pakka plantar fascitis.docx

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ICING:

Icing is important for any injury, including plantar fasciitis. t. Icing the plantar fascia canreduce pain and swelling, which allows the ligament to heel faster.Three "types" of ice relief for heel pain, plantar fasciitis, and heel spurs.

A Ziploc bag filled with crushed or cubed ice is the traditional way of icing.You can even add just a little water to allow the bag to contour to your foot.

The second option is a bag of frozen corn or peas from the freezer section inyour grocery store. After you have used the bag, youcan refreeze it and use it again (but not to eat!) Another

type of reusable icing option is the gel packs that can be either heatedor frozen, once the gel packs have warmed up, just pop them back inthe freezer for next time.

The final option, which perhaps is the best, is to keep paper or Styrofoam cups in the freezerfilled with water. When you are ready to use the cup of ice, peel away the top of the cup toexpose the ice and then massage the ice cup over your foot in a circular motion. As the icemelts, just peel away the cup so the ice is always exposed.

Please be sure to prevent frostbite by placing a protective layer in between your skin and the ice (unless the ice is in constant motion, aswith the ice cup). A thin hand towel or a few layers of paper towels will

protect your skin from frostbite. If you feel like you are losing feeling orhave a "pins and needles", remove the ice immediately and if your skin

does not warm up within 45 minutes and normal sensation does notreturn, contact your doctor.

After you choose which ice option you prefer, it's now time to apply theice. The best time to ice is as quickly as possible following a strain on the plantar fascia, suchas after a long day of standing on your feet, exercising or anything else that causes your

plantar fasciitis to flare up and cause you pain. It is most effective when the ice is appliedwithin 2 hours of ending your activity, and after 48 hours the effect of icing diminishes.

Once you have applied the ice, make sure that you move the ice around often to keep yourskin from getting too cold and if you are using the paper cup method, massage the ice into the

painful area. Remember that while you are icing, whether you are using the paper cup methodor stagnate icing, to keep your foot elevated, preferably above the heart, to reduce anyswelling and keep stress off of the foot.

Be careful not to ice for too long, the best time frame for icing is 15-20 minutes. After 20minutes, the ice can cause further damage to the tissue, such as frostbite. After 20 minutesallow your skin to warm for at least 45 minutes and normal sensation has returned. You canrepeat the icing process as many times as you would like, being mindful to allow 45-60minutes for the skin to warm in between.

Plantar Fascia Icing: A great way to ice and actively massage your plantar fascia is similar to therolling pin exercise. Place some plastic water bottles in the freezer until


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frozen. Place the frozen water bottle under the arch of your foot and roll back and forth underyour foot, all the way to the toes and to the center of the heel. This will ice and massage your

plantar fascia, in one simple and clean step! Plus the water bottles can be frozen again for thenext treatment.

CONTRAST BATH : Contrast bath also known as hot/cold immersion therapy is a method of treating muscle

soreness, swelling, and inflammation. Cold water constricts the blood vessels(Vasoconstriction ) and hot water opens up the blood vessels (Vasodilation ) this creates apumping action that forces circulation.

Contrast baths is used as a standard part of many rehab facilities for treating musculoskeletalinjuries , especially with repetitive strain or overuse injuries. These types of injuries oftenneed far more rest to recover from than people realize, and any technique for stimulatingtissue healing without stressing it.

Benefits of Contrast Bath:

The theory behind contrast bath therapy is that the warm water causes vasodilation of the blood flow in the limb or body followed by the cold water which causes vasoconstriction,increasing local blood circulation. Additionally, the lymph vessels contract when exposed tocold, and relax in response to heat.

The lymph system, unlike the circulatory system, lacks a central pump. Alternating hot andcold, lymph vessels dilate and contract to essentially pump and move stagnant fluid out of

the area. This positively effects the inflammation process, which is the bodys primarymechanism for healing damaged tissue.

Hydrotherapy Can Also Provide Therapeutic Benefitsfor.

plantar fasciitis

shin splints carpal tunnel

syndrome tennis elbow

Achilles tendinitis

The Equipment:

You will need access to hot water and containers for feet.

Time and Temperature

The hot bath should be anywhere from 100 to 111 F. The hotter you can take, the better butmake sure you can tolerate the temperature. 4 minutes or less.

