Alec Tinker Osteopath in Yorkshire – Back pain, Rehabilitation, Sports Injuries

Planta Fascitis or Chronic Plantar Heel Pain

The well known bane of runners; Planta Facitis is commonly thought to be a musculoskeletal condition of mechanical origin and is associated with pes planus (flat feet) and other lower limb biomechanical abnormalities. The theory is that the tensile strain caused by biomechanical problems results in microtears and chronic inflammation. However research into what actually happens to the planta fascia does not support this. Inflammation is rarely observed and research into the role of the arch is ambiguous.

So what is the Planta Fascia?

Fascia is a connective tissue that is found throughout the body and surrounds muscles, ligaments, organs and bones. The planta fascia is an extremely fibrous, dense tissue that forms a strong mechanical link between the calcaneous (heel bone) and the toes. The planta fascia’s job is to transmit force and also act as an active sensory structure. This fasica has the ability to adapt its composition depending on the amount of force transmitted through it.planta fascia

The enthesis is the name of the structure where the planta fascia attaches onto the calcaneous. It is at this point where the pain is normally felt. The degree of calcification of the fibrocartilage structure which joins the enthesis to the bone reflects the tensile strength of the enthesis.

Despite having the name planta fasciitis and therefore the assumption that inflammation is the key process the research says that this is unlikely. For this reason the condition is becoming to be known as chronic plantar heel pain (CHPH). It is now thought that the condition is related to changes of the cells and structure of the planta fascia tissue particularly of the calcaneal enthesis. The changes in tissue structure are similar to early osteoarthritis and the development of boney spurs is quite common.

The treatments below are aimed at easing the heel pain and reducing the degenerative process.

Stretching

Specific stretching of the planta fascia is considered an important part of the treatment for CPHP. The technique is shown in the picture below. Simply pull the big toe upwards and hold it there for 30 seconds.planta fascia stretch

Stretching the calf muscles is a commonly prescribed exercise however there is no evidence it will help reduce the pain in the short term but may be helpful in treating the biomechanical problems that caused the CPHP.

Ice

Ice is a great way of reducing pain without the use of pain killers.  The cold temperature blocks pain signals going to the brain and therefore stops you from feeling as much pain.

Taping

Taping for short term relief has been proven to be effective. The video below shows how to do this.

Orthotics

Custom orthoses can be effective at reducing the pain. Once the treatments above have been tried I would recommend seeing a podiatrist and getting some orthotics. After the pain has subdued weaning off the orthotics so that your foot does not have to rely on them for the rest of your life may be wise.

Biomechanical and other factors

Considering a wider approach and looking at possible factors that could have caused the biomechanical issues which lead to the CPHP is a logical step.  This is where the role of the osteopath, physio, of chiropractor comes in.  If you’re a runner then your technique may need to be tweaked or mileage changed. The type of trainers you run in could be having an effect. Tightness in your calfs, hips, low back could all have had a role to play. Addressing these issues should help in the rehabilitation and future prevention of CPHP.

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