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foot pain

Foot pain

Fasciitis Treatment: A Physios Guide to Fixing Heel Pain

December 15, 2017 • By

Do your heels hurt from a lot of walking or running? Or have you been told that you have plantar fasciitis or a heel spur? Well, you are certainly not alone!

We have developed this comprehensive guide to give you the what, why and how to help fix plantar fasciitis.

What does the plantar fascia do

fasciitis and heel pain treatmentThe plantar fascia is a strong band of connective tissue that starts at the bottom of your heel and runs along the bottom of the foot, attaching into the toes.Think of it like a big strong rope that supports your foot and helps you move.

It is important for:

  • Maintaining your arch when walking and running
  • Stabilises your arch: As you push off your big toe, the fascia is put on more stretch, which lifts up the arch into a more stable position so you can propel yourself forward. This is called the windlass mechanism. You can see in the diagram below how when the big toe is pushed up, that pulls on and tightens the fascia, lifting the arch up. For more info on the windlass mechanism, you can see this previous post.

plantar fasciitis treatment exercises

What is plantar fasciitis

In a nutshell: It is a thickening of the plantar fascia due to overload.

A massive 4% of the population over 20 have plantar fasciitis and it is a massive cause of loss of function. It is essentially an overload injury where multiple factors combine to increase the load/pull on the fascia. This overload combined with not enough time for the tissue adapt leads to mal-adaption.

Essentially, it adapts wrong and ends up getting thicker and dysfunctional.

Other common names of Plantar Fasciitis

  • Plantar fasciopathy or fasciosis
  • Plantar heel pain

Is fasciitis inflammatory?

No. There has been shown to be some inflammation early on in the pathology but on the whole, it is not an inflammatory injury after the first 1-2 weeks.

This is why over the last ten years, a lot of the medical profession and research down around this condition have been leaning towards calling in plantar fasciopathy, not fasciitis. For now though and the purpose of this article, we will continue to call it fasciitis for continuity. (1)

Fasciitis symptoms

  • Pain upon waking and taking your first few steps –This startup pain” is because your plantar fascia and calves have been in a contracted, shortened position all night.
  • Sharp stab or a dull ache in your arch or at the heel.
  • Pain after long period sitting.
  • Pain that eases gradually in a walk or run as it warms up

Risk factors for Plantar Fasciitis

  • Limited ankle or big toe range of motion
  • High body mass index/Overweight
  • Older age,
  • Prolonged standing.

The best Plantar Fasciitis Treatment

Nplantar fasciitis treatmentow that you know the what, why and how of how fasciitis can happen, we can move on to the main thing. How you can help your plantar fasciitis get better, faster.

These are the main things that need to covered in a comprehensive treatment of plantar fasciitis

  1. De-load the fascia through alteration of exercise or load
  2. Support the foot and fascia
  3. Improve strength of the calf muscles for better control and shock absorption
  4. Reduce the pull on the plantar fascia by
    1. Improving flexibility in the calf and plantar fascia
    2. Improving ankle dorsiflexion range if needed
  5. And last but importantly, we gradually load the plantar fascia to re-align the fibres and get rid of the thickening

Here are those steps laid out in far more detail:

1. Reduce load

Plantar fasciitis happens from the repeated load on the plantar fascia without enough recovery. So, simply, to help give it a chance to recover, we need to reduce the weight bearing load to a degree. It isn’t about stopping completely, that is barely ever needed.

For Plantar Fasciitis, it is all about the relative rest

This means resting the fascia, compared to what it has been doing and what overloaded it. For example, if you were running 5 or 6 days a week, you could cut that down to 3 times per week, every second day. There isn’t a set exact guide for this but the big thing is to listen to your body. If you have more morning pain the next day then ease off a bit more and don’t do quite as much.

Not satisfied with decreasing your running or walking or too sore to keep going? Then on the rest days or as an alternative, try getting on a bike or rowing machine and get your exercise in another way.

