Updated: Aug 22, 2023
The two things I always see a big spike in this time of year are Plantar fasciitis & Achilles tendinitis. But why?
The first things is it gets slippery. Finally, we’re getting some rain and either the grass is wet or gone altogether and the ground gets slippery. Even if you’re on firm footing the leaves can be a bit squelchy when it’s damp. Or when the temperature drops and it gets icy underfoot. Walking or running tentatively to avoid slipping makes us walk unnaturally with a huge amount of tension in our muscles and tendons, and these two factors combined can create irritation in the soft tissues around the foot and ankle.
The second big seasonal change is footwear. The big boots and wellies come out and even the ones that fit like a glove and are a lot more supportive can upset things.
What happens?
The plantar fascia & Achilles tendons are both part of the same bigger structure of fascia known as the superior back line. The Achilles being where the calf muscles (gastrocnemius & soleus) merge into a cord like structure (the tendon) that attaches onto the back of the heel, which is where the fibres then continue into the plantar fascia which are the cords of soft tissue which run into the toes. The difference between the issues depends on where the pain is presenting; back of the ankle = Achilles Tendinitis or under the heel & into the sole – Plantar fasciitis.
When we have trauma or overuse these structures become irritated and inflamed – the suffix ‘itis’ simply means inflammation – so a new episode of pain is simply inflammation in that soft tissue, hence the names plantar fasciitis or Achilles tendinitis.
If this isn’t addressed it can set up a cycle of pain & inflammation, whereby the pain settles but the soft tissues don’t repair correctly and scar tissue arises known as adhesions. It then can’t withstand further use adequately and becomes further irritated & inflamed, causing yet more adhesions. And so the cycle goes on – this is known as a tendinopathy.
So what’s the solution?
Firstly, prevention. If you know you’re prone to tight calves then some gentle stretches before and after activity (even if it’s normal routine activity like walking the dog) is wise.
Secondly, start gently. Build up the time and frequency in different footwear gradually and avoid any differing terrain to begin with. Sounds obvious but day 1 of the big boot season shouldn’t be a 10 mile hill session!
Finally, self care. Any niggles, even minor, shouldn’t be ignored. If they arise then apply a cold pack (either from the fridge or freezer is fine but if it’s the latter ensure its not directly on the skin to avoid ice burns) for 20 minutes twice a day for a week. Follow the cold pack this with a muscle rub like ibulieve or deep freeze/biofreeze/similar (cooling not heating). And whilst it may sound obvious try to rest and avoid any repetitive or prolonged activity on your feet.
These steps should be sufficient to prevent any issues from arising or continuing, but anything that’s either bad enough to make you reach for the medicine box or doesn’t settle after a week should be looked at.
How can it be treated?
There are lots of treatments available. Typically in the clinic we would use a combination of therapeutic ultrasound with dry needling & interferential therapy to begin with to break the cycle of inflammation, and start with gentle loading exercises asap to begin to rebuild the integrity & strength of the soft tissues. Once the symptoms settle down we move onto manual therapy, where we combine soft tissue release, mobilisation and manipulation. This is supported by stretching and strengthening work at home to support the rebuilding of those soft tissues.
Soft tissue problems like this rarely need a scan or more complex intervention and respond really well to physiotherapy. You don’t need a referral from your GP to access treatment either, but of course we will let you know if there is any extra support the GP might be able to give.
What next?
Use the tips above to help in the transition phase, and get out & enjoy the winter! If you have any niggles or concerns then we are always here to help, get in touch. Sarah 😊
