Foot Pain AKA Plantar Fasciitis
Foot Pain AKA Plantar Fasciitis
Dr. Christopher Aysom, Principal Clinician
BChiroSc, MChiro (Chiropractor)
Foot pain is a common problem and is often diagnosed as Plantar fasciitis. While this condition and diagnosis is common, it’s not highly descriptive in a clinical sense, as the diagnosis just tells us there is “itis” (pain and inflammation) in the plantar fascia, or the sole of the foot.
A diagnosis of plantar fasciitis unfortunately leaves a lot on the table. It’s not surprising that this condition can be so frustrating and stubborn for many people when it does not go away, despite their best efforts. The most common treatments include orthotics, stretching, icing, ultrasound, foam rolling, trigger point balls, massage guns, exercises and anti-inflammatory medication. When none of these put a permanent stop to the pain – you might ask the question, what is being missed?
Why doesn’t the pain go away?… and stay gone!
What we see commonly is that the initial diagnosis of plantar fasciitis has not taken into account other important factors of the patient case. One particularly important question that needs to be answered is:
Do you really have plantar fasciitis? Or more likely, could it be plantar fasciosis?
Fasciitis vs Fasciosis
Fasciitis is an acute overload of the tissue, causing pain and inflammation. Fasciosis is chronic overloading of the tissue, causing degenerative changes that lead to pain.
In our example, one is an acutely inflamed plantar fascia due to injury and the other is a degenerated plantar fascia due to chronic, repetitive stress.
If you hurt your foot through a traumatic injury, or just overloaded the tissue by doing to much work then it may become acutely inflamed and painful. This is something that should respond well to rest, some ice and activity modification until it feels better. The inflammation that goes with an injury like this is a normal response by the body in order to heal.
With fasciitis, activity will often make the pain worse. With fasciosis, activity will often make the pain go away (in the early stages of degeneration), until it reaches later stages of degeneration where it will hurt with activity as well. Both conditions can be treated to restore health to the tissues, but the management plan will look different depending on the diagnostic list.
There’s more than just fascia
The human foot is complex – there are many muscles, tendons, ligaments and nerves on the bottom on the foot. Much like the plantar fascia, any of these can become overloaded and painful. Aside from the fascia being painful, it’s common to see chronic foot pain caused by tendon degeneration, which is also due to chronic overloading and overuse. A lesser recognised cause of foot pain is nerve entrapment, however this is also a fairly common problem. No amount of stretching, icing, foam rolling, adjustment or massage is likely to provide sustained relief in these situations!
Why do common treatments often fail?
Many of the common treatments for foot pain provide intermittent relief because the diagnosis is incomplete or inaccurate. To address the problem at the root cause, you need to have healthy tissues in the foot, with healthy load. This means physical treatment of the unhealthy tissues to restore normal glide, slide and compressibility, but you also must have the appropriate range of motion and strength at the hip, knee and ankle.
Foot pain is frequently treated as plantar fasciitis, but it is actually plantar fasciosis and this is often accompanied by some level of tendon degeneration in the small muscles of the foot.
So, what’s the common cause of plantar fasciosis and tendon degeneration?
Soft Tissue Fibrosis AKA Adhesion
Adhesion can form in the soft tissues (muscles, tendons, ligaments) of your foot and leg from repetitive stress and overuse (standing, walking, running). Adhesion is like scar tissue; it acts like glue and is the body’s way of repairing the ongoing micro-trauma. Once adhesion begins to form, the affected soft tissues becoming tougher, inflexible and lose the normal glide and slide that is part of healthy movement.
Once the tissues become tighter, tougher and less flexible, there is a degenerative cycle created which places ever-increasing load on pain-sensitive tissues.
By the time you feel pain that isn’t going away, you may have already accumulated enough load over time that your diagnosis is now fasciosis, rather than fasciitis.
Adhesion in the soft tissues can be treated and must be done so, in order to restore normal movement and set the stage for regaining strength. Appropriate treatment of the adhesion will decrease load on the tissues immediately (fascia, tendon, etc). This should be coupled with activity modification and possibly other interventions such as orthotics and footwear changes, before progressing to rehabilitative exercises.
Final Thoughts
Foot pain can be very disruptive and can take a lot away from an active individual. It’s important to recognise that not all pain on the sole of the foot should be branded as plantar fasciitis. In our office we place a high emphasis on information gathering and diagnosis, to help decrease your chronic pain and get your foot as healthy as it can be.
If you, or anyone that you know is suffering with chronic pain that won’t go away despite everything you’ve tried so far, please consider scheduling an Initial Consultation (link below on this page).
Dr. Christopher Aysom, Principal Clinician
BChiroSc, MChiro (Chiropractor)
Apex Soft Tissue & Spine
Pymble, NSW, Australia
https://apexsofttissue.com.au
What is a Nerve Entrapment?