Introduction
I know what you are thinking. Who on earth are Sally and Ben?
In the clinic, I often see people with Plantar Fascia Pain (historically known as Plantar Fasciitis) and they tend to fall into 2 main groups. I use the characters of Sally and Ben to illustrate these 2 different groups whose lives are very different but who both struggle with this problem.
Let’s meet them and see if you identify with either of their case studies.
Sally
60-year-old Nurse, who works 13-hour shifts, regularly does overtime especially at the moment as they are short-staffed. She works in A and E and rarely sits down. She is about 3 stone overweight and wears flat unsupportive shoes to work. Outside of work she doesn’t exercise and wanders around the house in bare feet.
So for Sally to start seeing improvements there are a few things she is going to need to address that is specific to her.
- Long-term loss of weight will reduce the load through her feet – which will help prevent the problem from reoccurring.
- At work wearing shoes that support her feet – especially her arch, helps to offload her plantar fascia. At home her bare feet only add to the problem, wearing supportive shoes or innersoles will help.
- Her job – No matter what else Sally does if she doesn’t spend less time on her feet she will struggle to reduce her pain. So she is going to have to have a conversation with her manager, maybe reducing her hours or working in triage or another role where she can sit down. She also needs to learn to say no to overtime for a while and prioritise herself.
Ben
42-year-old IT Consultant, working from home. He runs 3 times a week normally 10km max, but he has recently been training for the London Marathon increasing his distance significantly. He has new trainers which he feels don’t support him as well as his last pair. His lower limb biomechanics are poor and he has short and weak calves.
For Ben to see improvements he too will need to make some changes.
- He needs to look at his running, in the short term he will need to stop before carefully reintroducing it without flaring it back up. he would benefit from learning about the effect running has on his foot and then training smarter in the future to prevent this overload.
- He probably needs different trainers and if they are not too worn returning to his old ones might help. It sounds like his current trainers do not give his feet much support, increasing the load through the plantar fascia.
- An assessment of his lower limb biomechanics finds that he has weakness in his glutes (bottom muscles) that is effecting his knee and foot position. Strengthening his glutes with exercises will help.
- Shortened calves change the pull and function of the plantar fascia. So stretching these will help optimise the way they work.
- Weakness in his calf will be having an impact on his foot function. The calf/Achilles complex works very closely with the plantar fascia. So having weak calves increases the load through his plantar fascia. This can be resolved by strengthening.
What have we learned?
Sally was overloading her foot mainly at work and I think we would all agree this was the main factor in her pain developing. Now I’m not suggesting that people change jobs but for those who are on their feet a lot, shop workers, postmen, and women, factory workers, chefs all of whom tend to work long shifts then something has to give if you are going to successfully settle your painful foot down. It might be that if you do everything else you can to improve things it might just be enough but often it will take a chat with the boss and maybe a temporary change of role to one where you are not standing.
For Ben, his work was no problem he sat at a desk all day. His main issue was his sudden increase in running which his body wasn’t used to. On top of his far-from-ideal strength and biomechanics issues.
These tend to make up the 2 groups – those who are overloading their Plantar Fascia due to their job and are often sedentary at home (Sally). Then those who have sedentary jobs but are overloading with active sports and hobbies (Ben). Maybe I should add a third person into the mix – Dave – postman, who has just entered an ultra marathon and spends his Sundays standing outside the supermarket with a bucket collecting for the Salvation Army – barefoot! Poor Dave, where to start?
Your risk factors.
But what about you and your risk factors?
Have a look at the full list of risk factors below and see if you identify with any of them.
- Age 40-60 is the most common age range.
- Being overweight/high BMI
- Occupation – any jobs with long hours on your feet.
- Footwear – Hard, flat shoe or barefoot walking.
- Exercise – especially long-distance runners, ballet dancers, or jumping sports.
- A sudden increase in training load. Training for an event, New Year’s resolution.
- Poor lower limb biomechanics
- Calf weakness and tightness.
- Poor foot position.
Do any of these look familiar, if so think about what you could do to change them. Unfortunately, there is nothing we can do about your age (although that would be nice) but we can look at the others. The more risk factors you have the more risk you have of overloading.
Making these changes in the short term will allow you to settle that acute foot pain down and more long-term changes like controlling weight and being mindful when choosing footwear will help prevent it from returning in the future.
Conclusion
Identifying and reducing your risk factors is a great way to start settling down this problem. Hopefully, you might be able to see how you have got to developing foot pain.
I have helped many people over the years resolve their foot pain and I would love to do the same for you. I invite you to have a look at my Plantar Fascia Pain Program where I guide you through everything you need to resolve your foot pain – fast. I help you identify your risk factors and you complete a lower limb biomechanics assessment to identify tightness, weakness, or poor alignment. Stage 1 is all about settling down the pain. Before stage 2 where the focus is on returning to activity and taking steps to ensure the pain doesn’t return.
Whether you are aiming to return to dog walking or ultra-marathons I got it all covered.
Enrol today and you will soon be back on your feet.
Take care, Helen
Helen Manders BSc (Hons) MCSP, HCPC,
