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.

  • Ankle sprains are injuries to the ligaments surrounding the ankle joint. They can either injure the ligaments outside of the ankle, or inside of the ankle, depending on the mechanism of injury.

    Chiropractic assessment involves grading the severity of the sprain, ruling out the need for imaging, and making sure there are no associated strains or other issues that follow.

    Acute ankle sprain treatment involves soft tissue therapy and gentle joint therapies, with gentle passive and active mobility exercises. Strengthening and balance training may be included after, depending on the severity of the sprain.

    Treatment will relieve pain and improve function as the ligaments heal, and often speeds up the recovery process.

  • 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.

  • Plantar fasciitis or fasciosis is a common condition that causes pain on the inside of the heel. Pain is often felt most in the morning when taking your first steps, but can persist throughout the day.

    This can be a stubborn and persistent issue that often requires both direct treatment to the lower leg and foot to relieve symptoms, while working on exercises to improve foot mechanics (posture, arch strength, gait modification, etc.). Often times more persistent or chronic presentations require exercise therapy to reduce pressure on the fascia in order for meaningful relief.

    Chiropractors are able to diagnose plantar fasciitis (there are other conditions that may mimic it), and assess foot functional in detail to determine if there are contributing factors that are preventing the issue from improving.

    For some people, looking into orthotics or new footwear may also be a helpful step to finding relief. Unfortunately, footwear or shoe inserts give relief but do not resolve the issue or fix foot function issues on their own.

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

  • Hallux valgus is when the big toe gradually deviates inward toward the 2nd toe, often causing weakness and discomfort around the big toe and other areas. Often it is associated with bunion formation on the inner big toe, especially in more severe or prolonged cases.

    Because our big toe function is so crucial to proper foot function, hallux valgus can also contribute to or cause other issues around the foot, for example plantar fasciitis, hallux rigidus, and metatarsalgia.

    Chiropractors work on this issue by treating stiff joints and tight muscles to help straighten the joint, and providing exercise to improve toe alignment, control, and posture.

    Like with other foot issues, splints, inserts, or orthotics may also help to give relief, but do not fix the issue by themselves.

  • In metatarsalgia, we have pain on the bottom of our foot around the balls of our feet. It is usually felt between the 2nd-5th toes when walking or standing, especially while barefoot.

    It is caused by repetitive pressure to the joints at the base of the toes, which often happens when our transverse foot arch is weak or flattened. This causes the tissues to be compressed, which can also lead to local muscle pain and nerve compression (numbness in the toes - it overlaps with a condition known as Morton’s Neuroma).

    Treatment from a Chiropractor involves joint and muscle therapies to reduce local pressure and irritation, followed by exercise prescription based on foot posture, strength, and control. Modifying our stance or walking technique (gait) is helpful, and performing exercises that strengthen and raise up the transverse arch is a key aspect of long-term recovery.

  • Ankle and toe arthritis can be a very painful and limiting condition. More severe cases may require surgery and bracing, but mild-moderate osteoarthritis is often very responsive to a dedicated arthritis rehabilitation plan.

    Chiropractor treatment involves using gentle soft tissue and joint therapies to relieve pressure and pain, and exercise prescription based on assessment of the issue. Since arthritis is a chronic condition, best results will come from exercise therapy for long-term management. This often includes things like gait retraining, posture exercises, foot and ankle strengthening, and mobility exercises. Studies show that significant pain relief can be reached with rehabilitation to mild-moderate severity ankle and toe arthritis.

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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