2. Support the foot

Helping support under the plantar fascia and encouraging good foot motion can be great for relieving pain when you have plantar fasciitis. There are a few options to help here including:

  • Orthotics – These help support the medial arch and cushion the heel and are recommended for up to 1 year
  • Gel heel pads – Great to help reduce impact and give a soft surface for your heel
  • Fasciitis compression sleeves – These great socks can mimick arch taping really well and we have found they can give patients great relief

3. Improve strength

Studies have shown that people with plantar fasciitis have calf weakness, as well as ankle and calf tension2. This can increase load and contribute to fasciitis as the calf is then absorbing less impact and there is less control.

Strengthening the calf is important but often when the plantar fasciitis is irritated, it can be too sore to do. Never fear though, we have provided a couple of different levels of strengthening for you to work at daily:

level 1: Theraband Calf Strengthening

As per the picture below, push your foot down again a resistance band (TheraBand for example) and then control back up.

Repeat this for 3 sets of 12 repetitions and adjust the tension of the band to make it easier or harder

calf stengthening for plantar fasciitis

Level 2: Heel raises

Starting on two feet, and holding onto a wall if needed for support, raise up onto your forefoot as shown and then slowly control back down over three seconds.

Do this for 3 sets of 12 repetitions and when that is easy, start doing them on one leg at a time.

Note, if there is more than a little pain then start with level 1.

Calf raise, calf exercise, heel raise

4. Reduce the pull

Both the calf and the plantar fascia attach onto the heel and some fibres of the Achilles tendon actually wrap around and attach to the plantar fascia. So it makes sense that any tension in the calf, plantar fascia or ankle can increase the pull at the heel and worsen fasciitis.

Here is a quick test t see if you have enough ankle range:


easy test to measure your ankle range

If you can’t get your knee touching the wall when your foot is 10cm (4 inches) without your heel coming off the ground then you have some work to do! Here are the top three exercises to regain ankle range and reduce plantar fascia and calf tension:

1. Ankle mobilisation

Improve the dorsiflexion range in your ankle if you failed the ankle range test above. See the video demo below for an easy ankle self-mobilisation at home. Alternatively, if you don’t have a band (you can get one here if needed), you can lunge your knee back and forth towards the wall for about 3 sets of 20 reps.

2. Calf stretch: Hang one heel off a step at a time to stretch out your calf and hold this for 30 seconds each side.

calf stretch , soleus, gastroc - self treatment for shin splints

3. Plantar fasciitis deep massage: Use a hard ball or a massage ball to roll out the sole of your foot. Do this between the heel and balls of your foot, NOT under the heel. Do this slowly and firmly for 1-2 minutes to relieve the plantar fasciitis – You can also use a small frozen water bottle!

plantar fasciitis treatment

5. Gradually load

The final aspect of rehab is to load the plantar fascia. The idea behind this and in some recent, successful research is to treat it like a tendon injury. In tendon injuries such as Achilles tendinopathy, the tendon is thickened and the fibres and dysfunctional due to overload. The big part of tendon rehab thing that helps this a lot is putting gradually more load through the tendon. This causes the tendon to adapt and change for the better.

Looking at it like this and treating the plantar fascia like a tendon (even though it technically isn’t) looks to be gaining good results in research and the clinic and is becoming a mainstay or plantar fasciitis rehab over the last few years.

If you want to read further about this, you can check out the main research paper here, with their main conclusion being:

High-load strength training may aid in a quicker reduction in pain and improvements in function

Otherwise, if you don’t want to read a research paper:

This is the main exercise that is used to load and strengthen the plantar fascia to ultimately help fix plantar fasciitis

The high load strengthening exercise is done as per the image below. A small towel is rolled up to raise the toe up (hence, putting the plantar fascia on stretch) while doing a heel raise off a step. Go up and down slowly (count 3 seconds each) and hold at the top for 2 seconds.

This can be started two-legged and progressed to one-legged as it gets easier. You can then add a backpack with something heavy in it to add a little extra load. Keep doing this until you are pain-free.

plantar fasciitis strengthening exercise

Rathleff Et al. 2014

 

Conclusion:

And that’s it – all the information, treatments and tools that help fix plantar fasciitis.

