The pain can decrease with activity, but can return after long periods of standing or after getting up from a seated position. Massage therapy as a therapeutic intervention is being embraced by the medical community. This is in part because it is a non-pharmacological therapeutic intervention that is simple to carry out, economical, and has very few side effects. One area that is being explored is the use of massage therapy for patients who suffer from plantar heel pain.

Existing evidence suggests that massage therapy (joint mobilization and soft tissue massage) is helpful in improving function and reducing plantar heel pain (Fraser et al. 2017, Martin et al. 2014, Mischke et al. 2017, Piper et al. 2016, Sutton et al. 2016)

Why Does Massage Therapy Work for Heel Pain?

A biopsychosocial framework helps put into context the interconnected and multidirectional interaction between: physiology, thoughts, emotions, behaviors, culture, and beliefs. In terms of clinical responses to massage therapy there are a couple of proposed mechanisms of action, including but not limited to: neurodynamics, contextually aided recovery, neuromodulation, social grooming and mechanotherapy.

Structures to be aware of when treating plantar heel pain

A massage therapy treatment plan should be implemented based on patient-specific assessment findings and patient tolerance. Structures to keep in mind while assessing and treating patients suffering from plantar heel pain may include neurovascular structures and investing fascia of:

• Plantar Fascia
• Lumbricals
• Adductor Halluscis
• Flexor Hallucis Brevis
• Tibialis Anterior
• Metatarsals & Interossei
• Peroneals
• Tibialis Posterior
• Triceps Surae 
• Hamstrings 

Stretch Training for Plantar Heel Pain

Calf tightness and reduced dorsiflexion are a possible factor for plantar heel pain (Bolivar 2013, Pascual Huerta 2014, Patel & DiGiovanni 2011). Therapists may want to consider including calf stretches part of a rehabilitation program.

Preliminary findings suggest stretch training is a viable way to stimulate architectural adaptation in the lower limb. Changes in the passive elastic properties and ROM induced by stretch training is due to both increases in stretch tolerance AND changes in passive properties of muscle. For a more indepth looks at theses changes you may want to check out these recent studies:

• 6 weeks of loaded stretch training of the plantar flexors resulted in hypertrophic like adaptations of the gastrocnemius (Simpson et al. 2017)
• 3 weeks of twice daily stretch training (4 × 30 s) lead to an increase in dorsiflexion range of motion (ROM)  a 28% increase in passive joint moment (Blazevich et al. 2014). 
• 4-week static stretch training program changes the flexibility of the gastrocnemius muscle tendon unit (Nakamura et al. 2012)

Intrinsic Foot Training

Intrinsic foot muscles play a crucial role in supporting the medial longitudinal arch, providing the foot stability and flexibility for shock absorption. There are a number of footcore exercises laided out by McKeon et al. 2015 that will help reconditinog foot muscles.

Burnaby Massage Therapy Clinic 2017