The cold bath should be anywhere from 50 to 61 F. Use ice cubes to get thewater cold. Most people cannot take longer than about 1minute of cold. Again, yourtolerance is important.
http://en.wikipedia.org/wiki/Inflammationhttp://en.wikipedia.org/wiki/Vasoconstrictionhttp://en.wikipedia.org/wiki/Vasoconstrictionhttp://en.wikipedia.org/wiki/Vasoconstrictionhttp://en.wikipedia.org/wiki/Vasodilatorhttp://en.wikipedia.org/wiki/Vasodilatorhttp://en.wikipedia.org/wiki/Vasodilatorhttp://rpm-therapy.com/2011/contrast-bath-for-pain-relief-inflammation/contrast-bath-feet/http://rpm-therapy.com/2011/contrast-bath-for-pain-relief-inflammation/hot-and-cold-bath-using-a-shower-head/http://rpm-therapy.com/2011/contrast-bath-for-pain-relief-inflammation/contrast-bath-feet/http://rpm-therapy.com/2011/contrast-bath-for-pain-relief-inflammation/hot-and-cold-bath-using-a-shower-head/http://en.wikipedia.org/wiki/Vasodilatorhttp://en.wikipedia.org/wiki/Vasoconstrictionhttp://en.wikipedia.org/wiki/Inflammation


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The Process

Get two bowls, buckets or storage bins which will fit the part of your body which needs thetreatment. Fill one bucket with cold water and the other with hot.

1. Wash and clean the area of skin of any oils and dirt.2. Submerge your body part in the hot water for 4 minutes.3. Then submerge your body part in the cold water for 1-2 minutes.4. Repeat this process at least 5 times if possible. The whole process should not take more than

20 minutes total.5. Theres a debut as to if you should finish the cycle in hot

water or cold. Since hot water brings blood to the surface of the skin,I recommend finishing in cold water.

For your feet and ankles something like this works best.

STRETCHING:

Over-pronation or flat feet is the leading cause of plantar fasciitis, according to Foot.com.This over-pronation leads to stretching of the plantar fascia, and that can lead to heel pain,arch pain and heel spurs. Stretching exercises are often used as a treatment for plantarfasciitis, and these arch-stretching exercises can reduce tension along the arch of the foot.

Step 1

Grab your toes with one hand and the middle of your foot with the

other hand. Pull the toes back until you feel a stretch in the arch ofyour foot. For better results hold the stretch for about 30 seconds andrepeating it for five repetitions and three sets during the day for a totalof 15 repetitions.

Step 2

Roll the arch of your foot over a round object like a small ball to stretch thearch area. You should apply increasing pressure while repeatedly rollingyour arch over the ball.

Foot stretches to prevent plantar fasciitis

1) Lying Calf Stretch

Starting Position: Sit on the floor with the leg to be stretched straightout in front of you. Place a towel or belt around the ball of your footand hold the ends
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Action: Draw your toes and foot up towards you, and pull through the towel to increase theflexion at your ankle until you feel a strong stretch in the back of your calf

Repetition: Hold for 30 seconds and repeat 3 times

Variations: To stretch your gastrocnemius muscle, keep your knee straight as you do thisexercise. To stretch Soleus, bend your knee slightly

2) Seated Calf Stretch

Starting Position: Sit in a chair with the leg to be stretched straight out in front of you.Place a towel or belt around the ball of your foot and hold the ends. Sit uptall

Action: Pull your toes and ankle up towards you and pull through the towelto increase the stretch in the back of your calf


Notes: 1) To stretch your gastrocnemius muscle, keep your knee straight as you do thisexercise.2) To stretch Soleus, bend your knee slightly (about 20degrees)3) Make sure you are sitting up tall as you do this exercise not slumped forwards

3) Standing Gastrocnemius Stretch

Starting Position: Stand facing a wall and step the leg to be stretched back behind you. Make sure your toes are pointing straight forwards.

Action: Keeping up tall and your back knee straight, lunge forwards ontoyour front leg until you feel a stretch in your calf muscle on the back leg.


