Massage therapy for plantar fasciitis
Plantar fasciitis massage can be a helpful tool for managing pain and has been shown to reduce common symptoms. Some plantar fasciitis therapy options are invasive and require surgery. In many cases surgery can be avoided by incorporating massage techniques into treatment plans. This guide to plantar fasciitis massage therapy will explain what plantar fasciitis is, identify risk factors associated with the condition, explore massage-based treatment options and self-care plantar fasciitis massage strategies that can be done from home.
What is plantar fasciitis?
The plantar fascia is a thick band of connective tissue that extends along the sole (medial longitudinal arch) of the foot. It connects the heel (calcaneus bone) to the ligaments of the toes. The plantar fascia plays a very important role in managing gait and absorbing the shock of walking and running. The plantar fascia creates the arches of the feet. If the fascia is pulled too tightly it can result in high arches. If it is too relaxed, ‘flat feet’ can develop. It’s also responsible for dorsiflexion – the movement the foot makes when it is flexed upward toward the shin.
Plantar fasciitis is the inflammation of the plantar fascia. It can be debilitating as standing and walking can become extremely painful. Typically, inflammation centres on the connecting point of the fascia with the calcaneus bone, although pain may be felt at any location along the fascia.
There are two types of plantar fasciitis. Traction plantar fasciitis is the most common variant of this condition. In these cases, the plantar fascia is required to absorb unusual amounts of force due to gait problems or overuse, it will stretch and incur micro-tears. When muscles are worked, they also incur micro-tears, and rest will give them time to heal and get stronger. As the plantar fascia is under constant use and stress from walking (and up to 3 times bodyweight impact while running) there is almost no time for these tears to heal. Repeated agitation of the tears causes scar tissue to form. The development of scar tissue leads to chronic degradation of the fascia, reduced blood flow due to abnormal blood vessel growth and overall weakening of this vital connective tissue.
Compression plantar fasciitis can occur when the fascia incurs a direct trauma, such as by landing on a pointed object, or being struck sharply on the sole of the foot. Compression plantar fasciitis is more likely to occur on the ball the foot but may affect the heel area.
Symptoms of plantar fasciitis
Plantar fasciitis may first present as a sharp pain, felt in the heel of the foot upon standing for the first time after waking. The pain may fade during the day but return the next morning. The pain is caused by the fascia being forced to move under the tension of bodyweight after fully relaxing during rest. As plantar fasciitis progresses, the pain may become persistent, or recur before, during or after exercise or prolonged standing periods. The sole and heel may become painful to touch. If the condition isn’t treated the pain can become consistent and interfere with general daily mobility.
Risk factors and causes
Populations most at risk for developing plantar fasciitis vary. It commonly develops in
- Runners (particularly new runners or those who increase mileage quickly),
- Athletes who train excessively with inadequate rest,
- People who stand repeatedly for long periods on hard surfaces,
- People with excessive pronation issues,
- Overweight and obese people,
- People aged over 40 years (as all fascia lose flexibility with age).
How can plantar fasciitis massage therapy help heal plantar fasciitis?
Chronic long-term plantar fasciitis pain is usually caused by a shortening and stiffening of the plantar fascia. The fascia becomes hardened by the development of scar tissue. As the fascia becomes impaired it pulls on the calcaneal insertion point in the heel, causing significant pain. This hardening reduces blood vessel distribution which further impairs the body’s ability to deliver oxygen and reparative nutrients to the area.
Plantar fasciitis massage techniques are becoming more popular, and have been shown to help encourage a return of function to the affected area. Massage therapy can help to break down scar tissue, improve blood flow and concurrently improve lymphatic circulation, which helps to remove the waste tissue efficiently. In 85% of random controlled trials that used massage therapy as the main treatment for plantar fasciitis, mobility was significantly increased and associated pain reduced.
In a recent study, researchers have shown that a combination of deep tissue massage and routine stretching is more effective at pain management than ultrasound treatments and stretching. One case study (PDF) found that twice-weekly plantar fasciitis massage therapy helped to increase mobility and decrease pain so significantly that physically taxing activities caused little to no plantar pain for the subject, after having previously self-excluded from those activities due to pain levels.
