5 ways to fix flat foot, fallen arches and plantar fasciitis
Updated: Sep 4, 2019
Author: Rory Finch
Location: Leeds and Sheffield
Occupation: Sport & Exercise Therapist, MSc Strength and Conditioning Student
Rory is a co-founder and one of the head Sport & Exercise Therapist at Next Step Therapy. Rory is a highly skilled practitioner specialising driven to improve function and strength to the athletic and non-athletic population.
Despite the development of environments and surfaces, our body’s still have not evolved to cope with the flat surfaces that eventually lead to pain and compensation in walking patterns. At some point in our lives you or someone you may know will complain of flat foot or sharp pain in the heels during long periods standing and walking. Typically, this injury can occur during spikes in training load and/or poor foot mechanics because of worn out shoes, poor shoe design that lack in arch supports.
Keywords: Flat foot, Fallen arches, Planter fasciitis, foot pain, heel pain
Here at Next Step Therapy, we regularly treat plantar fasciitis (fallen arches, flat foot) in the athletic and non-athletic populations. Recent research states that 20-30% of the general population at some point deal with this over use injury. This high prevalence represents the importance to introduce meaningful and simple rehabilitation that is at the fingertips of those suffering.
What is Plantar Fasciitis?
Plantar Fasciitis is one of the most common causes of heel pain located on the plantar aspect of the foot (the sole). The pain is associated with irritation and inflammation of the attachment points of the thick band of fascia that connects the ball of the feet to the heel bone. This overuse injury is often caused by repeated microtears of the plantar fascia due to high forces leading to repetitive straining and failure to heal appropriately.
Typical symptoms presented with this condition are sharp stabbing pains most commonly noticed with the first few steps in the morning, whilst standing or walking for long periods of time and after participation of physical activity. Typical areas of pain are often noticed on the underside of the Calcaneus (heel bone) or the fascia attachment to the balls of the feet and toes.
If left untreated, episodes of pain may increase in intensity and duration that may lead to further alterations in walking and standing to minimise pain that may lead to compensatory pain in the lower back, hips and knees.
Causes of Plantar Fasciitis vary between patients and practitioner’s opinion. When understanding the causes of Plantar Fasciitis, it is important to not only look at where the pain is but contributing factors too. Typical factors associated include:
- Poor lower limb biomechanics
- High spike in training load/physical activity
- Poor flexibility and strength of the lower limbs
- Reduced hip mobility and strength
It is important to pick apart the tight/weak muscles surrounding the hip joint that are contributing to dysfunction such as knee valgus (knocked knees) and further problems down the kinetic chain such as lack of ankle range of motion, alterations in foot position during locomotion and imbalances during gait. As the knee is a hinge joint, it is very easy to present deficiency of the lower limbs by simple functional screening such as the body weight squat that highlights the severity of lack of range of motion and strength around the hips and ankles.
When looking at the hip muscles controlling knee valgus, the main lateral rotators of the femur such as Gluteus Maximus and Piriformis and hip abductor: Gluteus Medius are essential for controlling the stability of the lower libs. The worrying factor when looking at those that have intense workload and training load is the lack of attention to the hip muscles.
How does poor activation of the glutes effect Plantar Fasciitis?
Lack of activation to the glutes limits the amount of stability and transformation of force through the hip and foot. This is seen in movements such as walking upstairs, doing lunges and yes, squats that can cause excessing pressure through the ankle and medial portion of the foot.
How to fix it
Unfortunately, the rehabilitation process is not fast although, it may vary patient to patient. To tackle such injury, you must use a multiple disciplinary approach to tackle some if not all the contributing factors aforementioned. Alongside this, consistency and patience are important to ensure that the injury is rehabilitated effectively.
Massage - When treating plantar fasciitis as previously mentioned, it is important to look at how musculoskeletal adaptations contribute to the condition. Typically, with flat foot, the knees tend to buckle in (knee valgus) due to lack of lateral hip strength and tight overactive internal/adductor muscles of the lower limbs. Therefore, addressing tight muscles by a means of soft tissue release and muscle energy techniques (MET’s) will improve the muscle fibre length and range of motion of the lower limb joints.
When Stretching tight muscles, it is important to carry out correct and proper form in order to gain the most out of each stretch. From the results in Table 1, the video below demonstrates proper when stretching common tight muscles which may influence Plantar Fasciitis.
Kinesiology taping during the early stages of rehabilitation may improve proprioception, muscle activation and confidence. This is thought to be because of the increased sensory nerve activation provided by the tape that excites the smaller intrinsic muscles.
Progressions when training weak muscles should start from short lever to long lever and then to weighted. It is important however, to ensure controlled and correct form is present to ensure the specific muscles are being trained. See the video below of exercises we use at Next Step Therapy to activate and strengthen those muscles that we deem to be important to improve the function of kinetic chain.
Orthotics - Alongside exercise, it is advised to wear suitable footwear to support the arches in your feet during long period of standing and walking. There are also various foot insoles on the market that assist in the rehabilitation of plantar fasciitis during the early stages. However, these should be used to supplement rehabilitation. Wearing arch supports excessively WILL lead to weak arches due to the intrinsic muscles of the foot relaxing that lead to further plantar fascia pain as the muscles becoming inactive. Below is our recommendation of orthotics tried and tested to assist in biomechanical adjustment with added support to the heels and arches.
Take home message
All in all, before seeking to buy the latest and most expensive pair of insoles. We have provided you with self care, stretches and exercises for a long term fix to plantar fasciitis.
- Use Arch supports during the early stages of rehabilitation
- Be more aware with posture and foot positioning when standing and walking for long periods of time
- It did not take one day for your arches to fall and it will not take one day to fix them!
- Persistence and patience are key
- Carry out stretches twice a day and exercises 3 times a week
Despite our recommendation, you should always consult with your doctor or local physiotherapist to gain expert advice before starting any rehabilitation programme to determine the level of care needed.
Head on over to our Instagram page to keep up to date with the latest exercise and self-therapy techniques. Alternatively, you can schedule an injury assessment online here or contact us directly at Info@nstherapy.co.uk
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