I was asked a great question recently… “Dear Mr Bartold, I understand that plantar heel pain is no longer considered an inflammatory condition. Can you please explain the mechanics of how plantar fasciitis is described as having neurological pathology….how does or is the neurology inhibited? How and where would a massage target their treatments?” Well,…
Simon Bartold
Director of Bartold Clinical
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One response to “Plantar Heel Pain. If It Is NOT the Fascia, What Else Might It Be?”
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Hi Simon
Thanks for the post. As ever it is an area of intervention that can be critiqued just as much as it can be welcomed. Once I had ruled out some of the issues that indicated massage may not be the best route I certainly used massage. I did so in a quite systematic way, as part of a care pathway for PF and would progress people from a prone, knee flexed and ankle / forefoot passively plantarflexed, working intrinsics of foot…passively take the foot to plantagrade and work the PF specifically as taking the ankle into dorsiflexion….. through to fully prone, knee extended and and ankle and forefoot passively extended, working tissues of the foot (including an increasingly tensioned PF). Going through graded applications of pressure. I would then have them prone whilst actively plantarflexing and relaxing the ankle whilst I worked the calf (and tissues of the foot) at reduce pressure of massage. Then have them weight bearing whilst working the calf as they went into heel raises. I could also place them (more the runner type) WB into dorsiflexed ankle position as they went into heel raises. None of this took more than a couple of sessions.
The main intention for me (apart from any possible physiological benefits of massage) was to consider this as a graduated increase in tolerance of stress to the tissues that the brain may not initially consider a threat, as it was not associated with active WB, then move it onto simply applied further stress to tissues with small amounts of WB whilst being massaged. In essence I hoped I was helping the brain to tolerate tissues being loaded once again. I used to describe it to patients as “re-educating the brain to tolerate loading”. Of course it went in conjunction with other active loading stuff. I kinda felt (did I really just use such a subjective term!!) this passive/active combination, with pt education had a confluence effect.
Who knows if that’s what happened???? Folk benefitted and it was part of my armamentarium for a long time. Shall I leave the room now 😉