Understanding Plantar Fasciitis
Plantar fasciitis is one of the most common causes of heel pain, affecting individuals of all activity levels, from top athletes to weekend warriors. This condition results from stress and microtears in the plantar fascia, a thick band of tissue supporting the foot arch. Understanding its causes, symptoms, and treatment options can help individuals manage pain effectively and prevent further complications. What is Plantar Fasciitis? Plantar fasciitis is a degenerative rather than an inflammatory one, often called plantar fasciopathy. It develops due to repetitive strain or overuse, leading to microtears in the plantar fascia, causing pain and stiffness. Despite its association with inflammation, research suggests that plantar fasciitis is primarily a degenerative disorder. Causes and Risk Factors of Plantar Fasciitis Several factors contribute to the development of plantar fasciitis, including: Symptoms of Plantar Fasciitis The hallmark symptom of plantar fasciitis is sharp, stabbing pain in the heel, particularly: Diagnosis is primarily based on clinical evaluation, including a physical exam and assessment of symptoms. In persistent cases, imaging techniques such as ultrasound or MRI may be used to rule out other conditions. Treatment Options Most cases of plantar fasciitis can be successfully managed with conservative treatments. Here are the most effective strategies: Nonsurgical Treatments 1. Rest and Activity Modification: Reducing activities that stress the plantar fascia helps alleviate symptoms. This is recommended in the early stages of plantar fasciitis, and as your treatment plan progresses, it’s recommended to gradually re-load the plantar fascia to rebuild tolerance to your favoured activities. 2. Weight loss: Research suggests that obesity is a significant risk factor for developing plantar fasciitis, as it contributes to increased foot pressure and biomechanical imbalances. By losing weight, individuals can reduce the strain on their feet, leading to less pain and improved healing. 3. Stretching and Strengthening Exercises: Targeted exercises will aim to improve the flexibility of the ankle and foot and strength of the muscles and tendons surrounding the plantar fascia. This will reduce strain on the fascia and lead to better long-term outcomes. When you book an appointment with us, tailored exercises will be provided to ensure you are effectively loading the correct areas. 4. Orthotic Devices and Taping: Custom or off-the-shelf arch supports and heel cups can provide cushioning and support. Contoured insoles and taping techniques provide short-term relief and improved function. 5. Night Splints: Wearing splints overnight helps maintain foot dorsiflexion, reducing morning pain. There is strong evidence to suggest night splints are useful for the treatment of chronic plantar fasciitis. 6. Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help manage pain in the initial stages of this condition. It is not recommended to use NSAIDs for long-term management. 7. Manual Therapy: Techniques such as shock wave therapy and therapeutic ultrasound can aid in recovery. Additionally, manual therapy performed by a chiropractor can improve joint mobility at the ankle and surrounding regions, which may assist in the management and relief of plantar fasciitis. 8. Injections Corticosteroid or platelet-rich plasma (PRP) injections can provide pain relief in stubborn cases. In rare and more chronic cases, surgery may be required to release tension in the fascia, however, this is generally only recommended once more conservative approaches have failed. Plantar fasciitis is a prevalent and often painful condition, but with proper treatment, most individuals experience significant improvement. Approximately 90% of cases respond well to conservative management. Addressing biomechanical factors, incorporating stretching and strengthening exercises, and using supportive devices can help prevent recurrence. For stubborn cases, more advanced treatments are available to restore mobility and alleviate pain effectively. By understanding the degenerative nature of plantar fasciitis and tailoring treatment approaches to individual needs, long-term relief is achievable. If you’re struggling with persistent heel pain, consult one of our chiropractors for a comprehensive treatment plan. Book a consultation today! References
Shockwave
In the realm of modern medicine, shockwave therapy has emerged as a groundbreaking treatment option for various musculoskeletal conditions and injuries. This non-invasive and highly effective technique utilises acoustic waves to promote healing, alleviate pain, and restore functionality. In this blog post, we will delve into shockwave therapy’s benefits, how it works, and the wide range of conditions it can treat. What is Shockwave Therapy? Shockwave therapy, also known as extracorporeal shockwave therapy (ESWT), is a procedure that involves the application of high-energy acoustic waves to affected areas of the body. These acoustic waves are generated by a device and directed towards specific anatomical regions, stimulating the body’s natural healing processes. How Does it Work? The mechanism behind shockwave therapy is fascinating yet straightforward. Here’s how it works: Stimulating Cellular Response: When the acoustic waves reach the targeted tissue, they create microtrauma at the cellular level. This microtrauma triggers a series of biological responses within the body. Blood Flow and Neovascularisation: One of the primary effects of shockwave therapy is the promotion of blood circulation. This increased blood flow accelerates the body’s healing capabilities by supplying essential nutrients and oxygen to the damaged tissue. Release of Growth Factors: Shockwave therapy stimulates the release of growth factors, which are essential for tissue regeneration and repair. This, in turn, aids in reducing inflammation and pain. Dissolution of Calcifications: Shockwaves can break down calcifications or calcium deposits within tendons