Exercise 2 Slowly walk barefoot across a hard surface. Notice what part of your heel lands on the floor first. As you roll forward onto the ball of the foot and the big toe, notice how the depth of the arch of your foot increases. This is the Windlass Mechanism in action. Next, repeat the exercise while running, still barefoot, and feel how much force is required to push off with the big toe into the next step of your stride. The plantar fascia plays a major role in how much force your foot is able to generate. Next, repeat both exercises while wearing shoes. For a more in-depth experiment, try the exercise while wearing running shoes or any other athletic shoes, and then again with any other pair of shoes that you wear often. Do you notice how much less the foot, especially the big toe, can bend and go through its natural range of motion in shoes? This can lead to a chronic shortening of the plantar fascia, which can be a contributing factor in inflammation of the plantar fascia, or plantar fasciitis. SECTION 2: WHAT IS PLANTAR FASCIITIS?
and range of motion. The normal range for plantar flexion is considered to be between 20 and 50 degrees, while the normal range for dorsiflexion is between 10 and 30 degrees. Anything less than 10 degrees is considered to be decreased or inhibited dorsiflexion; the reason for this can be skeletal, soft tissue, or both. Our focus will be on the soft tissue causes, as these are what massage therapy can address. Limited or compromised dorsiflexion causes a chronic shortening and tightening of the plantar fascia, which can trigger episodes of inflammation. When that consistent tightness is compounded by heavy use from the impact of running, pain often follows and can be persistent if the individual does not get adequate rest or if the calf muscles are not adequately and frequently stretched. Exercise 3 Sit barefoot with your knees at 90-degree angles, feet flat on the floor, hip distance apart, toes facing forward. First, press the toes into the floor, lift the heels, and bring the ankle into plantar flexion. Notice the degree of the angle between the sole of the foot and the floor, which should be significant if you do not have an ankle injury. Next, press the heels into the floor and lift the toes up toward the ceiling, bringing the ankle into dorsiflexion. The angle between the sole of the foot and the floor is probably much less than when your ankle was in plantar flexion, which is normal, but is your dorsiflexion limited? Were you able to roll all the way back of your heel surface and lift the rest of the soles of the feet off the floor? Did both feet lift an equal distance away from the floor? Did you notice tightness in one or both of your calves as you did this? Then, stand up and repeat the exercise. (You may want to have something nearby to hold onto if balance is an issue for you.) Again, measure your degree of plantar flexion, then measure your degree of dorsiflexion. Notice how much more difficult it is to lift the toes up and back to lengthen the plantar fascia when the feet are weight bearing and the muscles of the calves are engaged. Do you feel more tightness in the calves and soles of the feet when standing as opposed to sitting? To further investigate the relationship between the ability to dorsiflex the foot and the plantar fascia, repeat the exercise with shoes on, both sitting and standing. Notice how much restriction is placed on the front of the foot and toes when wearing shoes. Activity As previously discussed, runners are especially prone to plantar fasciitis as a result of overuse. The risk goes up with more aggressive training for speed and distance. Many runners also experience plantar fasciitis as an indication that their running shoes are worn out and need to be replaced (see “Poor Support/ Footwear” below). A sudden increase in exercise activity, as in those who have just taken up running and might not have developed good form yet, can also be a cause to acute episodes of plantar fasciitis. However, athletes are not the only ones to suffer from repetitive strain injuries. Jobs that require standing for long periods of time, such as retail or warehouse work, can be a risk factor—even more so if they require standing for
Plantar fasciitis is a condition that occurs when the plantar fascia becomes inflamed or torn, typically as a result of overuse or excessive strain. The American Academy of Orthopedic Surgeons states that “Plantar fasciitis occurs when the strong band of tissue that supports the arch of your foot becomes irritated and inflamed...The plantar fascia is designed to absorb the high stresses and strains we place on our feet. But, sometimes, too much pressure damages or tears the tissues. The body's natural response to injury is inflammation, which results in the heel pain and stiffness of plantar fasciitis” (Kadakia, 2010). The most common symptom of plantar fasciitis is pain in the front of the heel on the underside of the foot (at the attachment where you pressed in Exercise 1 above), particularly upon getting up in the morning after the feet have not been bearing weight for many hours. When plantar fasciitis occurs in runners, walkers, and hikers, it is considered to be a repetitive strain injury and the pain typically occurs soon after exercising. Other less common symptoms can include redness and swelling at the point of tenderness or elsewhere along the plantar fascia. Additionally, all of the symptoms can be exacerbated by standing for long periods of time. Episodes of inflammation in the plantar fascia can be acute and only last for a few days, or they can be chronic and recur frequently, as in the case of runners who log a lot of miles and do not allow adequate time for the inflammation to subside. It can become a very nagging problem for anyone who spends any amount of time on their feet. The pain caused by plantar fasciitis becomes hard to ignore; every step is a reminder. Plantar fasciitis can also be part of a more complex problem, which often happens with runners and other athletes. These problems can involve the Achilles tendon, the gastrocnemius muscle, and sometimes the soleus, as well as other small muscles in the lower leg. When the calves are chronically tight (hypertonic) from heavy use and inadequate stretching, as they can be from running or other sports that include a lot of running or jumping, the tension pattern causes a decrease in the degree of dorsiflexion that the ankle can achieve. Dorsiflexion is the movement of the ankle joint that creates upward movement in the top of the foot toward the shin, and the opposite ankle joint movement to plantar flexion, which is commonly known as “pointing of the toes.” Normal articulation of the ankle joint allows for much more plantar flexion than dorsiflexion (you can typically point your toes much father down than you can lift them). However, both are necessary for healthy joint function Risk factors According to the American Orthopedic Foot and Ankle Society: “Plantar fasciitis is a commonly encountered clinical entity generating nearly two million outpatient visits per year. It affects both active and sedentary patient populations with the most common presenting age demographic being 40-60 year olds” (Kane, 2015). There are, presumably, many more who suffer with this condition but who do not seek medical treatment. Although plantar fasciitis is more common in athletes, anyone can be affected by this affliction. There are risk factors related to both activity and general physical condition, which will be described below.
EliteLearning.com/Massage-Therapy
Book Code: MTX1324B
Page 116
Powered by FlippingBook