Unload, Support and Gradually strengthen

 


foot pain, Health, running

How to Run Better, The Basics

July 19, 2017 • By

There are a few easy things that everyone can apply to their running to decrease injury, pain and simply make running easier and faster! Today we are simply going to show you how to run better

This is perfect for those of you that have regular niggles or if you have plateaued with your running and need a way to step it up. So here is your easy guide on to how to run better and improve your run!

running cadence 1801: Cadence:

This is basically the number of steps that you take per minute and for best efficiency, this should be 90 steps per minute on each foot (180 total per minute). To achieve this, first of all, you need to measure what your current cadence is. You can do this by counting the amount of steps your right foot takes in one minute.

Try then increasing your rate (if needed) and time again in another 5 minutes. The trick is to think like you are running on an icy or slippery surface and your heels are coming up behind you. This could well feel awkward to do at first and can take weeks to get used to, but once you get used to it, running will feel much easier.

Tip: A great way to improve your running cadence and run better is to use a metronome (some examples here)

how to stop overstriding2: Don’t stride out:

When striding out the foot lands on the heel and with the leg relatively straight out. This creates a braking force up through the leg and acts to slow you down, meaning YOU have to work harder.

Run better by kicking your heels up more – don’t run with straight legs!

 

3: Think smooth, light and easy:

If you look at the best medium to long distance runners you will see they have very little upward head movement (less bobbing up and down). This means less wasted energy! So to run better, we need to lean our body weight forward more and imagine projecting yourself forward and slightly up. Practice standing 1 meter in front of a wall and leaning forward through bending at your ankles until you are about to fall forward and then come back again in order to get a feeling of shifting your body weight forward.

Exercise: Practice standing 1 meter in front of a wall and leaning forward through bending at your ankles until you are about to fall forward and then come back again in order to get a feeling of shifting your body weight forward.

Remember – Perseverance is key with this! You will feel like you can just keep running and running when this becomes second nature – and then you tell others how to run properly – I still find it amazing that no one gets taught how to run!

Lastly, check out the video below of what I think is some close to perfect (no one is perfect) running:

 


Health, running, Shin Pain

Shin Pain and Stress fractures – Heal strong and fast

July 16, 2015 • By

marathonTreating your shin pain and foot pain from stress fracture the right way, as soon as possible, means you heal faster and stronger. In this series on stress fractures, I will tell you what a stress fracture is, what causes them and most importantly what rehab exercises and self-treatment you can do to get it right.

Following on from the first post in the series which detailed what stress fractures and stress reactions are and why endurance athletes are so prone to shin pain and foot pain and what to do initially, this post gives you the rehab to help it heal faster, by covering phase 2 and 3 of stress fracture rehab.

Phase 2 – Strength, conditioning and rehab

When to start: Phase 2 of rehab from stress reactions starts when general activities of daily living (walking, hanging out washing etc) can be done without symptoms – Pain is an indication of overload to the bone in many cases, so we need to listen to our bodies.

The main three aspects that need to be covered in home rehab of stress fractures are:

  1. Exercise to maintain cardiovascular fitness and prevent muscle loss
  2. Rehab exercises to address cause behind the injury

So let’s address those:

1. Maintain fitness

It is important to note that in most cases you don’t have to completely rest – there is always something you can do, and very important not to lose fitness. So with that in mind, and the fact that exercise actually boosts healing, here are some things that you could do:

  • Pool training – this can start light, treading water in the deep pool and swimming, progressing to jogging in chest-deep water.
  • Stationary bicycle or exercycle – this is a great way to keep up the fitness without causing pain
  • When poor walking etc is pain-free, begin going for short walks and build this up. Eventually you should be able to walk without pain for 30 minutes at the end of this phase

Tip: Remember, you cannot return to loading the bone until the bone is pain-free to tap on and touch

2. Rehab exercises

These should aim to:

  • Increase muscular endurance
  • Improve core and pelvic stability
  • Work on balance training
  • Address flexibility issues
  • Re-train running pattern

Here are some great options to work on:

Heel raises to build calf endurance

Calf raise, calf exercise, heel raiseLevel 1: Start these on two legs, aiming for 3 sets of 10 reps

Level 2: When comfortable and pain-free, progress to single leg heel raises

Level 3: Goal: 30 heel raises in a row

 

 

 

One leg squats to retrain pelvic and lower limb stability

Single leg Squat, hip stability and strength

Aim for 3 sets of 10 reps.

