Heel pain and plantar fasciitis affects nearly 2 million Americans per year. The pain can range from mild to murderous. There is a lot of professional debate about treatment methods, but too many professionals ignore the role of basic foot mechanics.
I am a medical massage therapist with 24 years in the field, my first 5 working for an orthopedic surgeon, doing hip, knee, and ankle injury and surgical re-hab. We simply did not do surgery or shockwave for plantar fasciitis or tarsal tunnel syndrome. We didn't need to. 3-6 sessions, @ 30 minutes per foot was sufficient. Most patients took 4 treatments. No patient we treated in this fashion required surgery in the 5 years I was there. Understand, this is not standard, Swedish, "Calgon!., take me away" massage. It is firm, and VERY muscle specific. You will absolutely feel results your first session, often as soon as you stand up. The pain isn’t all gone, but it IS significantly reduced. Once the course of treatment is completed a few patients, usually those heavily involved in competitive sports, will do a "tune-up" every 6-12 months, but it's uncommon. I am a firm believer in giving people the tools they need to help themselves, which is why I’ve been teaching classes to massage professionals and the public since 1992. It’s why I’m writing and posting this.
Your feet bear active moving loads much more often than your hands. Mother Nature's way of getting you to stop doing something is to swell up and make the activity difficult. We must also consider the wound healing process that is activated every time you have pain. Your body sends building materials like proteins to the site of injury or pain in an effort to stabilize it and prevent further injury. This can cause greatly reduced mobility, adding strain to tendons that already have too much of it, which obviously causes more pain. The crude analogy is that these tendons are much like the bunch of spaghetti that someone threw into a pot and didn't bother to stir. The treatment for tarsal tunnel, is basically to gently separate the tendons, release the adhesions to the tarsal ligament, and then stretch the muscles that drive them. Once this is done, you perform MET (Muscle Energy Technique) to the involved muscles, re-training them to allow proper movement. The treatment for Plantar Fasciitis is to gently release all adhesions in tendons and ligaments throughout the ankle and all the way up to the knee. Then you use lateral techniques (not direct pressure) on the sole of the foot to release adhesions at the tendinous attachments, and through the plantar fascia. Then you do MET to re-train the muscles. Please note that this is the quick & dirty description.
So, what about night splints? Most people sleep with their toes at least somewhat pointed, which allows the tendons in the feet and calves to draw up and adaptively shorten while we sleep. This is why standing up first thing in the morning can be so excruciating. Night splints can be helpful in stretching the calf muscles, and they make it difficult for the plantar fascial tendon to shorten up at night, but it’s only part of the equation. Night splints do not re-program the muscles to keep the longer length. MET does. We discovered the technique in the 40’s and 50’s when we were combating the muscle shortening so prevalent with polio and other types of paralysis. Unfortunately, this great technique with 50+ years of research behind it is too often ignored in the name of prescribing pills, and injecting cortisone.
So what about stretching? Helpful, and very much needed, but you also have to re-train the muscles w/MET. You also can’t get a good stretch if everything is all bound up. Again, it’s part of the equation rather than the entire solution.
So what about orthotics? Again, part of the equation, but not the whole solution. Orthotics artificially reduce the amount the plantar fascial tendon can stretch, thereby reducing the pull on the insertion of the tendon at the heel. This can give the tendon time to heal, but it doesn’t solve the root problem when bad mechanics are involved. Please note: Good shoes with proper support are important for EVERYONE!
So, the next question is usually, "Can I do this at home?" For plantar fasciitis? Sometimes. The only reason this is a "sometimes" is because there are angles that are very hard to reach on your own body. If you have a helper who is willing to follow instructions, it makes relieving plantar fasciitis much easier. If people are interested in specific home massage techniques, I am willing to post a DETAILED guide and "how to". It's long, with diagrams etc. I don't know if I'm allowed to post the URL to my own website here, but if the moderators allow it, I can put the entire thing on my website in a few days time.