Comments on: Grounded temporarily - Plantar Fascia

By: Doug

Doug — Fri, 21 Aug 2009 10:34:00 +0000

Geoff,

I may have appeared to be in the UK, but I’m acually in the US. Sorry.

My knock on night splints is that they theoretically stretch out the plantar fascia. I contend that walking barefoot to the bathroom provides more stretch to the plantar fascia than wearing a splint all night. The mechanism of injury is plantar fascia stretching, so adding to this doesn’t make physiologic sense to me. Plus, the splints are a pain to wear, and patients tend not to be compliant.

By: Geoff C

Geoff C — Fri, 21 Aug 2009 08:15:21 +0000

Doug,
Thank you for such a detailed answer, most interesting. My symptoms match your description perfectly: the pain is at the bottom of the heel and a little towards the medial side.
I was looking at those night splints on the Sports Injury Clinic website and wondering if they were worth buying, but I decided to proceed with the physio first.
My orthotics are getting old now and the physio said one didn’t fit well any more, maybe it’s time for a new pair.

Where are you based - anywhere near Cheshire?.

By: Doug

Doug — Fri, 21 Aug 2009 02:42:18 +0000

As a podiatrist, I see plenty of plantar fasciitis (as opposed to calcaneal apophysitis that is prevalent in early adolescence). Many of the treatments are ineffective since they don’t address the primary problem - excessive traction pull on the plantar fascia (PF) when standing / walking / running. If you calculate the daily traction force on the plantar fascia (body weight x 10,000 steps), it figures out to be millions of pounds for all of us.

If you look at a diagram of the PF from the bottom with an engineering perspective, the greatest tension is at the heel where the PF is narrowest. Tension is also higher along the medial edge (the big toe side). The combination gives the characteristic pain site of the bottom of the heel, somewhat towards the medial side. Orthotics are the best way to lessen this PF tension, and any type can be effective, though I tend to favor softer ones that are more easily modifiable.

Other modalities - icing, anti-inflammatories, cortisone injections, etc. help relieve inflammation, but they do nothing to address the primary biomechanical cause of PF tension. I recommend and utilize these methods, where appropriate, but only if the patient agrees to use their orthotics nearly all of the time. My success rate is fairly high - usually pain free in 1-3 visits.

There are plenty of other modalities that I don’t agree with - ultrasound, night splints, or surgical intervention, but I’ll spare the lengthy explanations.

By: Geoff C

Geoff C — Tue, 18 Aug 2009 13:40:28 +0000

Plantar, sciatica, tendonitis… we’re all falling apart!.Still, I’m sure we’re in far better shape than most.
I agree on the Jura, a nice light one. Haven’t tried the Islay yet.

By: Northern Walker

Northern Walker — Tue, 18 Aug 2009 11:05:14 +0000

Boy, do I know these stretches well! After a visit to the physio last week, I’ve had a few new ones added to my routine to ease my sciatica… my new favourite being the ’sun warrior’ (bit hard to describe, but seems to do the trick!) Hope all sorts itself out, anyway.

I can recomend the Jura, by the way. This is classified by my malt-drinking circle as a ‘party whisky’ as it is a little lighter and more quaffable than our favourtie dark, smoky Islas. Enjoy!

By: Geoff C

Geoff C — Tue, 18 Aug 2009 10:16:22 +0000

John,
Should be useful, I’ll bear that one in mind.

By: john hee

john hee — Mon, 17 Aug 2009 17:09:32 +0000

Try to track down a copy of ‘Running - Fitness & Injuries’ by Vivian Grisogono. Full of self-help and proactive exercises to assist & prevent

By: Geoff C

Geoff C — Mon, 17 Aug 2009 08:43:25 +0000

Martin,
It’s already improved a lot. I’ll have to see about the orthotics, I’m not surprised that my feet have changed from the original prescription. It’s definitely worth a consultation with a sports physio for a bad foot, the problems might be building up slowly to the point where they are hard to correct (my 1-hour consultation session was £48). The older you are, the harder it is to treat and the more slowly injuries heal.
Jeff,
The Salford clinic is a good idea to keep in mind, I keep forgetting about the possibilities at the universities - a great deal cheaper than doing it through a private podiatrist if the inserts sound good.
PW,
I might add those stretches to the main site as a reference along with the written instructions, I’ll continue to do them regularly from now on. It is hard to know which are the best physios, it would help to know one who is a regular backpacker and understands hiking with a pack on rough terrain.

By: Peewiglet

Peewiglet — Mon, 17 Aug 2009 06:38:29 +0000

Thanks for describing those stretches, Geoff, and I’m sorry to hear that PF has struck.

I’ve had a problem that I’ve been unable ever to completely shake off with achilles tendonitis, which set in about 6 years ago when I did too much running, too fast. It really helps to find a good physio, but I found that surprisingly difficult, considering that I was in a running club. Lots of people just press on without advice, which of course tends to make things worse in the long-term. Hopefully you’ve caught it in time.

That clinic mentioned by Trenthamwalker sounds excellent!

By: Trenthamwalker

Trenthamwalker — Sun, 16 Aug 2009 15:32:29 +0000

Hi Geoff,Sorry to hear about your heel problems.Never had a pro blem myself despite playing lots of football in my younger days and hillwalking since the age of 17(now age 54)However,the last 18 months have been spent trying to find a cure for my Son’s heel pains.He is age 15 and a keen footballer but for the last 2 seasons he gets severe pain in his heels when running.We have tried everything without success but have now made several visits to the Podiatry Clinic at Salford University.The students there will examine you as part of their training and for the sum of £35 you can have a cast of your foot done and special custom inserts made for your shoes.This is all undertaken under the supervision of a chap named Neil who seems to really know his stuff.Anyway,this has resulted in a big improvement in my Son’s heel pain.The left heel is completely cured and the right one shows a big improvement.We are going back again in Sept for another consultation when the Students return from their break.Anyway,if your problems persist,it may be worth giving them a try.