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Massage Aha!

Professional therapeutic massage therapy in Kansas City, MO by Aaron Harris, BCTMB

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Plantar Fasciitis vs Plantar Fasciosis

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You woke up this morning and jumped out of bed and triggered a searing pain in your foot that brought tears to your eyes. “Ouch,” you cry, “my plantar fasciitis is back!” Not so fast: you might have plantar fasciosis instead. Massage therapy can help both conditions but they require exact opposite treatments.

Fortunately, nonsurgical treatments, mainly massage, is shown to resolve 90% of all cases within 12 months.

Plantar Fasciopathy

Plantar fasciitis and plantar fasciosis both involve the plantar fascia, a thick ligament that runs across the bottom of your foot and connects your calcaneus (heel bone) to your toes. This ligament supports the arch of your foot and acts as a shock absorber. When it is subjected to repeated stress and tension, it can develop small tears and become painfully irritated.

The plantar fascia
Diagram of the bottom of the foot, showing the plantar fascia and calcaneus.

Podiatrists use the term “plantar fasciopathy” to describe any conditions related to this structure in the foot. Plantar fasciopathy is very common, affecting 10% of people at some point in their life. Fortunately, nonsurgical treatments, mainly massage, is shown to resolve 90% of all cases within 12 months.

Repetitive Strain Injury

Plantar fasciopathy is an overuse or repetitive strain injury, much like carpal tunnel syndrome or tennis elbow.

There are many root causes including:

  • flat feet,
  • high arches,
  • obesity,
  • menopause,
  • pregnancy,
  • age,
  • poorly supportive shoes,
  • pronation,
  • tight Achilles tendon,
  • tight calf muscles,
  • trauma,
  • standing, running, hiking, or walking for long periods.

Plantar fasciitis and plantar fasciosis are both characterized by a stabbing pain near the heel that is usually most painful with your first few steps in the morning or after extended inactivity. The similarities and treatments end there.

What is Plantar Fasciitis?

The suffix “-itis” means inflammation. Plantar fasciitis is the chronic inflammation of the plantar fascia. Those small tears from repetitive tension and stress become inflamed, triggering stiffness and heel pain.

What is Plantar Fasciosis?

Plantar fasciosis is a non-inflammatory degeneration of the plantar fascia. You can think of plantar fasciosis as the “second stage” of plantar fasciitis that occurs when your symptoms have been left untreated for a long time. The fascia begins to soften and is unable to support your body weight.

Treating Plantar Fasciitis with Massage

The Gastrocnemius Muscle
The Gastrocnemius Muscle is the superficial muscle of the back of your calf.

Plantar fasciitis requires massage techniques that treat the foot and calf muscles, particularly Soleus and Gastrocnemius. Because this condition occurs in the early stage, massage therapy can bring very quick results. A combination of myofascial and deep tissue massage can relax painfully tight calf muscles back into their correct posture. Other muscles in the calf are often tensed to try and balance out the Soleus and Gastrocnemius.

Most clients who receive gentle stretching and patient deep tissue treatments report an 80% reduction in their pain level after just one session. This is a better result than cortisone injections and physical therapy. It can take up to 30 minutes per foot for proper treatment.

Treating Plantar Fasciosis with Massage

Plantar fasciosis calls for a different massage approach. The goal in treating this second stage is to soften and shorten the fascia to increase blood and nutrient flow to the area. This can slow or even stop the degradation of the tissue. Overly aggressive stretching can actually cause more harm than good.

Muscles of the foot, including the abductor hallucis, that contributes to plantar fasciosis..
Muscles of the foot, including the abductor hallucis, that contributes to plantar fasciosis.

The focus of treatment should be on the abductor hallucis, a muscle in the foot that abducts and flexes the big toe. This muscle can put pressure on the medial plantar nerve and restrict blood flow to the plantar fascia. When this happens, the soft tissue begins to break down.

It’s important that your massage therapist doesn’t “grind” down into the plantar fascia, as that can cause inflammation and reverse healing.

Experience Counts

Choosing a massage therapist who is familiar with both conditions and has experience in treating them is vitally important. As a California Certified Massage Therapist with a background in emergency medicine, I know the proper questions to ask and have the proper assessment skills to determine the best treatment for your heel pain.

Disclaimer: I am a Certified Massage Therapist (CMT) who provides mobile massage therapy in the greater Kansas City area. I am not a medical doctor and I am not licensed to diagnose any diseases. If I suspect a serious medical condition based on my past medical experience and research, I will refer you to consult with your primary care physician.

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3 Responses

  1. Hi Aaron,
    I’ve been doing some research concerning Plantar Facsiosis. My podiatrist has been helping be through heal pain, but the left foot is getting worse with the treatment plan, which included eight weeks of physical therapy. I would like to find a certified, soft tissue therapist who understands the Facsiosis treatment. Is there an association for CMT’s that I might use to locate a therapist in my region?
    Joye Meinsen

    1. Hi Joye – I don’t know of any specific association of massage therapists that deals with plantar faciitis/facsiosis. My suggestion would be to reach out to any therapists in your area that offer NMT (neuro-muscular therapy) or that are Board Certified (usually listed as BCTMB or NBCTMB), as they will have a more advanced knowledge base. Good luck to you!

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