Plantar fasciitis is a common foot problem that affects millions of people worldwide. It involves the inflammation of the plantar fascia, a thick band of tissue connecting the heel bone to the toes[1]League AC. Current concepts review: plantar fasciitis. Foot & ankle international. 2008 Mar;29(3):358-66..
Deep tissue massage can be an effective method to help alleviate the pain and tension caused by plantar fasciitis[2]Fraser JJ, Corbett R, Donner C, Hertel J. Does manual therapy improve pain and function in patients with plantar fasciitis? A systematic review. Journal of Manual & Manipulative Therapy. 2018 Mar … Continue reading.
In this article, we’ll discuss techniques on deep tissue massage for plantar fasciitis and how to effectively apply them for maximum relief.
Definition
Plantar fasciitis is characterized by pain and inflammation caused by injuries to the foot’s plantar fascia.
The pain is mainly concentrated in front of the heel and tends to become acute after a long period of immobility, whether the individual is standing or sitting.
Generally, radiographs and magnetic resonance imaging demonstrate that a bone spur has formed at the insertion of the anterior calcaneus.
Not exclusive to athletes
It is a condition that usually affects adults, mainly men and women over 45 years old. According to Ruth Werner, author of A Massage Therapist’s Guide to Pathology, about 10% of all runners suffer or will suffer from plantar fasciitis during their careers.
However, contrary to what many think, it is not a pathology that affects only athletes and runners; many sedentary individuals are susceptible to it.
Conversely, because their plantar fascia is relatively elastic, children are more difficult to be affected by such inflammation.
Why does it happen?
The causes of plantar fasciitis are varied. The main ones are:
- Overweight.
- Tight calf muscles (gastrocnemius and soleus)
- Stiffened and inflexible plantar aponeurosis.
- Flat feet or pronated.
- Fasciitis can be a secondary consequence of disorders such as gout or rheumatoid arthritis.
- Excessive and repetitive use (running too much, standing for a long time on hard surfaces, among others) puts stress on the feet.
Deep Tissue Massage for Plantar Fasciitis
Manual therapy or massage is extremely indicated in the treatment of plantar fasciitis[3]Prakash S, Misra A. Effect of manual therapy versus conventional therapy in patients with plantar fasciitis–a comparative study. Int J Physiother Res. 2014;2(1):378-82.
Several maneuvers can be used to ‘loosen’ and make the calf muscles more flexible (which are shortened in this type of condition), a muscle that, because it is connected to the Achilles tendon (or calcaneus), exerts traction on the plantar surface.
Assessing Foot Movement and Tension
Before beginning the massage, it’s important to assess foot movement and identify areas of tension. This can be done through gentle stretches of the foot.
Keep in mind that there may be limited movement due to tension in the arch and calf muscles.
Footwork and Avoiding the Problem Area
It’s crucial to avoid applying pressure to the area where the plantar fascia is inflamed, as this can be excruciatingly painful. Instead, focus on massaging the toes, the side of the foot, and the arch, paying extra attention to the arch as it can hold tension that affects the plantar fascia.
Techniques for the Arch and Calf
Using a press and release method, work on the arch, focusing on any bands of tension you may feel. You can also use a stretching technique to access the arch more deeply. Keep in mind that this may be tender, so adjust the pressure accordingly.
After working on the arch, move up to the calf muscles. Apply oil and use upward strokes towards the heart, separating the calf muscle as you go. Work on the entire calf area, adjusting pressure and speed to suit your comfort level.
Interchanging Between Arch and Calf
Spend around 10 minutes working between the arch and the calf, as loosening one area will help to loosen the other.
Keep in mind that some clients may be prone to cramping, so work slowly and gently if needed.
Additional Techniques and Stretches
Don’t neglect the front and sides of the leg, as they can also benefit from massage. Finish the treatment with some deeper stretches, which can help increase foot movement and provide further relief for the client.
- Step 1: Warming up the foot. Before starting the treatment, it is crucial to warm up the foot by gently massaging it. You can use your hands to apply pressure on the foot’s various parts, such as the heel, arch, and toes, to loosen up the muscles and joints. Additionally, mobilize the ankle by gently pushing and pulling to improve circulation and prepare the foot for the treatment.
- Step 2: Addressing the plantar fascia. The plantar fascia starts at the heel, where it connects to a small bony protrusion. Using your knuckle, apply pressure on this area to stimulate the plantar fascia. Then, glide your knuckle along the length of the fascia, warming it up and releasing tension. Make sure to communicate with the person receiving the treatment to locate the exact origin of the pain.
- Step 3: Breaking up calcification. Calcification can build up within the plantar fascia, causing pain and inflammation. Using your elbow or fingers, apply pressure on the area where the calcification has originated. Slowly grind over it while adjusting your angle and pressure to effectively break down the built-up calcium deposits.
- Step 4: Working on the foot’s sides and metatarsals. After addressing the plantar fascia, move on to the foot’s sides and metatarsals. Apply pressure on the areas where pain is present, as this indicates where the body needs attention. Work between the toes and along the metatarsals, using a small amount of wax or oil to facilitate smooth movements.
- Step 5: Mobilizing the foot. To further improve the foot’s mobility, use your hands to pull up on the foot while applying pressure on the affected areas. This technique can help stretch the fascia and release tension in the foot.
- Step 6: Methodical approach. Remember to be methodical in your approach and focus on the areas where the person experiences pain and discomfort. Work systematically through the entire foot, guided by the individual’s feedback.
Conclusion
Deep tissue massage can be an effective method for helping to alleviate the pain and tension associated with plantar fasciitis.
By focusing on the arch, calf muscles, and other surrounding areas, you can help speed up the healing process and provide relief for your client. Remember to always work within the client’s comfort level and adjust your techniques as needed.
Diene Oliveira Cruz
Physiotherapist, with specialization in Orthopedics and Traumatology by Santa Casa de São Paulo. Pain and Rehabilitation Specialist.
References
| ↑1 | League AC. Current concepts review: plantar fasciitis. Foot & ankle international. 2008 Mar;29(3):358-66. |
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| ↑2 | Fraser JJ, Corbett R, Donner C, Hertel J. Does manual therapy improve pain and function in patients with plantar fasciitis? A systematic review. Journal of Manual & Manipulative Therapy. 2018 Mar 15;26(2):55-65. |
| ↑3 | Prakash S, Misra A. Effect of manual therapy versus conventional therapy in patients with plantar fasciitis–a comparative study. Int J Physiother Res. 2014;2(1):378-82. |