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Treating Plantar Fasciitis:
An Unknown Therapy: Heel-Spur Syndrome
by Michael Young, NCTMB
This article appeared in the Oct / Nov 1999 issue of Massage & Bodywork Magazine, the official publication of Associated Bodywork & Massage Professionals: (800) 458-2267
I have heard numerous complaints from my clients, coming in for their regular massage therapy treatments, about excruciating foot pain. Some would complain the pain was in the bottom of the foot, while others complained the pain was in or around the toes. Most would comment that the pain was considerably worse in the morning, making it almost impossible to walk when first getting out of bed. Many clients said their doctor had diagnosed this problem as Plantar Fasciitis. I started investigating the best way to help my clients suffering from this ailment. My investigation led to a treatment program that has given my clients permanent relief.
What is Plantar Fasciitis?
The plantar fascia is a ligament-like band, running from the heel to the ball of the foot. This band pulls on the calcaneus, raising the arch of the foot as it pushes off the ground.
Plantar Fasciitis is also known as heel-spur syndrome. It is a common problem among people who are active in sports, particularly runners. It starts as a dull, intermittent pain in the heel. If not treated correctly, it will progress to a sharp, persistent pain. Classic symptoms include pain that is worse with the first few steps in the morning, pain after sitting or standing for prolonged periods, and pain at the beginning of a sporting activity. Problems may occur when part of this inflexible fascia is repeatedly placed under tension. This can occur in various situations, such as running or when people who sit at a desk hold their heels off the floor for long periods of time. This tension causes an overload that produces inflammation, usually at the point where the fascia is attached to the calcaneus. The result is pain.
Plantar Fasciitis may also occur at mid-sole or near the toes. Since it is difficult to rest the foot, the problem gradually grows worse. In severe cases, the heel is visibly swollen. An inflammation process at the calcaneus may produce heel spurs, yet heel spurs do not cause the initial pain or problem. Rather, they are the result of the prolonged muscle tension. If untreated, these heel spurs will cause sharp pain when walking.
Podiatrists and orthopedic surgeons claim that some contributing factors to Plantar Fasciitis and heel spurs include: poor shoe support, the aging process, high arched feet, toe or hill running, family tendency, flat feet and running on sand.
Conventional Medical Therapy:
Doctors use ice, medication, physical therapy, orthosis (sometimes known as orthotics), taping and finally, surgery. Let's take a closer look at each of these treatment protocols.
Ice: Most soft tissue injuries are caused by muscles and tendons that are shortened. When a person has short, tight muscles, the result is a lack of circulation resulting in inflammation. Ice will numb the area, giving temporary pain relief. However, ice does nothing to increase circulation. In fact, it slows down circulation. Without circulation, no healing can take place. Thus, ice is only treating the symptoms by masking the pain for a short while.
Medication: Doctors prescribe strong, anti-inflammatory drugs and these drugs have many side effects. In most cases, drugs simply mask the problem, making the injured soft tissue feel better temporarily. Then the person tends to use the muscles even more, adding to the tension in the muscles. Plantar Fasciitis is not caused by a drug deficiency. Therefore, drugs are simply a quick fix to mask the pain.
Physical Therapy: The objective of physical therapy is to strengthen muscles. If one strengthens a muscle, that muscle gets shorter and tighter, resulting in less circulation, as well as causing more adhesions and scar tissue. If strengthening was the answer to Plantar Fasciitis, then runners would never have that affliction. A runner's muscles are very strong. Runners develop Plantar Fasciitis because their strong muscles get shorter and tighter, through overuse.
Orthosis or Orthotics: These are inserts a person wears inside the shoes to support the foot. These inserts range in cost from $150 to $500. According to The Whartons' Stretch Book, by Jim and Phil Wharton, "Myth #10: Flat feet and fallen arches are corrected by support devices that are put inside the shoe, right? Wrong. If you put a support in your shoe, you are guaranteeing that your 'spring' has nowhere to go and your shock absorber can't absorb shock. It will feel good temporarily, because it will relieve tension in your foot, but, long-term, it will accomplish nothing." In other words, these devices only treat the symptoms by allowing the already tight muscles to remain that way.
Taping: Taping will relieve the tension, in a manner similar to the orthotics. This is, however, only a temporary fix.
