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Heel Pain? Massage and Plantar Fasciitis

Do your heels and the soles of your feet hurt when you first step on them when getting out of bed in the morning?  If so, you may have the most common form of heel pain, Plantar Fasciitis.

I should note before we start that none of this is intended to be a diagnosis of plantar fasciitis, and if you are experiencing heel pain, you should have your physician examine you to determine what’s going on.

What is the Plantar Fascia?

Image from NIH.gov

The plantar fascia (also called the plantar aponeurosis) is a thick band of connective tissue on the plantar surface (underside) of the foot.  It originates on the medial tubercle of the calcaneus bone (a particular landmark on the underside of the heel bone), and continues beneath the other bones of the foot out towards base of the toes.  The plantar fascia is made up of collagen fibers that run mostly along the length of the foot, although some move in other directions as well.  The job of the plantar fascia is to support the bones of the arch of the feet by acting as a tie-rod.  From a mechanical perspective, the plantar fascia supports up to 14% of the load the foot has to bear as we move.  So as you can see, it is one of the most important structures in our feet!

What goes wrong?

pronationThere are several reasons why plantar fascitis occurs, but a major cause is overpronation of the foot.  The foot pronates, that is, it rolls toward the center line of our body, as a normal function of our stride.  In overpronation, the foot rolls excessively inward.  You can see if you overpronate by looking at your shoes.  If the outer sole of the shoe tends to wear out near the inside of the ball of the foot, you’re probably a pronator.  If the outer edge of the sole of the shoe, you’re likely a supinator.

There is also an indirect relationship between the calcaneal (achilles) tendon and the plantar fascia, especially in adolescents and younger adults.  There are fibers of collagen that connect these two structures together, but as we age, those fibers disappear.  Nevertheless, tight calf muscles and calcaneal tendons can be a contributing factor to plantar fascitis, by providing excessive plantarflexion of the ankle and increasing tension on the plantar fascia.

Another factor in the severity of plantar fasciitis is obesity.  The heavier we are, the more weight the feet have to bear, and this can cause considerably more strain on the foot and fascia than our bodies can handle.

A final factor is in wearing shoes too long after they have worn out.  Shoes that are ill-fitting or old and no longer providing the proper support for your stride type (pronator/supinator) can contribute to the symptoms of plantar fasciitis.

Where does it hurt?

The classic symptom of plantar fasciitis is significant heel pain upon first rising from bed – those first few steps to the bathroom in the morning.  Typically the pain decreases as the foot warms up from walking around, but often there is a low-level of pain throughout the day.  The pain tends to be most severe right at the heel bone where the fascia attaches to it, and then radiates toward the toes.

Plantar fascitiis is self-limiting, meaning that it will generally go away on its own, usually in six to 18 months.

What treatment options are availble?

Physicians will generally prescribe NSAIDS (aspirin, acetomenophen, ibuprofen, etc) to alleviate the inflammation and decrease pain.  As well, they will direct the patient to stretch the calves, possibly do ice massage, and shoe inserts are sometimes also indicated.  All of these things are very useful in reducing the symptoms.

In more severe cases, night splints, casts, or even surgery are options for treatment.

However, I have found that self-care and detailed, thorough bodywork can do wonders in treating plantar fasciitis.

Stretching

Two stretches are very important in reducing the pain of plantar fasciitis.   The first is one you should do when you first wake up in the morning, and that is dorsiflex your ankles.  Dorsiflexion is the action performed by your shin muscles (tibialis anterior) – bring the dorsal (top) surface of your foot toward your knee.  This will stretch the achilles tendon and calf muscles (soleus and gastrocnemius muscles) and take some tension off of the plantar fascia, and it will help mitigate the pain of the first morning steps.  To do this stretch:

  1. Inhale.
  2. As you slowly exhale, dorsiflex your ankle by contracting the tibialis anterior.
  3. Repeat several times, until you feel the calf muscles relaxing and stretching.

The other strech is another calf stretch, but this one done from a standing position:

  1. Face a wall and place one foot approximately 6-8 inches from the wall, toes pointing toward the wall.
  2. Place the other foot approximate two-three feet from the wall, toes pointing toward the wall.
  3. Inhale.
  4. As you slowly exhale, shift your weight from the back leg to the front leg.  Keep your heels planted on the ground.
  5. Breathe normally, and hold this stretch for two to three minutes.  You will feel the calf muscles open up, and the tension on the calcaneal tendon relax.
  6. Switch feet and repeat steps 1 – 5.
  7. Repeat this stretch with the back knee bent for one round, and straightened for another round.  That way, you will target both the gastrocnemius (knee straightened) and the soleus (knee bent), and more thoroughly stretch the calves.

