7 Things You Need to Know About Plantar Fasciitis

Plantar fasciitis is one of the most common and painful foot conditions. It is treatable but the longer you go without taking care of it, the harder it is to get back to normal. Here is a list of seven things you should know if you think you have plantar fasciitis.

  1. What is plantar fasciitis? Anatomists use plantar to refer to the sole of the foot. Fascia is a thin sheath of connective tissue that encases and connects structures in the body. The plantar fascia is located in the sole of the foot and connects the front of the foot to the heel and accommodates them to form the longitudinal arch of the foot. Basically, it is a web-like ligament that provides shock absorption and supports the arch while walking. Whenever “-itis” is added to a word it indicates inflammation. So, plantar fasciitis is inflammation of the plantar fascia.
  2. Stretch the calves! The fascia that surrounds the Achilles tendon and the calf muscles above it connect to the plantar fascia. Stretching the the calves is vital in treating plantar fasciitis. To properly stretch these muscles stand close to a wall with one leg forward and one leg back. Plant the rear heel to the ground with the knee bent. Lean forward with your hands against the wall until you feel a nice stretch in the back of your leg. It is important to perform this stretch at least once a day and to hold for longer than 30 seconds.
  3. Break up scar tissue. Plantar fasciitis occurs when there are microtears in the tissue. These tears are usually the result of repetitive stress and/or a decrease in elasticity. Age, weight, activity, nutrition, injury, and foot shape and function are all contributing factors. When tissue tears, a scar forms which is less elastic and prone to reoccurring tearing. Breaking up this scar tissue is important. To do so I recommend firmly rubbing the sole of the foot over a soft corner of a coffee table or on a frozen knobby water bottle. I will often strip the plantar fascia with my thumb on a willing, if not masochistic, patient. Massage therapists are often happy to oblige in this particular form of torture/treatment, as well.
  4. Ice your foot. Speaking of frozen water bottles, as this is an inflammatory issue, icing it will reduce the inflammation and arrest further tissue damage from this process. As mentioned above, rubbing your foot on a frozen water bottle will not only break up scar tissue but will also ice the sole of the foot. If that doesn’t take care of the inflammation it may be necessary to use an ice bucket. This is its own form of torture but quite effective. You can find more information on that here.
  5. The arch of the foot needs to be addressed. In my practice I often adjust feet. If the joints of the feet are not moving properly, it can put a strain on the plantar fascia and it can overwork the calf muscles. Sole inserts can also assist in correcting the proper mechanics of the foot and reduce the stress placed on the plantar fascia. I recommend trying a non-custom insole that has sufficient arch support and a decent heel cup. I like Superfeet that you can buy at REI or Kaiser but I am also trying out a new company that I will write a product review for if I like them. You can also get a great product from The Good Feet Store but it is an expensive product. If none of those options work, a podiatrist and some chiropractors can fit you for a custom orthotic. I have strong opinions about these and really prefer ones that correct gait. I really do not like posts that only correct the foot while standing. Unfortunately, the vast majority of orthotics are the latter.
  6. Podiatrists can help. A good podiatrist, or foot doctor, can make a big difference in difficult cases of plantar fasciitis. If you have done everything I mentioned above and you are still struggling, you made need more invasive intervention. If a podiatrist tells you to wear a boot for six weeks, I recommend getting a second opinion. This usually just means that they don’t think it is bad enough to do something more invasive and they are too busy to tell you to do more of the above. If it is severe enough, the first aggressive step is to get a cortisone injection. This is not without risk. Cortisone is very effective in reducing inflammation and can be what is needed to put the foot on a healing course. However, it also dries out tissue. As dehydration leads to a decrease in elasticity, cortisone can worsen the problem. At the very extreme, surgery is the last option. Typically the podiatric surgeon will cut the plantar fascia and release the tension placed on it. Yes, it is the last resort but there are times when it has to be done. By the way, I know some really good podiatrists in the area.
  7. Is it really plantar fasciitis? Finally, just because you have foot pain and your GP diagnosed it as plantar fasciitis doesn’t mean that is what you have. I cannot tell you how many times people have told me they have plantar fasciitis and I rub my fingers along the sole of the foot eliciting zero pain. It will absolutely be painful with tiny bumps on the sole of the foot if you have plantar fasciitis. Often times the real problem is that the foot is maladjusted. Getting it adjusted enough can remedy the problem in this case. Sometimes it is an Achilles or calf issue. In that case, stretching and massaging the calf can help. Occasionally, a heel spur is the culprit. Most people have heel spurs and they are rarely the cause. But, I have had patients where it made a huge difference to have surgery to remove them. Lastly, the heel has a fat pad that provides cushion while walking. If it gets injured it is extremely painful. There is not much but rest and maybe cortisone that will help with that.

***Photo by Imani Bahati on Unsplash

Strengtheining the Core Through Coordination

When we talk about “the core” of the body, we are typically referencing the musculature around the abdomen and low back. These muscles consist of the abdominal muscles (rectus abdomini, internal obliques, external obliques, and transversi) and the muscles of the back (lattisimus dorsi, serratus posterior inferior muscles, erector spinae, multifidi, interspinalis muscles, lateral intertransversi muscles, quadratus lumborum, and to some degree the iliopsoas).

Strengthening the core has become a fairly popular mantra these days. Many of us are walking around with poor posture and a fair amount of dysfunction as a result of poor core stability. A weak core leaves one susceptible to a host of joint and disc injuries as well as overly tight butt and leg and muscles. In contrast, a strong core can prevent a host of back injuries.

The word strength, however, needs some clarification in the context of strengthening the core. When most people think of strengthening muscles, they picture muscles moving against significant resistance like lifting weights or power movement against gravity or some other force. These type of exercises can actually be detrimental to the core muscles and increase the risk of injury to the spine. Coordinating the movement of all of these muscles is what is most beneficial.

I mentioned in my last article that postural muscles are slow twitch, white fiber muscles designed for endurance. They need to be strong enough to hold you up all day. Strength, in this case, does not come from bigger muscle fibers but from having all of the muscles firing in a controlled and proper order. For example, if you lift a box, ideally your abdominal muscle and your spinal muscle would contract at the same time to stabilize the body so the shoulder and arms and hips and leg muscles can utilize their power to lift it. What often happens is that core muscles lay dormant until a significant strain forces them to respond. So, when you lift a box, you first engage your back muscles until you are upright then, if you go past vertical, the abdominal muscles will engage. Then, they will fire back and forth while they try to find a semblance of stability.

I bring this all to your attention to encourage you to strengthen your core appropriately. Exercises that promote coordinated movement like yoga, pilates, and modified exercises from yoga can make a huge difference. It can take time to build coordination and it takes a consistent effort. In the following videos, I demonstrate four very useful exercises for coordinating core muscles and therefore, strengthening it.

Cat/Cow

Bird Dog

A Safe Crunch

Side Bridge

Photo by bruce mars on Unsplash

Spinal Stabilzation Exercise Bird Dog (#2/4)

In this video, I explain how to perform the “The Bird Dog.” This is not a difficult exercise but it does require some coordination. It helps facilitate the erector spinae muscle which are the long muscles that run on either side of the vertebrae. I recommend doing this daily 10-20 times after doing the Cat/Cow.