Pain of the plantar surface of the heel is the most common form of heel pain seen by health care professionals, which impacts approximately 2 million people annually and up to 15 percent of the athletic population. That demands better treatment and expedited recovery to keep your runners healthy and training hard.
While commonly called plantar fasciitis, the condition seems to lack the inflammatory histology and is more consistent with degeneration and disorganization of the collagen within the structure akin to many chronic connective tissue pathologies, most notably of the Achilles tendon. The treatment of plantar heel pain frequently includes local exercise, stretching of the triceps surae and plantar fascia, and activity modification to unload the tissue. These techniques, despite demonstrated success, may be further enhanced with trigger point interventions according to a recent study in the Journal of Orthopaedic and Sport Physical Therapy.
To investigate the impact of soft tissue therapy in unison with traditional stretching therapies, Renan-Ordine and colleagues conducted a study comparing the outcomes of stretching with or without soft-tissue therapy in a group of 60 individuals. Participants were included if they met the criteria of insidious onset, unilateral pain that was worse in the morning and lessened with light activity. Exclusion criteria included a history of foot surgery, fibromyalgia, or previous experience with soft-tissue therapy for the condition.
Subjects took an SF-36–a series of 36 questions designed to ascertain general health, functional limitation, pain, emotional health, social activities, and physical health–and were assessed in 3 locations for pressure pain tolerance–the gastroc, soleus, and posterior calcaneus–to ascertain pre-treatement status.
Groups were then divided into stretch and soft-tissue or stretch only treatment therapy and met with a therapist and osteopath 4 days per week for 4 consecutive weeks. The stretching protocol consisted of 2 series per day of a gastroc stretch against a wall and a seated stretch of the plantar fascia with the ankle and 1st MTPJ joint dorsiflexed, a position which increases tension on the plantar fascia most (Flanigan, 2007). Each position was held for 20 seconds then followed with a 20 second rest and repeated for a three minute cycle until 3 minutes of stretching time was accrued.
The stretch and soft tissue group received the same stretch protocol in addition to trigger point compression at the triceps surae. The therapist compressed with pincer grasp until a resistance barrier was offered by the tissue and progressively increased compression as the tissue opened to new barriers for 90 seconds. Then 3 non-painful compressive efflurage strokes were performed from caudal to cranial over the area.
The purpose of the selected tissues were based off of Travell and Simon’s work, which noted that trigger point referral from the gastrocnemius resulted in referred pain at the plantar surface. The longitudinal stripping is theorized help assist in the normalization of sarcomere length, which is abnormally short at the trigger point.
Not surprisingly, the group receiving trigger point compression and stretching demonstrated much greater improvements in function and decreases in pain. The same group saw slightly better scores of emotional and general health than the stretching-only group. The massage treated groups also demonstrated improvements in pressure-pain threshold scoring.
What You Can Do
It appears that when faced with an insidious onset plantar fasciopathy, seeking a qualified manual therapist or engaging in self-treatment along with frequent stretching of the tissue, can enhance your functional outcomes. Well-programmed exercise progressions and loading can also help develop the requisite control of your segments and reduce the loading of the plantar fascia.