What types of massage can be used for plantar fasciitis?
Deep tissue massage
Deep tissue massage can be effective for relieving pain and discomfort associated with plantar fasciitis. The technique involves concentrated finger pressure being applied with slow strokes to the areas that are connected to the fascia. This includes the outer calf muscles, Achilles, heel and the sole of the foot. The pressure helps to break up scar tissue and increase blood supply. Massaging the muscles and tendons that surround the fascia also help to relax them which can help to reduce referred tension. Deep tissue massage for plantar fasciitis can be intense and patients may feel discomfort during and after treatment. Relief is often experienced in the days following the treatment. Patients are advised to increase fluid intake after treatment to remain hydrated and assist any toxins or waste products from the massage to be flushed from the body easily.
Avoid deep tissue massage if the plantar fascia or any surrounding areas have open wounds. Osteoporosis sufferers should not have deep tissue massage, nor people with known blood clots as they may be disturbed/displaced and be moved to other areas of the body unintentionally.
Cross fibre techniques
Transverse friction massage promotes collagen production, increases circulation and reduces collagen cross-linking which discourages new scar tissue. A plantar fasciitis massage therapy practitioner will apply pressure with quick movements horizontally across the outer calf muscle, Achilles area and the sole of the foot below the heel. The practitioner will slowly increase pressure on the area to patient tolerance, with the aim of impacting deeper tissues and avoided surface friction. It may be a short session of around 5 minutes, although additional sessions may increase in time depending on fascia mobility and pain tolerance. Cold therapy may be applied after cross fibre massage sessions to reduce soreness or inflammation.
Avoid cross fibre techniques if the massage sites have trauma, acutely inflamed tissue, vascular concerns, or haematomas, and if the patient reports high-dose or long-term steroid use.
Hot and cold stone massage
Hot stone and cold stone massage may be effective for treating plantar fasciitis. Smooth stones may be heated to touch tolerance and used to apply deep moving pressure in a similar fashion to deep tissue massage. The addition of heat is said to encourage thixotropy, the softening of damaged connective tissue. Cold stones may be used in alternation, or as a stand-alone strategy. Applying cold stones as a massage technique may help to reduce soreness and inflammation, in a similar way to applying cold packs, but in a deeper and more targeted fashion. Cold stones can also act as an analgesic and reduce nerve sensitivity, which can provide temporary pain relief.
Hot stone massage should be avoided by children under 18, and people who have open wounds, acute injury or have recently had surgery. It should also be avoided by older people who have thinner skin. Cardiovascular conditions and high blood pressure can be exacerbated by additional heat. Diabetic patients may have loss of sensitivity and may not be able to report if the stones are too hot.
Ultrasound therapy, also known as percutaneous ultrasonic fasciotomy, is a minimally invasive technique that is sometimes undertaken for intractable cases. A doctor will perform an ultrasound or MRI to identify areas of significant scar tissue build up. A small, needle-like probe is inserted under the skin under local anaesthetic. The probe emits ultrasonic energy which breaks down the scar tissue in a very targeted way. Concurrently an inflow outflow irrigation device floods the area and removes the debris from the area. Once the procedure is finished the incision is closed. Patients require pressure bandages and may require a walking boot or other method to reduce pressure on the foot but should return to normal in 7-10 days.
Avoid ultrasound therapy if the plantar fascia has suffered a complete tear.
Shock wave therapy
Extracorporeal shock wave therapy involves non-invasive acoustic waves being targeted at scar tissue on the plantar fascia, in order to break up the tissue and encourage growth of new healthy tissue and encourage renewed blood flow to the area. Similar technology is accepted practice for targeted breaking up of kidney stones. Nerve endings are made less sensitive and less likely to transmit pain signals for a time giving pain relief.
Avoid ESWT if there is acute trauma to the area, infections or comorbid vascular diseases of the foot, metal implants or anticoagulant therapies.
