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

Massage and Chiropractic

Just about everyday I get asked whether it would be a good idea to get a massage. Almost always my answer is absolutely! I am a big fan of massage as a healing art and a therapy. As with all professions, there are very good practitioners and some that are not so great. I have, of course, known patients who have been to massage therapists that caused more discomfort and may have even caused some tissue damage. However, most therapists do a good job helping people relax their muscles, free their fascia, move their lymph, etc. Remember, massage therapists in the State of California are licensed and have many hours of schooling and practice and if you go to a reputable clinic, you will be in good hands.

Like chiropractic adjustments, it is rarely bad to get a massage at any time. However, also like adjustments, the type of massage must adapt to the body’s condition. For example, when people ask if they should get a massage right after an auto accident, I am often hesitant to endorse such a therapy. The right kind of massage can help flush out inflammation and soothe really sore muscles. However, if the massage therapist is too aggressive the muscles might spasm completely. In addition, massaging recently injured tissues can cause more swelling. On the same note, massage, when muscles are in spasm, requires a special touch. Most massages will help settle down spasmed muscles. Notwithstanding, if the muscles are spasming, chances are they are doing so to protect an injured joint. Take away what is protecting the joint and there are often painful consequences that could prolong healing.

Another question that often comes up is whether it is better to get a massage before or after an adjustment. Most people think that getting massaged before getting adjusted means they are relaxed for a better adjustment. While that is true, as a chiropractor, often times I find that if the muscles and the joints are too relaxed, it can be difficult isolate the stiffer joints and get them to move properly due to the laxity of normal functioning ones. In general, I prefer to adjust people before they get massaged. Adjustments can settle muscles that are tight while protecting joints that are not functioning properly. Personally, I much prefer to get massaged after getting adjusted because it allows me to enjoy the massage better. At the end of the day, it really comes down to preference whether one gets adjusted before or after an adjustment, but more often than not, I would choose to get adjusted before getting a massage.

Regular massages are wonderful thing. How often and how long you need to be massaged is a great discussion to have with your therapist. Additionally, people respond to different techniques and therapists. I have had many massages throughout the years from various massage therapists. I have also enjoyed some styles better than others. Some massages I enjoyed the results much more than the process. To that point, some people feel a massage has to hurt to be of any benefit. I disagree. Sometimes the body needs to be worked over significantly and sometimes it just needs a light touch. A good massage therapist who is intuitive and willing to listen to the patient will know what to do and when.

***Photo by Toa Heftiba on Unsplash