and other soft tissues. This is particularly useful for conditions like plantar fasciitis and calcific shoulder tendinitis. Pain Reduction: The therapy also has a pain-relieving effect by inhibiting pain signals and reducing muscle tension around the affected area. What are Shockwave Therapy’s Benefits? Shockwave therapy has gained recognition and popularity for its versatility in treating various musculoskeletal conditions and injuries. Here are some of shockwave therapy’s benefits for some common issues: Plantar Fasciitis: Shockwave therapy is a proven treatment for the painful foot condition known as plantar fasciitis, which affects the sole. Tendinopathies: It is highly effective in treating tendinopathies such as achilles tendonitis, tennis elbow, and rotator cuff tendinitis. For more information on rotator cuff injuries, read our blog. Calcific Tendinitis: For conditions involving calcium deposits within tendons, shockwave therapy can help dissolve the deposits, promoting healing. Bone Healing: Some studies suggest that shockwave therapy can accelerate the healing process for certain bone fractures. Myofascial Pain Syndrome: Patients suffering from myofascial pain syndrome, characterized by trigger points in muscles, can benefit from shockwave therapy. Shockwave therapies non-invasive nature and versatility make it a valuable tool in the world of musculoskeletal medicine and rehabilitation. If you’re experiencing pain or discomfort related to any of the conditions mentioned above, consider discussing shockwave therapy with your chiropractor as a potential treatment option to get you back to doing what you love. By Dr Jess Milsom (B.Chiro Sc, M.Chiropractic)
Don’t Tread on Me
Can your shoes be causing you pain? Dr Braeden Melmer Choosing a shoe can be difficult, especially when it comes to exercise. Many factors can influence the type of shoe we choose, such as the shape of the foot, the brand of shoe, walking/ running style, and the form of exercise. If you find yourself getting pain or discomfort when walking or exercising in the following body parts (foot, toes, heel, calf, knee, hip, or low back), there is a good chance you may be wearing the wrong shoe, or the shoe needs to be modified for your feet. Although there has been a shift in shoe design in the last 5-10 years due to foot mechanics research, most traditional shoes do not support natural foot mechanics. This is due to a modernised design of style, which creates a narrow toe box. This inhibits natural foot mechanics in a few ways. Imagine you’re at the beach, walking on the sand or in the yard, walking on the grass barefoot, and you feel the sand and grass between your toes. We put weight on our foot and push off. Our toes spread apart before we push off. With most shoes, a narrow toe box prevents this and causes our toes to compress up against each other. This can change the toe off-angle, which resultantly can increased shear forces through the knee and hip, which over time leads to dysfunction. Continuing off the last point, most formal shoes or dress shoes and women’s heels have a heel lift, which causes the forefoot to drop, respectively. A rise as little as a 2-5cm increase in heel lift shortens the Achilles tendon and prevents the foot from naturally flexing. At this heel elevation, shear forces increase through the forefoot and knee up to a 23% increase in body weight. If we were to increase that to a 7.5 cm heel, which can be quite a common height, the forces shoot up to 76% body weight felt through the foot and knee. These are quite large increases in forces that the lower limb will not withstand for long. Long-term effects that can come from such dysfunction are: Choosing the Right Shoes for You The three main shoes we typically look at are: Minimalist shoes have become a more popular choice for exercise, and I do advocate for this type of shoe, in most circumstances, and for day-to-day movement. However, they may not always be appropriate, as I will highlight. Minimalist shoes usually have a wide toe box, and as the name suggests, “minimal” cushion support allows for the foot to act naturally while walking and the toes to splay as they should. These shoes also have minimal to zero heel raise, which takes the pressure off the knee and changes gait from a heel strike to a mid to forefoot strike. This type of strike allows the calf to absorb more forces, but because of this, an increase in stress on the shin, Achilles, and calf can occur, increasing the chances of overuse injury during long periods of running or walking. In the case of running, we may want to consider a shoe with a typical or maximal cushioned support, depending on the individual’s foot shape and ground strike, particularly if you are a heel striker. A maximal shoe has quite large midfoot support with a slight slope towards the toe. And although this shoe may seem like a good option for running, the evidence is mixed and minimal. The idea is they reduce forces through the foot and Achilles but still seem to aggravate what they are helping, along with the knee. My advice would be to start on a typical/neutral running shoe first before jumping to a maximal. Some other factors we must consider are as follows, which become tricky: Summary Regardless of the shoe, we should always still seek out one that has a wide enough toe box for our feet. It is important to have your foot mechanics assessed along with gait and running style, as this will help decide which shoe is best for you with the type of exercise being done. At the end of the day, every foot is different, so different styles that are good for one may not be so for another. Therefore, it is important to always ask a professional with a biomechanical background who can help choose the right shoe for you! References: J.J. Hannigan and C.D. Pollard. Differences in running biomechanics between a maximal, traditional, and minimal running shoe. Journal of Science and Medicine in Sport 23(2020) 15-19 E. James.2014. Born to Walk: Myofascial Efficiency and the Body in Movement.
