The Plantar Fascia is a fibrous band which spreads across the sole of the foot from the toe to the heel. It attaches from all the toes and across the base of the heel. The typical site of pain is on the inside edge of the heel.
Plantar fascia is generally caused by poor bio-mechanics with the foot rolling in and applying too much pressure and force to this area. This type of overload causes strain, micro-tearing and laying down of scar tissue. This gradually becomes more inflexible and eventually becomes chronically inflamed and thickened.
The cause of the poor bio-mechanics can be from a number of sources but commonly tight calves and weak foot invertors, (tibialis posterior) as well as poor gluteal control and strength.
The pain can be intermittent and excruciating and has been described from a burning sensation to a feeling of a nail being driven into the heel! The discomfort is usually worse in the morning when getting out of bed or after long periods of inactivity. This is because the scar tissue stiffness up is given the opportunity and takes longer than normal tissue to become flexible.
Treatment starts with the scar tissue which needs to be made much more flexible and its strength increased. Manual and shock wave (Extra Corporal Shock-wave Therapy) work to the calf and the arch of the foot is very useful. It has excellent results and research behind it.
Beyond the local scarring you need to look at why you are overloading the tissues in the medial arch of the foot. As said above the most important area is weakness of the foot invertors – Tibialis Posteror. This hugely important muscle holds the arch up and decelerates the rolling in of the arch of the foot on impact (pronation). Secondly is the strength in the calf which helps to absorb impact.
However, a full bio-mechanical assessment is essential to properly treat this condition and this is what we do from the first session with us.