Conditions

Plantar Fasciitis

Plantar Fasciitis Treatment in Chilliwack

Plantar fasciitis is one of the most common types of persistent foot pain, especially around the heel. Our plantar fascia is a connective tissue structure that attaches from our heel to the base of our toes. It’s function is to help support the arch, aid in propulsion during normal gait, and help with shock absorption by distributing force across the foot.

When the plantar fascia is overworked, small tears can occur leading to a repetitive cycle of inflammation and adaptive thickening. As this happens, the insertion point of the plantar fascia on the heel can start to get inflamed and irritated, causing pain and difficulty walking or running. In textbook plantar fasciitis, pain is often worst when taking first steps after a period of rest (getting up in the morning, getting up after sitting for a while). Initially the heel pain improves as we get moving, but when allowed to progress, the pain can start to creep into the rest of our day.

There are a few short-term relief options for helping the plantar fascia, ranging in effectiveness depending on the person and the modality. These treatments are helpful to provide some initial relief, but can sometimes fall short at providing long-term improvements unless they are repeated. This is part of why plantar fasciitis is known to be such a stubborn condition.

For more long-term relief, it’s more effective to consider how your overall foot mechanics place added stress on the plantar fascia tissue. By identifying risk factors that place more force or load on the plantar fascia, we can find ways to then offload or reduce the stress placed on the plantar fascia in standing, walking, and running. For example, weak intrinsic foot muscles, excessively tight calf muscles, too high or too low of an arch, and poor big toe function are just some of the mechanical risk factors that increase the stress on the plantar fascia. For many people, assessing foot function and seeing if there are any mechanical reasons that keep irritating the plantar fascia is the key to long-term relief and management.

See below for treatment options & causes of plantar fasciitis as well as other types of heel pain.

Plantar Fasciitis Chilliwack Treatment
Plantar Fasciitis Mechanics Chilliwack

Causes of Plantar Fasciitis

Below are some of the most common causes of added strain on the plantar fascia that can contribute to plantar fasciitis.

  • Weakness in one or more of the muscles of the feet is a major contributor to adding stress on the plantar fascia.

    This is an issue that happens slowly over time, often due to lack of activity, a specific foot function problem, or wearing over-supportive footwear.

    As a result, examining the most important foot muscles that take pressure of the plantar fascia is a very important part of plantar fasciitis treatment for long-lasting results.

  • Ankle strains are injuries to the muscles around the ankle joint. They often happen during ankle sprains, but can occur on their own. This is a common injury that Chiropractors often treat.

    Symptoms include pain around the lower leg, ankle, or foot. As with ankle sprains, assessment to grade the severity is important, and treatment involves soft tissue therapy to relieve pain and speed up recovery.

    In more severe strains, or chronic strains, extra effort to retrain balance and re-strengthen weakened areas is crucial to allow full healing and reduce risk of re-injury.

  • Injury to the achilles tendon most often happens with repetitive use. Pain is felt at the back of the heel, around where the achilles tendon attaches. Usually this is felt with activities that contract or stretch the calf muscles, such as walking, stairs, and dynamic loads like running or jumping.

    It is important to diagnose whether the achilles tendon issue is a tendinitis, or a tendinosis, as each will require a different treatment approach. There are also insertional achilles tendon issues, and mid-portion achilles tendon issues that change how rehab will be best performed. This specific diagnosis is often best made by a sports-injury oriented Chiropractor or physiotherapist.

    Treatment typically involves soft tissue therapies to the calf muscles to reduce strain at the muscle-tendon-bone complex for both tendinitis and tendinosis. In tendinosis a protocol of graded tendon re-loading exercises is necessary to allow full healing of the tendon.

    Custom orthotics can also help with achilles tendinitis. This works by improving foot mechanics (foot posture, arch support, gait efficiency, and shock absorption) to reduce strain on the tendon itself.

  • Hallux rigidus is a condition where the big toe joint(s) get very stiff and restricted in their motion. This may present as pain in the big toe itself, but often presents as pain in other tissues of the foot. Hallux rigidus may or may not be associated with arthritis at the base of the big toe.