Notes: 1) Ensure you keep your back up straight and tall rather than bending forwards2) Keep your back knee straight and your heel on the floor3) Check your toes are pointing directly forwards, not out to the side often it feels like they

are but when you look they are actually turned out slightly4) Standing Soleus Stretch

Starting Position: Stand facing a wall and step the leg to be stretched back behind you.Make sure your toes are pointing straight forwards

Action: Bend the back knee slightly and, keeping up tall, lean into thewall until you feel a stretch in your calf muscle on the back leg.

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Notes: 1) Ensure you keep your back up straight and tall rather than bending forwards2) Keep your back knee slightly bent and your heel on the floor3) Check your toes are pointing directly forwards, not out to the side often it feels like theyare but when you look they are actually turned out slightly

5) Calf Stretch On A Step: Top Stretch!

Starting Position: Stand on a step with the heel of the leg to be stretch resting off the back ofthe step

Action: Drop the heel down by slightly bending the other knee until you feel a

stretch in your calf


Notes: 1) To stretch gastrocnemius, keep the knee straight throughout2) To stretch soleus, bend the back knee slightly during these calf stretches3) If you are doing the exercises on the stairs, you may find you get more of a stretch if youhave your other foot on a higher step

6) Outer Calf StretchPurpose: Stretches the lateral head of gastrocnemius (the outer side)

Starting Position: Stand leaning on a wall with the leg to be stretched back behind you

Action: Turn your toes inwards and then lean forwards until you feel astretch in the back of your calf, mainly on the inner side


Notes: Ensure your knee is straight and you are keep your upper body upright

7) Inner Calf StretchPurpose: Stretches the medial head of gastrocnemius (the inner side)

Starting Position: Stand leaning on a wall with the leg to be stretched back behind

you

Action: Externally rotate the leg (turn it outwards) at the hip and then leanforwards until you feel a stretch in the back of your calf, mainly on the inner side


Notes: Ensure your knee is straight and you are standing up tall
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How To Get The Best Results

Calf stretches are simple, but in order to be effective, there are a few guidelines to follow:

1) Length of Hold: Studies have shown the most effective way to stretch is to hold calfstretches for 30 seconds2) Repetitions: You get the best results if you repeat calf stretches at least three times3) Degree of Stretch: Stretches should be uncomfortable, but not painful. Any discomfortfelt should stop as soon as you stop stretching. Effective stretching isnt particularly

pleasant!4) Safety: Stretching should not be done immediately following an injury eg calf tear as itcan cause further damage. You should be able to push down through your toes againstmoderate resistance without pain before you commence calf stretches. Always consult yourdoctor before commencing an exercise programme after injury.5) Position: Due to the anatomy of the calf muscles (one comes from above the knee andone from below the knee), you have to stretch each muscle separately:a) Soleus: this calf muscle starts just below the knee so is stretched with the knee bentb)Gastrocnemius: this calf muscle starts above the knee so the knee needs to be straightwhen stretching it. The top of the muscle comes from two different places, known as themedial (inner) and lateral (outer) heads. Gastrocnemius stretches can be done as a wholeunit, or can be performed to bias the two different heads

Gastrocnemius stretches tend to feel stronger than Soleus stretches.

Trigger Points

When the foot becomes fatigued the musculature becomes compromised. Muscle support andlocomotion are hampered. An environment ripe for the creation of trigger points is generated.Trigger points are knotty, involuntary contractions of muscle bundles. They prevent the hostmuscle form relaxing and recovering. Trigger points are painful. The foot contains 126ligaments, muscles and tendons, so there is plenty of hiding places for trigger points. Theseaggravating little knots can be found in any muscle. In fact, trigger points in the calf oftenrefer pain directly to the bottom of the foot. Therefore, trigger point therapy of the lower legand foot is essential in the successful management of plantar fasciitis.

Common Trigger Points of the Lower Limb Common Trigger Points of the Foot


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Leg Management Regimen

I like to start the treatment with the lower leg. I recommend and use a trigger point therapy product called the Intracell Stick. TOf the several different models, I prefer the short lengthwith good flexibility. The Intracell Stick compresses and stretches muscle. It simultaneously

moves fluids. The Stick performs trigger point therapy and myofascial release with virtuallyno effort.

Step 1 [about 30 seconds]

Place the hands close together for better control and easier use ofthe Intracell Stick.