Self-massage techniques for plantar fasciitis
It is possible to find temporary relief from heel pain by using self-massage for plantar fasciitis techniques. Applying pressure to the painful area can often bring some relief, even if no particular method is used. Using a massage aid may help to apply pressure evenly to the plantar fascia. Common household items such as golf balls and tennis balls can be rolled under the feet to pain tolerance. A water bottle that is filled with cold water (or ice, wrapped in a towel) can provide alleviating pressure and analgesic cooling at the same time.
Deep tissue massage and cross fibre techniques can be used on the painful foot. The patient should sit comfortably and bring the affected foot within reach, with ankle resting on the opposite thigh. Use both hands to massage across the back of the calf, working downward toward the Achilles. Working cross fibre near the Achilles can be tender but may be tolerated for a brief time. Next, work at the point where the heel of the foot and the arch blend. Work across the width of the foot, varying pressure without being painful. Plantar fasciitis massage timeframe suggests performing this type of massage once or twice a week if professional assistance is inaccessible. Alternately, firm circular motions made with the thumbs may be applied at the site of the pain and around it whenever discomfort is noticed.
Cost guide for professional services
Plantar fasciitis massage cost can vary depending on the technique, the timeframe and how many sessions are required. Patients may consult their GP to find out which services are covered by the NHS. Accessing specific therapeutic plantar fasciitis massage timeframe may be faster using private health insurance.
- Deep tissue massage: £50 - £60 per hour
- Shock wave therapy (ESWT): £70 - £80 per session
- Hot stone massage: £20 - £60 per hour
- Targeted specialist plantar fasciitis massage techniques: £60 for 15 minutes up to £90 for one hour
Plantar fasciitis massage timeframes
Plantar fasciitis massage therapy timelines vary, dependent on the severity of the injury and the efficacy of adjacent therapies.
If plantar pain is quickly recognised as such, rest and implementation of preventative strategies (below) may be sufficient to heal the inflammation in a matter of days. As the intensity of pain and scar tissue increase, so does the average length of time required to recover. Weekly or twice weekly massage therapy sessions may be required for 4-6 weeks to markedly reduce scar tissue and pain and increase flexibility. The most intractable and chronic cases may take up to two years to heal. The success of plantar fasciitis massage techniques depends on the effort the patient is willing to make during non-contact time with the therapist or practitioner. To further complicate matters, plantar fasciitis appears to respond differently to various treatments, that is, what may work for one person may not work for another. Massage can help to reduce pain temporarily in some cases and be near-curative in others. In almost all circumstances, massage can provide temporary pain relief both during and after a session.
Managing plantar fasciitis at home
It is possible to lessen plantar fasciitis pain with at-home techniques. Some strategies can be implemented quickly and easily, and some may need to be applied over time.
- Incorporate a daily lower limb stretching routine. Stretch calves, ankles, Achilles and feet to maintain flexibility and mobility, and to prevent shortening of the fascia,
- Stretching before getting out of bed may help to reduce the pain typically felt upon standing for the first time in the morning.
- Avoid standing on hard surfaces for long periods. If this isn’t possible, take regular seated breaks,
- Avoid wearing soft-soled, flat or unsupported shoes. Seek out shoes that provide cushioning around the heel and support arches. Use orthotic supports to create this if required,
- Investigate if specialise night splints will help prevent the fascia from relaxing overnight,
- Stop or reduce sporting activities if they are the source of the plantar fasciitis. Many other sports and recreational activities can be carried out without causing significant inflammation and foot pain
- If appropriate, reduce overall bodyweight to alleviate pressure and load bearing on the plantar fascia.
If pain is interfering with regular tasks, try one or more of the following:
- Self-massage for plantar fasciitis,
- 15-minute application of an insulated ice pack or cold bag,
- Taping the affected foot,
- Appropriate dose of a non-steroidal anti-inflammatory drug (NSAID).
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Whilst Enertor has over 18 years Orthotics experience, our blog content is provided for informational purposes only and it is not a substitute for your own doctor’s medical advice. Enertor advises anyone with an injury to seek their own medical advice – and do not make any health or medical related decisions based solely on information found on this site.