as long as or longer than the abnormal walk. If, for example, the big toe has sustained a minor injury and the resulting soreness causes the weight to be distributed more toward the outer edge of the foot while walking to favor the painful area, the plantar fascia can become inflamed for a few days until the soreness subsides and the weight distribution returns to normal. Long- term injuries (or serious injuries that require surgical repair that affect the weight distribution on the sole of the foot) can be even more problematic. Injuries or surgeries to the Achilles tendon can also greatly reduce the range of motion of the ankle joint, causing a very awkward gait— especially in the early stages of healing or return to weight bearing. are usually administered into the heel where the pain commonly presents in cases of plantar fasciitis. However, this treatment may not be effective for everyone and steroid injections cannot be given frequently. If a client comes to you soon after having a steroid injection in the plantar fascia (within a few days of the injection), the safest course of action is to leave the area alone while the anti-inflammatories take effect. The injection site may also be tender to the touch. In those cases, it might be far more effective to work on the calf muscles and apply gentle stretching to the calf and Achilles tendon until the injection has had some time to work. Massage therapy applications will be discussed further in Section 3 of this course. Surgery Surgical treatment for plantar fasciitis is usually reserved as a last resort, after no other treatments have been able to improve symptoms. Only about five percent of those who suffer from plantar fasciitis resort to a surgical solution, called a “plantar fascia release.” Plantar fascia release is a surgical procedure that removes or releases the diseased portion of the tissue that is responsible for the pain. This is reserved for patients who have severe pain and have failed other treatments” (American Orthopedic Foot and Ankle Society, 2018). The surgery carries potential risks, and is not an effective solution for every patient. If a client has recently had plantar fascia release surgery, the safest course of action is to get the treating physician’s approval before working on the area during a massage. If the client had the surgery some time ago, be aware that there may be some structural abnormalities to the plantar fascia and proceed with caution when applying massage therapy to the area.
maintaining the arch of the foot. If it is injured or degenerating, the arch will eventually collapse and will result in flat feet. As mentioned above, flat feet are susceptible to plantar fasciitis. Aging feet are also more prone to arthritis and bone spurs, which can hinder the normal joint articulations in the feet and damage the tendons and ligaments. When the foot cannot function normally, the plantar fascia often pays the price. Injury to the foot or ankle Any injury—even a temporary one—to the foot or ankle that affects the weight distribution on the sole of the foot can be a risk factor for an injured or inflamed plantar fascia. Any awkward gait or limp can cause plantar fasciitis. This inflammation can last Common medical treatments for plantar fasciitis Clients who come to us for massage who already have already been diagnosed with plantar fasciitis by a physician may already have undergone treatment, or they may be in the process of treating it. It is important for us to know what treatments our clients may be receiving, so as not to interfere with those treatments and, ideally, to work in conjunction with them to fix the problem. Keep in mind that we cannot give medical advice to our massage therapy clients because it is outside of our scope of practice. We cannot diagnose plantar fascia or any other condition (unless you also hold a medical license in your state). However, it is appropriate to ask your clients questions about what treatments they are receiving, how long they have been getting them, and how effective those treatments seem to be. Listed below are the most common treatments used for plantar fasciitis. Orthotics Orthotics are supportive inserts that go inside the shoes. They are available over the counter, or they can be prescribed by a physician and be custom made to meet a patient’s specific needs. Orthotics typically offer more arch support than normal shoes, but they can also be designed to stabilize the foot. Some types of orthotics also cup the heel, thus assisting to replace a worn fat pad described above as age risk factors. Many patients find relief by consistently wearing properly fitted orthotics. Night splints Night splints are devices that hold the ankle in a position of dorsiflexion and are intended to provide consistent stretching to the calf muscles and the Achilles tendon when the feet are at rest. They are typically worn during sleep, as it would be difficult to walk in them. Many patients find that using night splints can help to avoid those painful first few steps upon waking that are associated with plantar fasciitis. Physical therapy A treating physician may prescribe physical therapy for patients with chronic or particularly stubborn plantar fasciitis. This can work well for those whose plantar fasciitis is caused by limited dorsiflexion in the ankle, as described above, or after surgery to the foot or ankle. Physical therapy typically involves strengthening exercises to stabilize the foot and ankle as well as stretching exercises for the calf, Achilles tendon, and plantar fascia. It may also address abnormalities in the gait, as well as balance issues. Steroid injections A treating physician may also use anti-inflammatory steroid injections either as an initial course of treatment or in conjunction with some of the other treatments listed here. Steroid injections Our approach to working with clients who have been diagnosed with, or who are having a recurrence of, plantar fasciitis would depend on whether it is an acute episode or a chronic condition. Obtaining a thorough health history from your client, as well as getting any necessary updates from existing clients, can provide you with a wealth of information and allows you to proceed safely. It is appropriate for you to ask questions about any soft tissue injury or condition that your clients may have,
Although they are not necessarily treatments, physicians may also make recommendations to patients who suffer from plantar fasciitis, based on their presentation of the risk factors described above. For example, overweight patients may be advised to start a weight loss plan, athletes may be advised to avoid the activity that is causing the problem for a period of time, or patients whose work requires long periods of standing may be given footwear recommendations. It is important for us, as massage therapists, to be part of our clients’ comprehensive healthcare team, especially if we are to be taken seriously by the medical community. Our goal should be to work with whatever medical treatments our clients are receiving and provide complementary care. Our role in their treatment and recovery will be discussed further in the next section. SECTION 3: HOW CAN WE TREAT PLANTAR FASCIITIS WITH MASSAGE THERAPY?
as that is within your scope of practice. The information you need to determine how to proceed might include how long ago the injury took place or how long ago the issue started (if it is not a definitive injury), what treatments they have used (or are currently using), which of those have provided them some relief, and any patterns they may have noticed with the occurrence of symptoms. Often, clients who have recurring episodes of plantar fasciitis can identify what may have set it off, like a change in
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