Heel pain, also known as plantar fasciits or fasciosis is a common condition that can effect many adults. To understand the true cause of plantar fasciitis we need to explain what fascia is. Very simply, facsia is a type of fibrous connective tissue that runs over and between all of our muscles, ligaments and tendons. It is a continuous structure and hence, indirectly acts as a connection or link between different muscles, ligaments, tendons etc.
The plantar fascia is most commonly seen in anatomy text as deriving from the heel and extending out to the toes. However, research has shown that the plantar fascia is actually a continuation of the fascia that runs from our buttocks to the back of our leg and ultimately to our toes. Hence, not only does the plantar fascia get stretched when we put pressure on our feet, but is ultimately affected when we sit, stand, walk and/or run. Inversely, when we go to bed at night and relieve the tension on our legs and feet the fascia contracts and tightens. Because individuals spend a lot of time on their feet the plantar fascia can become irritated. Common causes of irritation include; poor footwear, flat feet, being overweight, improper walking or running mechanics, standing on hard surfaces for a prolonged time, weakness or muscle imbalances in pelvic stabilizers and/or tight hamstrings, calves and achilles tendon.
Once the plantar fascia becomes irritated, a classic cycle of events usually occurs. When we go to bed at night and are off our feet, the fascia contracts and shortens. When we wake up in the morning and step out of bed, placing pressure on our feet, that tight, shortened fascia stretches very quickly and abruptly and usually results in further tearing, irritation and inflammation (this stage is known as plantar fasciitis). Because of this series of events it is difficult for the fascia to heal properly. Over time our bodies compensate by laying down scar tissue to “fill in” the tears causing further shortening, aggravation, poor mechanics and pain. At this stage, we now refer to to the problem as plantar fasciosis.
In order to properly treat plantar fasciosis, we need to start by breaking up that scar tissue, to allow healthy tissue to form. Graston Technique is a fairly new type of soft tissue technique used by manual therapists, including physiotherapists, to break up scar tissue and “kick start” the process of tissue regeneration. Once the scar tissue has been broken down, the role of the physiotherapist is to assess other factors that may be contributing to the problem. As mentioned previously, poor mechanics, weak and/or short muscles are often the underlying cause and if patients want to avoid recurrences, these issues need to be addressed correctly.