Painful and often persistent, plantar fasciitis can be troublesome to treat because what is necessary seems nearly impossible.
Plantar Fasciitis illustration copyright HeelThatPain.com
plantar fasciitis (PLAN-tur fash-e-I-tis):
an inflammation of the plantar fascia, a thick band of tissues that runs from the heel to the toes
Along the bottom of your foot runs a thick band of connective tissue. Starting at the heel, the band fans out to connect to each of the toes. It’s called the plantar fascia, and it’s engineered to act as a shock absorber for all the pounding the body takes. However, all that pounding can cause small tears in the plantar fascia, creating an irritating, inflamed source of pain. Once the plantar fascia is damaged, the condition is called plantar fasciitis. Plantar fasciitis is known to affect those who exercise regularly, those who are overweight, those with a high arch, and those with a flat foot. In other words, it’s not very discriminating.
“The theory is that there is a design problem with the way the body was engineered,” says David Martin, a triathlete and chiropractor in Johnson City, N.Y. “But more likely it’s because of the way we use — and abuse — our bodies.” Whether the cause is overuse through exercise, excessive weight, a hard landing, or our footwear, the result is the same: The arch drops, causing the fascia band to stretch and then tear.
In most cases, the plantar fascia tears near the heel. Many times it is ignored and worsens until the repeated irritation and prolonged inflammation causes the body to develop a secondary problem: heel spurs. “The body creates a bony spur because it’s afraid the inflamed tissue will tear away from the heel,” explains William Smith, owner of Southern Tier Pedorthic Center in Endicott, N.Y., a specialty shoe store that fits many clients suffering from plantar fasciitis.
Sufferers of plantar fasciitis describe the pain as most acute during the first steps taken after an extended rest, such as first thing in the morning. The pain often becomes less severe as the body loosens up through movement. However, the pain can return after a prolonged period of standing. It’s a delicate balance trying to keep the plantar fascia limber without aggravating it from overuse.
“Once you’ve damaged the plantar fascia,” say Smith, “you need to have a lifestyle change to correct it.” According to the American Academy of Family Physicians, treatment generally takes between six and 18 months. Treatment could include a visit to a podiatrist to be fitted for orthotics. It may mean physical therapy or regular massage. It most definitely, says Smith, means being fitted for the right shoe. “It’s not just an issue of arch support,” Smith warns. “It’s about the structure of the shoe. The engineering of the shoe needs to include support in the middle of the foot.”
“Stretching and strengthening exercises are among the top recommendations for treatment,” says Dr. Martin. Along with a personalized stretching plan, common ways to treat plantar fasciitis include using devices such as a night splint, which looks like a brace and is used to provide a consistent and gentle stretch to the achilles tendon and plantar fascia. Another device looks similar to a large light switch. The foot lays flat on top of the device, and the toes slide the “switch” up and down, causing the arch to elevate, which provides a stretch for the plantar fascia. A less expensive option is to put the foot on a towel and scrunch the towel into a ball with the toes, says Dr. Martin.
Beyond shoes, stretching, strengthening, and massage, plantar fasciitis (and the pain associated with the condition) is traditionally treated by using ice packs, anti-inflammatory medication, and even steroids. Surgery has also been an option for people who suffer from plantar fasciitis; however, only about 5% of sufferers require surgery. The January 2010 issue of Runner’s World listed four new procedures that appear to offer new hope for plantar fasciitis sufferers, though not all are covered by insurance and may prove to be cost prohibitive. They include shockwave therapy, dry needling, and injecting the site with blood that contains platelets that will “stimulate the regeneration of tissue.” Finally, early studies show Botox offers help for the pain, if not the injury itself.
Ultimately, what is required to treat plantar fasciitis amounts to changing the habits that caused the injury, which is why treatment is considered lengthy and arduous.
What’s a Tech To Do?
While there is nothing in the tech’s toolbox in the way of a buffer or file that will fix plantar fasciitis, there are a couple of ways techs can aid a suffering client. First, if you suspect a client could be suffering from plantar fasciitis, refer her to a doctor immediately. The sooner the client is under the care of a doctor, the sooner she will be fitted for orthotics, referred to a physical therapist, or given other appropriate recommendations.
Second, gently squeeze the arch to see if you can relieve pressure. Smith says he can often give immediate relief to a customer by squeezing the inside of the arch, which removes the stretch and strain on the ligament. However, Smith cautions, sometimes even the slightest pressure can cause severe pain, so squeeze gingerly. Each person’s toleration level will differ.
Another consideration for techs is to sit with a physical therapist to learn the correct way to stretch and massage the foot on a client with plantar fasciitis. If a tech has a high number of clients who complain of plantar fasciitis pain, she could learn ways to offer relief and then become the “go-to” person for pedicures among runners or other high-risk clientele.
Finally a tech can inform clients of different devices and procedures that are said to give relief to plantar fasciitis sufferers. Remember to inform, not recommend. Suggest that the client ask the doctor to weigh in with an opinion. In the end, neither a tech nor a doctor can heal plantar fasciitis. The body needs time and rest to fully recover. What you can offer is temporary relief during the process.
KEYWORDS: FEET, HEALTH