If you’ve ever had a pain in your heel or underneath your foot, chances are it’s plantar fasciitis. Statistically about one in ten of us are likely to get it and we are most at risk during middle–age. I’ve had conversations with a number of you recently about this most frustrating of conditions so I asked Susie Burness of Bristol Physio if she could explain what it is, how it comes about, and what treatments are available. Here’s what she said:
"What is plantar fasciitis?
Plantar fasciitis is a pain located at the inner part of your heel bone (or calcaneum) where the plantar fascia attaches. It is often associated with a feeling of tightness in this area. The plantar fascia is a tough and flexible band that runs under the sole of the foot connecting the heel bone with the toes. The pain, which is often intense, is usually worse first thing in the morning or when you first take a step after a period of inactivity.
How does it come about?
The plantar fascia acts as a kind of shock absorber to the foot (in conjunction with other muscles that form your arch) and is responsible for supporting the arch and helping propel us when walking. A wide number of factors may contribute to its overload and subsequent irritation including:
• reduced medial arches or flat feet
• increased BMI
• reduced control around the hip and core
• increased pronation (rolling in with your foot when walking)
• poor footwear
• increased calf tightness
• increased calf weakness
How to treat it and how to avoid it
Plantar Fasciitis is a notoriously difficult thing to treat and has been significantly lacking in evidence over the last few years. However here’s some actions that are likely to help with rehabilitation:
- Strengthening your calf muscles and ensuring you stretch your calf muscles after walking (using a foam roller is helpful here).
- Strengthening your glutes (the muscles in your bottom) and the other muscles that help stabilise your hip.
- Checking your bio-mechanics - the way your body moves and muscles activate - when you walk to see which muscles are weak and which are overloaded.
- Improving your core strength.
- Using gel heel inserts or medial arch supports may be a useful tool to help offload and support the foot to help things settle.
To avoid plantar fasciitis in the first place we recommend that you regularly update your trainers and keep on top of stretching and rolling your calf muscles. If doing large amounts of walking or running you also need to ensure you keep up strength and conditioning work to maintain strong core, glutes and leg muscles.
If you’re having pain or discomfort in your heel that isn’t settling don’t ignore it - pop in to see one of our physios at Bristol Physio for an expert assessment. We’d be happy to help."
Susie Burness, Specialist Musculoskeletal Physiotherapist, Bristol Physio
Be watchful of the cows
Last week a man was trampled to death by cows in Sussex. Since 2000, 70 people have met the same untimely end and hundreds more injured. I must say that I have had a few scares whilst out walking and am always immensely grateful to have my Nordic walking poles with me. The sharp tip is an effective self-defence weapon and the poles look similar to the plastic tubing that farmers use when moving them so they are very wary. Since this latest death, there's been some helpful advice in the press on how to be animal aware. Here are the important bits...
We are all instinctively wary of bulls but it appears that cows with calves are the most dangerous, especially if you have a dog with you. Also beef cattle tend to be more hostile than dairy herds, which have more regular human contact. Cows don't have a straight-ahead line of sight because of the positioning of their eyes so ensure that they see you as you approach so you don't surprise them. Andrew Cobner, the president of the British Cattle Association is reported in The Times as saying this was one of the more dangerous times of the year. "Young stock on the whole are curious. Some will ignore you. Others will wander up simply because they're nosey. Usually they'll walk up reasonably quietly. What you mustn't do is run away. They start running, not because they're trying to attack, but because they're being young. The main thing is to keep calm."
I am now very cautious when entering a field of cows. If in doubt I turn around and re-route my walk. It often means a big detour but there's a lot of wisdom in the adage 'better safe than sorry'.