Foot & Ankle Disorders

Foot & Ankle Disorders with reference to Plantar Fasciosis (Plantar Fasciitis)
by Greg Morling

Much of my research and associated workshops over the past 15 years has been focused on stability and balance with reference to the lower back and of course, the Iliopsoas. My latest workshop around Australia has been an extension of these workshops and relate to foot and ankle disorders common to us as massage therapists.

Normal foot function is represented by a natural cycle of pronation and supination, accompanied by internal and external rotation of the lower leg. Abnormal foot function is commonly associated with excess pronation and may cause several problems that can be addressed with massage and sports taping.

One of the most common condition I find with both runners and with the general population is Plantar Fasciosis (Plantar Fasciitis). There is pain at the site of the attachment of the plantar fascia and the calcaneus (heal bone), with or without accompanying pain along the medial band of the plantar fascia. Treatment involves calf muscle and plantar soft-tissue foot-stretching exercises, and specialised massage techniques. Orthotics, and shoes with appropriate heel elevation may also be of some benefit. My own opinion is that a good brand of generic orthotic or heal support is usually sufficient in the first instance.

I always recommend thermal stone when working with massage, particularly on the dorsi side of the foot, between the metatarsals. There are few more wonderfully therapeutic techniques than this when loosening up the fascia of the foot.

Recognized causes of plantar fasciosis include shortening or contracture of the calf muscles and plantar fascia so we are the practitioners to address this condition. Risk factors for such shortening include a sedentary lifestyle, occupations requiring sitting, very high or low arches in the feet, and chronic wearing of high-heel shoes and obesity. As mentioned, the disorder is common among runners and dancers and may occur in people whose occupations involve standing or walking on hard surfaces for prolonged periods.

Plantar fasciosis is characterized by pain at the bottom of the heel with weight bearing, particularly when first arising in the morning; pain usually abates within 5 to 10 min, only to return later in the day. It is often worse when pushing off of the heel (the propulsive phase of gait) and after periods of rest. Acute, severe heel pain, especially with mild local puffiness, may indicate an acute fascial tear. Some clients describe burning or sticking pain along the plantar medial border of the foot when walking. Plantar fasciosis is confirmed if firm thumb pressure applied to the calcaneus when the foot is dorsiflexed elicits pain. There can also be the extra bonus of calcaneal spurs (see image below), associated with this condition so it may be necessary for the GP to recommend X-rays to confirm this finding.

In conclusion, the massage therapist is advised to use appropriate stretching and specialised techniques to address Plantar Fasciosis, recommend rest during the inflammatory stage and consider sports taping to assist recovery.

My next two Foot & Ankle Disorders workshop will be in Hobart on 8 July. Call 0409600300 for further information.