Begin by rolling the muscles outside the shin bone use short,specific, back-and-forth strokes

Roll lengthwise, starting at just below the knee to immediatelyabove the ankle

Search for trigger points [ouch pain] and roll with a progressivelydee per pressure. When found roll trigger poonts an additional 10 15

seconds

Step 2 [about 45 seconds]

Follow the same procedure for the calf muscles as you did instep 1

The area between the two large muscles of the calf,downward to the heel cord, usually needs special attention

Always end the session on the calf with several long back-and-forth rolling strokes

The Foot Regimen

A simple, yet very effective, body tool that absolutely eliminates shortened, tight plantarfascia. Its called a Foo tWheel. The FootWheel easily compresses and stretches the complex

musculature of the plantar fascia. This process increases circulation and rapidly permitschronically shortened muscles to relax and recover. The 3 treating surfaces of the FootWheelare designed to target the 3 major support muscles of the foot.

Step 3 [about 45 seconds] Procedure

Place the FootWheel on a thick carpet or heavy towel always stand Support your weight on the opposite side, and begin rolling the bottom of the foot.

Use gentle, pleasant pressure Roll the 3 therapeutic wheels to locate and destroy trigger

points Trigger points will be recognized as tight, knotty, tender bands

of muscle


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When trigger points are located [ouch pain] continue rolling for 15 / 20 seconds Move slowly and be gentle. Use specific, short, back-and-forth movements Be sure to tilt and roll the foot on both the inside and outside before completing

the session.

The foregoing is an amazingly effective procedure to prevent or manage plantar fasciitis. Ittakes about 3 minutes. Use the techniques at least twice per day namely before and after anights sleep. Use more often if needed. Keep the sessions short and gentle to avoid soreness.Progress is gauged by the way you feel and the number of trigger points you extinguish.

MASSAGE :

What areas can you massage, strengthen and tone to get the maximum amount of flexibilityand range of motion? To help answer this, grab the back of your leg and squeeze firmly.

After you have a good grip on the muscle group, rotate your footin a circle. You may find that it is difficult to rotate due to thecalf complex being over worked and tight, therefore pulling onthe insertion points that connect in the bottom of the foot. (Pleasenotice how the thumb is placed on inside of the soleus muscle,not on the bone, and the forefingers are on the outside of thesoleus).

Now, apply pressure with the opposite hand where you wouldnormally feel discomfort on the bottom of the foot. By doing thissimple test you may feel a change in sensation on the bottom ofthe foot. This is a great experiment to see if the muscles within thecalf region are in fact tight and pulling from their insertion points.

All the muscles in the calf region connect in the bottom of thefoot. Once they get over worked and bound up, they will pull from the muscle's insertion andorigin. This not only causes loss of flexibility in the foot and ankle, but also creates aches and

pains within the bottom of the foot.

In order to free your foot to function properly and to eliminate discomfort associated with themuscles pulling from the insertion points in the bottom of the foot, you must go after themuscles that control the foot. Without optimal flexibility in the foot and ankle, you need tostrengthen, tone, and massage the muscles that control the foot and ankle.

Ultrasound Therapy

For many people, ultrasound therapy is an effective form of treatment for heel pain. It sendssound waves to the injured, painful area. These waves move at a frequency of one million

vibrations per second. They can penetrate over 2 inches into the body providing the targetedrelief you are looking for.


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Benefits

There are many benefits to this type of treatment for heel pain. First, the penetrations fromultrasound therapy reach deep enough to affect the plantar fascia. This area is often inflamedand one of the reasons so many people suffer from foot pain. Through ultrasound therapy, the

fascia tendons and surrounding tissue can be soothed. In addition, there is an increase intissue relaxation of the muscles and ligaments. This helps stimulate blood flow and reducesswelling. Because of the increased blood flow, the tissues receive more oxygen and nutrients.In addition, waste in the tissue is removed, helping to heal the area.

Disadvantages

While ultrasound therapy is a great treatment method to relieve heel pain, it is not a permanent solution. Regular treatments are often necessary to prevent the heel pain fromreappearing. For many people, it works well to supplement their current treatment methodswith ultrasound therapy. Combining the two allows for better treatment of the feet and

provides quicker relief of heel pain.