Ice Massage

ice-massage-cup-readyFill several 3 or 5 ounce paper cups with water and freeze them.  When frozen, remove a cup from the freezer and peel back an inch or so of the cup, exposing the ice.  Using the remaining cup as a handle, massage the heel and underside of the foot with the ice, in circular motions and with medium pressure, for 10 to 15 minutes.  You will have to continue to peel the paper cup back from the ice as it melts, and you’ll want a hand towel to blot the water as it melts, but this is a highly effective treatment for plantar fasciitis.

You can combine ice massage and the second stretch I mentioned above:

  1. Ice massage the plantar surface of the foot as directed.
  2. Perform the second stretch listed above.
  3. Repeat with other foot.

Another way of using ice is to soak the feet in a basin of water and ice cubes in the evening when you get home from work.  Soak the feet for 10 to 15 minutes in this icy bath and after ward, dry them off and do that stretch.  Also, using a 500ml plastic water bottle filled two-thirds with water and frozen as a roller is effective.

How can massage therapy help?

Highly targeted, therapeutic massage can help by relaxing and lengthening the muscles of the calves, the calcaneal tendon, as well as directly working on the plantar fascia and muscles of the underside of the foot.  This work can be very deep, but highly beneficial because through it, we can help to re-educate your legs and feet to retain their relaxed states.  Many clients see dramatic improvement in three to four weekly one-hour sessions, as the feet and legs receive detailed attention.  Pain can be reduced and eliminated with a combination of self-care and massage.

If you are experiencing the pain of plantar fasciitis, massage and self-care can be a huge help!  Why not book a session with me today and get the ball rolling to a pain-free stride?

References:

  1. Plantar Fasciitis and Other Causes of Heel Pain: 1999 Barrett, O’Malley
  2. Plantar Fasciitis: Office Management: 2007 Patel, Holman
  3. Treatment of Plantar Fasciitis:  2001 Young, Rutherford, Niedfeldt

{ 5 comments… add one }

  • Vicki Sauder 23 June 2010, 14:50

    Dear Sir,
    I had a mild form of plantar fasciitis, with mild heel pain the first 15 minutes or so of walking each morning (plus Morton’s Neuroma, fairly controlled by orthotics). However, I had other intense muscle problems with my foot (after some nerve damage from back problems), such as intense cramping periodically during the night and the muscle on the top of the ankle going into clonus with just the slightest provocation. Obviously, my leg muscles were not good either. A very good neuromuscular massage therapist did 2 massage treatments centered especially on my feet, lumbar spine, and legs. The third treatment, she did some very deep massage with the heel. Immediately thereafter, my plantar fasciitis got very much worse. On a 1-10 scale, it went from a 1 to a 10. I’m barely able to walk at all in the morning, and the whole day, I have pretty intense heel pain with each step, even using a cane to help. Can you explain what happened? And would you recommend any more massage (after it hopefully cools down, using your above mentioned therapies)? Thank you so very much for your time!!
    Sincerely,
    Vicki Sauder

  • Paul Brown 29 June 2010, 09:23

    Hi, Vicki,

    I have commented to you privately.

  • USHA 19 June 2011, 22:46

    Dear Mr. Brown,
    I had severe Plantar Fascitis since 2007 and eventually it’s goes off. Eversince then…I had mild pain all the time untill at one point I was walking in a mall I heard some sound near my right side heel and I can barely walk. After that I went for few sessions of physiotheraphy and now I’m having heel pain with my legs feel lethargic as well as pain in buttock area…is all this coused by my platar facitis. I can hardly stand more then 10 minutes. I also fell pain in my heels eventhough I’m not walking. I have pretty intense heel pain with each step, even using a walking stick. I’m not sure whats wrong with me…appreciate your comments and advice very much.

  • Foot Doctor 22 July 2011, 00:47

    Nice article!! RICE is best option as home treatment for heel pain…Using padding and strapping in shoes also helps a lot. Limitation on activities is important in the treatment of heel pain.

  • Paul Brown 22 July 2011, 09:25

    Without evaluating you, I would be hesitant to say what might be going on, but I suspect that there’s something further up the line that is contributing. Something in the calf, thigh, or hips.

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