery: If the PF has ruptured then surgery might be needed, again it is not always successful and can lead to other issues in the future. It is always recommended to exhaust all of the natural and self care modalities before trying something more invasive.
I hope this short blog has given some insight into PF. It can be such a debilitating condition but at the same time with proper care and knowledge can be helped so you can get back on your feet and get back to enjoying life again.
Yours in health
Matthew Corbin D.C
References:
1. Tu P, Bytomski JR (October 2011). "Diagnosis of heel pain". Am Fam Physician. 84 (8): 909–16. PMID 22010770. Archived from the original on 2013-12-30.
2. Zhiyun L, Tao J, Zengwu S (July 2013). "Meta-analysis of high-energy extracorporeal shock wave therapy in recalcitrant plantar fasciitis". Swiss Med Wkly. 143: w13825. doi:10.4414/smw.2013.13825. PMID 23832373. Archived from the original on 2014-01-02.
3. Jeswani T, Morlese J, McNally EG (September 2009). "Getting to the heel of the problem: plantar fascia lesions". Clin Radiol. 64 (9): 931–9. doi:10.1016/j.crad.2009.02.020. PMID 19664484
4. Hill CL, Gill TK, Menz HB, Taylor AW. Prevalence and correlates of foot pain in a population-based study: the North West Adelaide health study. J Foot Ankle Res 2008;1(1):2 doi: 10.1186/1757-1146-1-2[published Online First: Epub Date]|
5. Cheung JT, Zhang M, An KN. Effect of Achilles tendon loading on plantar fascia tension in the standing foot. Clin Biomech (Bristol, Avon) 2006;21(2):194-203 doi: 10.1016/j.clinbiomech.2005.09.016[published Online First: Epub Date]|
6. DiGiovanni BF, Nawoczenski DA, Lintal ME, et al. Tissue-specific plantar fascia-stretching exercise enhances outcomes in patients with chronic heel pain. A prospective, randomized study. J Bone Joint Surg Am 2003;85-A(7):1270-7
7. Kongsgaard M, Kovanen V, Aagaard P, et al. Corticosteroid injections, eccentric decline squat training and heavy slow resistance training in patellar tendinopathy. Scand J Med Sci Sports 2009;19(6):790-802 doi: 10.1111/j.1600-0838.2009.00949.x[published Online First: Epub Date]|.