Surgery: The surgeon goes in and cuts the fascia in the bottom of the foot. At times, the tendons are even cut. This is an invasive and unnecessary solution. The human body is an amazing creation. Each tendon, muscle and organ was placed there for a particular purpose. After all surgeries, scar tissue develops. These tissues form in irregular patterns which are often stronger than the original fascia. As the body heals from the invasive surgery, the problem redevelops since the original cause was not addressed.
The Common Sense, Permanent Treatment:
Plantar Fasciitis is an injury derived from repetitive use, similar to Carpal Tunnel Syndrome. Like any repetitive use injury, the muscle is stressed from overuse. The fibers in the muscle get tighter and tighter. This, in turn, leads to the muscle losing its memory of a normal relaxed state. Adhesions and scar tissue build up. As the muscle tightens, less circulation is supplied to the damaged tissue.
This results in inflammation. The attachment sites of the muscle begin to get sore from this constant pulling. Pain results from the oxygen deprivation of the muscles, tendons and attachment sites.
Conventional medicine often perceives this as muscle weakness. To quote The Whartons' Stretch Book, "There is a big difference between a strong muscle and a tight one. A tight muscle can be very weak. A tight muscle is an inefficient muscle. It can not elongate and then reflex quickly to make a joint move." This is the classic scenario of a repetitive use injury.
The culprit is a short, tight muscle or a group of tight muscles. What sense does it make to strengthen an already tight muscle, or to take drugs to mask the problem? Orthotics and taping also treat only the symptoms. Surgery is an extremely radical way to treat the symptoms. Instead, all that is necessary to get a person out of pain and on the road to complete recovery is to release the powerful muscles that drive the foot. As the Whartons write, "To avoid Plantar Fasciitis, concentrate your flexibility work on the lower leg, ankles and feet."
Along the same line of thinking, doesn't it follow that if the solution to this problem is increasing flexibility, then the cause of the problem must be a lack of flexibility? I have found this to be true in my practice.
I have helped many of my clients toward total pain relief from their diagnosis of Plantar Fasciitis. I perform the treatment and teach my clients how to continue the treatment for themselves.
Treatment Plan:
Lay the client prone. Raise their foot and lower leg, flexing the leg at the knee, so that the plantar portion of the foot is facing toward the ceiling. With one hand, grab all five toes and stretch the toes toward the massage table, holding each stretch no more than two seconds. At the same time, use the thumb of the other hand to apply moderate pressure on the plantar side of the foot. During the stretch, apply pressure from the heel toward the toes. This helps lengthen the fascia and tendons.
It has been my experience that the primary cause of the problem of Plantar Fasciitis is the Flexor Digitorum Longus. The belly of this muscle must be released to increase circulation. Once circulation is increased, permanent healing can, and will take place.
With the client still prone, have the client dorsaflex the foot to stretch this muscle, holding each stretch no more than two seconds. At the same time, the therapist applies a moderate amount of pressure to the belly of the muscle, starting at the distal portion of the belly and moving toward the origin. This work will help to break up the adhesions and scar tissue which form from the muscle being tight for long periods of time.
I caution each therapist to work within the pain tolerance level of each client. Remember that this problem did not originate overnight and it will take some time to lengthen the muscle and restore the muscle memory. Giving too much of a stretch can cause excruciating pain for the client. That defeats the whole purpose of the work since the muscle will tighten up even more with too much pain. Our goal is to elongate the muscle back to its full resting length. By doing this, the pain will disappear as will the problem. Once a therapist fully understands how this technique works, this plan will work on at least 90% of the people experiencing the pain and problems associated with Plantar Fasciitis.
Miracle treatment? No, simple common sense. This is "the missing link" that the health professionals and specialists are not focusing on. The specialists seldom look at the muscles when searching to discover the culprit for Plantar Fasciitis, Carpal Tunnel Syndrome, Thoracic Outlet Syndrome,
Tendonitis, Hammer Toes, Tennis Elbow, Piriformis Syndrome, most sciatic problems and more.
Once a therapist learns the specifics to release the muscles that are hidden behind these afflictions, their clients will notice a dramatic difference in their health.
Michael Young is a massage therapist in private practice in Evergreen, Colorado. With his wife, Vicki, they operate Massage Works of Evergreen, Inc., A Place to Relax.
Michael may be contacted at 303/674-7948. He holds workshops to train other professionals in this work and sells video tapes regarding this treatment.
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