These need to be done with good technique so it can help to do them in front of a mirror

 

 

 

 

Wobble board balance re-training

Bosu ball, wobble board ankle and calf re-training rehab quick

 

Re-training your balance and coordination of the muscles is very improtant, and easily done with either a wobble board or a Bosu ball.

Aim for at least one minute on each leg.

If you can’t get a wobble board, try rolling up a towel firmly and standing on this

 

 

Stretching:

Calves

calf stretch , soleus, gastroc - self treatment for shin splints

Hang one heel at a time off a step and hold for 30 seconds

 

 

 

 

Hamstrings

doorway stretch

 

MTSS shin splints self treatmentStretch out your hamstrings up a doorway of wall as shown here and hold for at least 30 seconds each side

Alternatively you could use a Foam Roller to loosen up your hamstrings and calves!

 

 

Tip: Continue to ice after exercise and exercise should always be pain-free – a return of shin pain or foot pain can’t be taken lightly.

Phase 3: Safe progression back to full activity

Before starting this phase, you need to be able to do all the previous exercises and painfree and ideally be cleared by your physio or doctor.

When returning to running, a good guideline is to increase activity by no more than 15% to 20% per week. You should also be able to walk for 30 minutes comfortably and you can build this up the same way.

A good starting point, is to run 500m followed by a day of rest or a short walk. If this is pain-free, then you can jog 3 x weekly, ensuring that there are rest days

The distance above is just a guideline but basically start with a short distance and if this is pain-free, slowly increase this, never increasing by more than 15% per week. This is because bones take time to adapt, heal and get stronger – you need to give them this time and only increase in small amounts so as not to overload them.(1)

Numb feet when running lace up properlyTip: when returning to running, it is important to have the right technique – pay a visit to your local sports physio or appropriate professional to have this looked at and also to get some advice on footwear for you as this is very individual (but maybe stay away from minimalist or “barefoot” footwear and aim for motion controlled footwear initially (2).


Foot pain, Health, Lower limb

Arch Pain? Easy Self-Treatment

July 22, 2014 • By

sore-feet - myofascial releaseIn today’s world of concrete pavements, cushioned shoes and sedentary lifestyles – Our feet get stiff, imbalanced, achy and neglected. This often leads to arch pain and plantar fasciitis (or fasciopathy) but luckily these is a way to help loosen off your arch!

It is time to take 2 minutes to wake up your feet and get them loose and mobile again with one simple exercise.

Our feet lay the base for our entire body to work off and they really are an amazing piece of machinery, they:

  • Absorb impact
  • Propel us forward with spring-like mechanisms (see more here)
  • Have cat-like reflexes
  • Balance out and lay the foundations for our whole upright body

 

The amazing human footplantar fascia - myofascial release : This BBC documentary on the human foot gives a great insight into all the structures that combine to give the foot the ability to take all of our weight, day in day out. At 18-19 minutes you can see the plantar fascia that runs along the bottom of your feet clearly and how it gets tensioned as you walk, acting like a spring – this is the spring that you are going oil up with this treatment today!

The feet really do have a lot to do, and have a lot of weight and forces going through them every single day. This combined with us tending to keep them cramped up in fabric coffins for the better part of the day, or even worse in flat shoes and flip-flops – leaves them needing a little R & R.

 

So how can you say “thank you feet” and give them some relaxation and mobility?

Myofascial release foot pain, plantar fasciitisTake a ball, any ball will do (I prefer to use a lacrosse ball as they are grippy and firm) but the firmer, the better. Place it under you foot, apply some pressure and slowly roll it around the bottom of your foot.

Maintain a comfortable pressure, while rolling it into all the tight spots in the sole of your foot – namely the inner arch and outer arches of your feet between your heel and the ball of your feet.

