 |
 |
Well said Andrew! Surely if one can ease the stress on an area of sensitised tissue it would facilitate correction of the hyperalgesia. Then place progressive stresses back on the fascia area. From my point of view and clinical experience one cannot change gross movement patterns. We can alter pain which affects muscle tighteness etc. How can somebody who has a fallen arch etc survive 30 years of his life with no pain in his heel then, with a bit of time have no heel pain again. Am i wrong in saying that we have become to locked in to the details of mechanics and disregarded simple pain mechanics. We get hyperalgesic nerve endings/roots which with time and correct management (reassurance, exercise, pain control modalities) ease with time. If somebody told me my calcaneus had microfailure at the enthesis etc it could well sensitise my perception of pain and prolong or exacerbate disability, than reassurance, simple exercises etc. Don't they all resolve about the same time too. Paul Sumner Cornwall uk >>> Andrew Tindall <[log in to unmask]> 11/07/01 11:43AM >>> "Physiobase" writes about the plantar fascia: It is largely non-elastic and that's why we get the irritation at the attachments. It is precisely at that weak point/tissue interface that I am referring to when I mean and in commas "tighten up". Perhaps I should say seize up somewhat with the products of repair mechanisms. I cannot see how taping a calcaneous into supination could help anything. This sounds like trying to shift the pain rather than the problem? So why does stretching work? I give my patients calf muscle and plantar fascia stretching with good results. Taping the calcaneum works on a simple principle of biomechanics: The plantar fascia is like a cross beam in a roof (the arch of the foot. If the arch lowers, the two end points or insertion points are further apart, therefore putting more strain on the fascia. The end that would seem to become inflammed first is the proximal insertion as it inserts into the tuberosity. By strapping the calcaneum into a more supinated position you are causing the medial longitudinal arch to heighten and therefore reducing the distance that the fascia is spread over, thereby reducing the strain on the tuberosity. I have had patients hobble in, I've strapped them, and they walk out symptom free. Obviously this is a short term measure. I combine it with stretching, icing, massage (foot on a golf ball is good for the precise area)and possibly a medial heel wedge.