This is a condition that affects the soles of the feet. This tends to be present in people who have poor support footwear, especially work boots, large amounts of weight gain which can include pregnancy, and tend to have to walk or stand on hard surfaces for long periods of time every day. It can also be present in very active athletes, especially if they do a lot of running on pavement. There is a tissue called fascia, that covers the soles of the feet. This tissue is present around muscles, but in the case of the feet it is an added layer of fibrious tissue, used to help support the foot. When the fascia becomes damaged from not having proper support or just being on hard surfaces all day, it starts to send fibers to other tissues to try and help it from being damaged even more. When this happens, it causes adhesions, which limits the movement in the fascia, and there is also swelling present. This causes a lot of pain, usually first thing in the morning when you first get up, then eases after you start walking for a bit of time, then increasingly becomes more painful as the day progresses.
For this condition the treatment itself isn’t very long depending on if it is only affecting one foot or if it is affecting both feet. If it is affecting both then the 30 minute session will be plenty of time. If it is only the one, then there will be more work done on the surrounding muscles that can also contribute to the pain, as well as the other leg because you will have been using it more since the opposite foot is in pain, also known as compensating factors. Depending on how long you have been suffering from this condition, you can even start getting pain into the knees, hips and into the low back, since you will be changing how you walk, which in turn will change the position of all the joints above, making you unbalanced. These areas will also be worked on if this is the case, extra time will be required for the session.
To start the session it will depend on if there is still swelling present in the plantar fascia. If there is then there will be ice, or at the very least cool if you find ice too cold, placed on the foot. If there isn’t any swelling then usually a moist heat is used to help relax the muscles and the fascia. In either of these cases you will start with being in a face down position, as it will make it easier to work on the compensating muscles and the sole of the foot. If you are already starting to get pain in your low back that is where the therapist will start working and work their way down towards your calves, which will be affected from this condition, no matter how long you have had it for. Most of this work, will be to help with fixing your posture, get rid of any trigger points as well as some relaxation techniques to help lower your pain and calm the nervous system. Once the therapist gets to the lower leg, if there is swelling they will do some lymphatic drainage, if no swelling is present they won’t do this step at the beginning of the session, rather just at the end, as they can produce some swelling in the area from the treatment.
Next is working on the sole of the foot, the root of the problem. Depending on how tender your are, certain techniques won’t be used, until you can handle them. This includes stripping through the fascia, skin rolling, kneading, frictions, joint movement on any joints that are having a hard time moving, and even some compressions. One thing that I personally like to do during this treatment, if the client can tolerate it, as it is a bit more uncomfortable to have done, is bending the knee, so the foot is no longer on the table, then I move the toes to point towards the table, at this point it stretches out the fascia and helps me to reach some of the deeper adhesions. Then I use muscle stripping through the sole of the foot. I find it is very effective, but like I said it can be quite uncomfortable, so you definitely need to state if the pressure is too much, as it doesn’t take a lot of pressure to begin with to get really deep into the foot in this position.
Last part is where you are face up, and the front of the leg and tops of the feet are worked on. Again this is to get rid of any trigger points and adhesions that can be present. Sometimes stimulatory techniques are used on some of the muscles that help you to point your toes to your nose, as these muscles tend to be over stretched from the way that we walk, especially in women who wear heels. But this can also happen to men as well, especially if they walk on their toes which happens a lot when we do stairs, or if they are wearing work boots as some of them have a bit of a heel on them compared to regular shoes. Then everything is ended with a few relaxing techniques and possibly some lymphatic drainage in case there is any new swelling present from the treatment itself, which can happen, especially if frictions are done on the fascia itself.