Do this for two minutes on each foot and feel the difference. You do this while standing or sitting (under the desk at work even), so really there is no excuses 🙂

This is a great little exercise to really loosen up the Fascia (connective tissue), massage the muscles and mobilize the bones, and as a bonus, it increases your flexibility.

Myofascial release foot, plantar fascia

 

As a quick test to see if your tight feet are affecting your flexibility – before you start the myofascial release, slide both hands down your legs and see how far down you can get (toe touch), and remember how far down you get. Roll out both feet for two minutes each and then re-test – Most of you will be pleasantly surprised that you get significantly lower down

 

And YES if you have Plantar Fasciitis or Heel spurs – This will really help you.

So, if you have any foot arch pain, heel pain, calf pain or just generally want to look after your hard working feet – Take a few minutes out of your day and get this done and you will be much better off for it.

 

Thanks for reading, you will most likely also enjoy our value packed Ebook and these past blog posts:

Please share, like or comment if you want more

 

 


Calf Pain, Foot pain, Health, Shin Pain

Flip-flops and moon boots

April 26, 2014 • By

jandals profWhenever I see a patient with a lower limb injury come into the practice wearing flip-flops I cringe inside. Really, these simple bits of plastic are causing a lot of pain and injury and are not something you should wear all day.

Flip-flops absolute lack of arch or heel support puts you at risk of unnecessary pain and injury. We are (I am generalizing here) so careful to wear the best footwear when exercising, keeping up to date with the latest running shoes, orthotics, braces etc but when it comes to relaxing and what we wear outside of work and sport – we aren’t so smart. A study found that in a large shopping center, 43% of all women were wearing flip-flops(1) – That is a huge amount of foot, calf, shin, knee and back pain! Yes this may keep Physio’s and podiatrists in business but it keeps a lot of the population out-of-pocket – And often there is a very simple thing you can do to ease your pain and injuries….

Throw your thongs away!!

Really flip-flops aren’t that bad if you just wear them to the beach, around the changing room or shower etc – It’s when you start wearing them out shopping, to lunch, all day, everyday that they can cause real problems. What problems can flip-flops cause you may ask? and why? Flip-flops can lead to:

  • Plantar fasciitis
  • Stress fractures – Hence the moon boots
  • Shin splints
  • Calf pain and strains
  • Foot pain e.g. Mortons neuroma, metatarsalgia
  • Low back pain
  • and more

And Why?

Flip-flops change the way we walk

They wouldn’t be so bad if our feet weren’t so weak and de-conditioned. Yes we evolved to roam the open plains and jungles barefoot but now that we live in this concrete world – we need a little more protection for our feet. Also because we so often wear cushioned supportive shoes the rest of the time, our feet are not able to handle the complete lack of control and support when wearing flip-flops – Like sleeping on a nice comfy bed one night and then on concrete the next – You will get sore right?

And because they change the way we walk, we use our muscles in a different way, while increasing the shock going through and feet and legs due to lack of shock absorption. Wear them for a long time and the repetitive strain leads to overuse injuries. For example:

  • Every time you step, you need to squeeze and scrunch your toes to hold the flip-flops in place! Meaning your feet and calf have to work very, very hard = tight, tight calves.
  • Due to the total lack of arch support the arch can repeatedly over-pronate, increasing the stretch on your plantar fascia. Repeat this over hundreds of steps and you get micro-tears, inflammation and pain. You can read more about this here.

Good things in moderation

So, you don’t need to go and throw your flip-flops out but PLEASE limit the amount you wear them as they can be a huge cause of pain and injuries. This is also such an easy thing to change that can drastically improve your function and decrease injury risk, so why not do it huh?

jandalsAddendum: As a proud Kiwi I feel I should give a quick history on the proud origin of flip-flops.. or should I say Jandals! The flip-flops was originally invented in Auckland, New Zealand in 1950. The idea came from the original Japanese sandals which allied soldiers saw while doing occupation duty in Japan during WWII. The original name Jandal (Japanese sandal) was trademarked so that lead to other countries having t come up with other names such as:

  • jandals 1Flip-flops
  • Sandals
  • Slippers
  • Thongs, etc

So wear this great invention in moderation and save yourself a lot of trouble. Please Share, like and comment away!