Ouch! Sharp pain is a common reaction many people feel when their foot first touches the ground after a night’s rest. This sharp pain lessens gradually as one continues to walk throughout the day. However, it may return after long periods of standing or returning to your feet after a long period sitting.

This pain may be caused by plantar fasciitis (pronounced fash-ee-EYE-tus). Plantar fasciitis is a common cause of foot pain in middle-aged people. However, it can also occur in younger people, particularly athletes (runners in particular), pregnant women, and those who are overweight. Plantar fasciitis is often associated with another, sometimes painful, foot condition known as heel spurs.

What is Plantar Fasciitis?

Plantar fasciitis is said to be an inflammation of the plantar fascia, but recent studies show that it is actually due to loss of blood circulation and collagen degeneration associated with microscopic repetitive tears of the plantar fascia.1 What’s the plantar fascia you ask? It is a thin, tough band of connective tissue on the bottom of the foot extending from the ball of the foot to the heel and supports the arch. During walking or running the plantar fascia may pull from its attachment on the heel bone especially if the foot is excessively pronated.2

Excessive pronation occurs when your weight is shifted toward the inside of the arch of your foot. Essentially, it is like walking on the inside edge of your foot. Excessive pronation causes added strain on the plantar fascia, which in turn causes excessive strain and pull where the plantar fascia connects to the heel bone.

The pain of plantar fasciitis is generally felt on the bottom of the heel more medially as seen in the above photo.

Treatments & Prevention

Plantar fasciitis can take 6-18 months to resolve with common treatments.3 This can be very frustrating especially to athletes in training. There are many types of treatments available, common ones include: stretching the calves, strengthening foot muscles, arch supports, orthotics, night splints, anti-inflammatory agents, corticosteroid injections, and surgery. But did you know that massage can greatly hasten the healing process?

Massage can be very helpful in the treatment of plantar fasciitis. Tight calf muscles cause the foot to spend more time in a plantar flexed (toes pointed) position, especially during sleep. This shortens the plantar fascia making it more susceptible to overstretching and microtears leading to plantar fasciitis.4

Since various leg muscles aid in the stabilization of the foot, it is necessary to consider them in the treatment plan. With massage, we begin by assessing the muscles of the legs. There is usually tightness and at times weakness in the calf muscles, as well as the anterior and lateral muscles of the lower leg. The hamstrings should also be checked and relaxed with massage.

Therapists also use a variety of massage techniques for the entire lower extremity and hips because the foot pain causes biomechanical compensation in other parts of the body while walking or running.

Massage techniques include the following to the entire lower extremity: trigger points in the legs and hips, crossfiber-friction, counter-strain, and stretching of the plantar fascia which helps stimulate and quicken the healing process.  Only after the pain is decreased on the bottom of the foot, do we begin massage directly on the plantar fascia.

It is then suggested that the client to stretch the calf muscles at least every hour while awake between treatments to lengthen and normalize the muscle and other soft tissue.

If you are experiencing heel pain it is best to check with your physician and then follow up with a well-trained massage therapist in your area.  There is hope for quick recovery.

For those of you seeking to avoid plantar fasciitis (or avoid getting it again) … preventive measures include: wearing proper shoes, adequate rest and recovery time, proper stretching, strengthening, and massage.

 

1. Young, C; Rutherford, D., & Niedfeldt, M. (2001). Treatment of plantar fasciitis. American FamilyPbysician, 63(3),467-474, 477-478.

2. Pribut, S. (2004, October). Heel pain: Heel spur syndrome and plantar fasciitis. Dr. Stephen M. Pribut’s Sport Pages.

3. Young, C; Rutherford, D., & Niedfeldt, M. (2001). Treatment of plantar fasciitis. American FamilyPbysician, 63(3),467-474, 477-478.

4. Karageanes, SJ. (2005). Principles of manual and sports medicine. Philadelphia: Lippincott Williams & Williams


About the Author

Carola Janiak, MS, RN, LMT, ACSM

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