Plantar Fasciitis is a condition which causes pain in the underside of the foot or feet as a result of the tightening up of the plantar fascia, a tough layer of connective tissue that runs from the ball of the foot to the heel. Typically the feet will also feel very stiff and often painful first thing in the morning or when rising from bed at night, this wears off after movement. As the fascia continues to tighten it will start to pull away the periosteum of the heel bone. The periosteum is the layer of tissue that forms a covering to the bone and the body responds to this trauma by starting to lay down additional calcium deposits, this eventally comes to feel as though you are walking on grit or even a pea in the heel area and may have been preceeded by increasing pain in the area of the heel. (In the past this condition was known as policeman's heel) Once this condition is established and the bone has been laid down it is irreversable and it is therefore important that it is treated at the early stages of onset to prevent the formation of significant boney deposits. Once the additional bone has been laid down the options are limited to managing the condition and providing special shoe inserts to relieve the pressure on the base of the foot, which is expensive and inconvenient. Plantar Fasciitis is commonly accompanied by tight calves, which may give cramp and tension in the area of the achilles tendon, which can predespose it to injury.
The traditonal approach to treatment is poor and limited, with most doctors only able to offer pain relieve with drugs and nothing to stop the condition worsening.
In the hands of an appropriately trained and experienced manual therapist, the treatment is rapid and effective. The layer of fascia is freed off and immediate relief is felt. If the boney deposits have already begun, whilst this won't reverse the condition it will stop it worsening and should help ease the pain. Additionally the calves, achilles and legs in general will improve.
Sciatica is the term given to the pain caused by pressure on the sciatic nerve. This may come from a number of causes, vary in severity and include inflammation. The symptoms can vary though the cause may be the same. Typical symptoms include:
- pain in the lower lumbar
- pain deep in the centre of the buttock
- pain radiating down the back of the leg an/or calf and/or in the foot
- sudden shooting apin
- deep aching pain
- collapse of a leg or sudden motor weakness
The most common cause of sciatica is piriformis syndrome, where pressure occurs on the sciatic nerve as it passes behind or through the piriformis muscle. The piriformis muscle is located deep in the buttock underneath the large gluteus muscle and is responsible for flexing the hip and turning the foot outwards.
The other main cause of sciatica is through pressure of a spinal disc on the sciatic nerve in the lumbar region, usually between the vertebrae L4, L5 or S1. The disc will have herniated and bulged through pressure, the most common causes of which are sudden trauma like lifting a heavy object, or poor posture over many years.
Sciatic pain may in rare occasions be caused by a number of other factors where pressure builds up on the sciatic nerve. This can include tumours, solidified odema following trauma, spondylosis and others. For this resaon if your sciatica doesn't respond fairly quickly to treatment or I have reason to believe that further investigation may be necessary, you will be referred back to your GP for X rays and/or a scan.
It is possible to have more than one cause.
The activities that make sciatica better or worse are often good indicators of the source of the pain. Palpation by a medical professional or bodyworker with in-depth experience of sciatica will also help establish the cause and determine the most effective options for treatment. Please be aware that few doctors or consultants have the palpation skills required and rarely have the skills and facilities to recognise and deal with soft tissue and postural dysfunction. An X-ray or scan that shows up little dysfunction does not mean that you cannot be in pain. Additionally the pain you may be experiencing may not be sciatic pain or may involve other nerves or tissues as well.