    Our big toe functioning well is crucial to proper foot mechanics, so any faulty mechanics may lead to issues elsewhere (such as plantar fasciitis).

    Chiropractic treatment involves soft tissue and joint therapies to reduce stress and strain on the surrounding tissues, and graded mobility and control exercises to re-introduce normal motion. Some people also benefit from foot posture and gait retraining or modification.

  • Shin splints happens when we overuse the muscles on the front of the lower leg. In anterior shin splints, the tibialis anterior muscle is overused, leading to achy and even sharp pain on the front of the lower leg along the shin bone. In posterior shin splints, this pain is felt in tibialis posterior, located on the inside of the lower leg.

    In some cases the muscle itself is spared, but the tendon attachment to the foot is affected, causing tendinitis or tendinosis. This is usually felt either on the outside or top of the foot, and be painful enough to cause limping or interfere with walking and other daily functions.

    Chiropractic treatment involves soft tissue therapy to the affected muscle, and exercises to either further reduce stress, or rebuild weak muscle tissue or heal damaged tendons. For some people treatment also includes assessment and treatment of foot, knee, and hip mechanical issues, since other issues in the lower extremity may contribute to this problem.

    In the case of poor foot mechanics, custom orthotics can also help with shin splints. This works by improving foot mechanics (foot posture, arch support, gait efficiency, and shock absorption) to reduce strain on the tendon itself.

Rearfoot valgus involves bowing inward of the heel and back of the foot. This is one of many foot function issues that can lead to added stress on the plantar fascia over time, in this case by causing an excessively low arch that leads to a stronger pull on the heel bone from the plantar fascia.

Other Causes of Heel Pain

When it’s not plantar fasciitis. There are other tissues that attach in and around the same area as the plantar fascia, that can mimic plantar fasciitis and often be misdiagnosed as plantar fasciitis. Below are the most common ones.

  • Tibialis posterior is a muscle that runs along the inside of our lower leg and attaches to our inner foot, just past the heel. Issues with this muscle can sometimes cause pain to refer to the inner heel, thereby mimicking plantar fasciitis.

    In some cases weakness of the tibialis posterior muscle can also contribute to plantar fasciitis by adding extra force to the plantar fascia when walking or standing.

  • The medial plantar nerve branches off of the posterior tibial nerve, then supplies sensation to the area as well as strength to some of the foot muscles.

    If the nerve is compressed along it’s course down the lower inner leg and foot, it can cause pain and weakness in the area of the inner heel, thereby mimicking plantar fasciitis.

    There are many cases of plantar nerve entrapment that are misdiagnosed as plantar fasciitis because of this location overlap. A good physical exam where we check for nerve sensitivity in the posterior tibial nerve and the medial plantar nerve will help to differentiate this from a plantar fasciitis issue.

  • Baxter’s neuropathy involves compression of the inferior calcaneal nerve that supplies sensation to the inner heel.

    The nerve arises similarly as the plantar nerve, but more often gets compressed by one of the big toe muscles, the abductor hallicus.

    Compression of this nerve causes inner heel pain, thereby mimicking plantar fasciitis.

  • There are a few muscles that attach around the plantar fascia, either deep to it or beside it.

    The tendons (the portion of the muscle that attaches to the bone) of these muscles can get injured or irritated, causing tendinitis or tendinosis. Flexor digitorum brevis is a muscle that is often involved with plantar fasciitis, either because it is weak and leads to increased force on the plantar fascia, or because its tendon is directly inflamed and is mimicking plantar fasciitis.

    As a result, flexor digitorum tendon issues are often misdiagnosed as plantar fasciitis.

A common cause of heel pain besides plantar fasciitis. Flexor digitorum brevis is a muscle that lives one layer deep to the plantar fascia. Weakness in this muscle is a common contributor to true plantar fasciitis, and tendinitis of this muscles tendon at the heel can mimic plantar fasciitis.

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