Extracorporeal Shock Wave Therapy

Extracorporeal shockwave treatment, also known as ESWT, is anon-invasive, non-surgical treatment option for the intense,

persistent heel pain associated with chronic plantar fasciitis. Extracorporeal means 'outside the body'. Shockwaves, alsoknown as pressure or sound waves, are generated from a specialESWT device and focused onto the targeted tissue. The

shockwaves are delivered outside the body to trigger anindividual's own repair mechanisms. Shockwave stimulates andreactivates healing to encourage revascularization and otherelements necessary to advance normal tissue healing.

Additionally, shockwaves help to over-stimulate pain transmission nerves, which can lead toa reduction in sensitivity and pain.

Who can recive ESWT for plantar fasciitis?

Prior to undergoing ESWT treatment, the patient must have been diagnosed with chronic plantar fasciitis for at least six months. Only after the patient's symptoms fail to respond to

three conservative treatments should ESWT be administered. Conservative treatments includerest, physical therapy, heel cushions, non-steroidal anti-inflammatory drugs (ibuprofen,acetaminophen, etc), cortisone injections, taping, orthotics, shoe modifications, nightsplinting and casting. In years past, surgical intervention for chronic plantar fasciitis wasrequired when these other treatments had failed. Today, ESWT is available as an alternative,non-invasive treatment option.

ESWT is not appropriate for individuals suffering from acute plantar fasciitis.


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Arch support, heel cups and orthotics:

The key for the proper treatment of plantar fasciitis is determining what is causing theexcessive stretching of the plantar fascia. When the cause is over-pronation (flat feet), anorthotic with rearfoot posting and longitudinal arch support is an effective device to reducethe over-pronation and allow the condition to heal. Those who have high arches, which canalso lead to plantar fasciitis, cushion the heel, absorb shock and wear proper footwear thatwill accommodate and comfort the foot. Other common treatments include

, plantar fasciitis night splints, wearing shoes that have a cushionedheel to absorb shock, and elevating the heel with the use of a heelcradle or heel cup. Heel cradles and heel cups provide extra comfort,cushion the heel, and reduce the amount of shock and shear forces

placed during everyday activities. Every time your foot strikes theground, the plantar fascia is stretched.

Plantar Fasciitis is primarily considered a condition where the fasciais subject to excess load and responds with physiological changes and pain. The sole aim is toreduce load on the plantar fascia through footwear selection. This will only be a part of the

management of the condition but can prove very helpful in reducing symptoms especially inthe acute stages.

There are 3 premises to this approach; reduce achilles load, support the arch and reduceeffects of the 'windlass mechanism'.

Reducing achilles load

Increase load on the calf complex and achilles tendon has been associated with increase loadon the plantar fascia. Use of a heel raise has been shown to decrease achilles load. The theorythen, is a shoe with a reasonable heel section and heel to toe drop should help reduce stress

on the plantar fascia.

Supporting the arch

It is shown that supporting the arch using orthoses can be effective in managing plantarfasciitis. It would seem then that a shoe that incorporates arch support may help. On a

practical note what I've seen clinically is that rigid arch supports sometimes aggravatesymptoms due to pressure over the tender plantar fascia so a cushioned arch support may be agood choice.

The windlass mechanism
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The windlass mechanism describes how dorsiflexing the big toeincreases stress on the plantar fascia;

The aim here is to reduce great toe dorsiflexion by selecting a shoe witha fairly firm inflexible toe section rather than one that allows a lot of

movement. The great toe dorisflexion range during walking in a standardshoe, the shoe plus a firm carbon fibre insole and range when barefoot.

Average great toe dorsiflexion was 28.2 in a standard shoe, this dropped to 24.1 with the additionof the insole on barefoot, average great toe extension was significantly higher at 48, nearly double

the range seen with a standard shoe with insole. This has implications for barefoot running whereyou might expect increase load on the plantar fascia from increase great toe extension.!

What about barefoot running?

Putting an athlete with plantar heel pain into a minimalist shoe, or barefoot, is pretty much a100% recipe to make them worseThe reason for this is that barefoot running tends toincrease load on the calf muscle, achilles tendon and plantar fascia. Barefoot runningencourages a forefoot strike which increases load on the calf complex, this combined with anincrease in great toe dorsiflexion is likely to increase plantar fascial.
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