What seems like a long time ago, I wrote about plantar fasciitis (PF). I think it was one of the first posts I wrote for an old blog. I have included it below so you can see what I am referring to throughout this post. Recently though, I have been running into many more cases of PF that are seemingly not as related to the LOWER leg as I would have previously thought. I know this is because of my continuing education, and continued development as a professional, but I do not think that enough people are receiving as much information about plantar fasciitis as they should.
First, let me re-itterate some of the info from that past post.
Common Causative Factors:
- Improper footwear
- “Flat” feet
- 40-60 years old
- Rapid increase in activity level, duration,and/or intensity
- PROLONGED SITTING
That’s right, if you compare the list below to the one I just mentioned, the new list includes prolonged sitting. I have treated maaany patient with plantar fasciitis who have proper footwear, are male, have a decent arch, and are INACTIVE. Well that doesn’t make much sense based on the list BELOW, so I say go by the one above.
Prolonged sitting usually leads to a multitude of conditions, but the two PF cares most about are weak glutes and tight hip flexors (two parts of Janda’s Lower Crossed Syndrome). But these are at the hips Mike. Well, I hope we are all becoming more aware that the body is made up of different segments, all of which influence the other parts; regional interdependece.
Like I state in the old post, PF can be caused from a tight gastroc/soleus complex. These muscles (mostly the soleus) are postural muscles (meaning they are designed to keep the body upright). When our hip flexors are tight and we stand, we go into an anterior pelvic tilt. This tilt causes an anterior weight shift. Well, well, well. Where does this leave us? Leaning forward. I want you to stand up with your feet shoulder width apart. I want you to keep your knees straight, and I want you to lean forward. Feel your toes grasp the floor, but also, feel your gastroc/soleus complex contract, attempting to keep you upright and off your face.
After sitting all day we then decide to go move. We tie on our running shoes, and hit the pavement or treadmill. However, after sitting on our asses, our glutes decide they aren’t needed to keep us upright so they turn off or don’t receive the correct motor sequencing (search: glute amnesia). So there we are, running in an anterior pelvic tilt, with a forward weight shift (most times it goes unnoticed), and we cannot propel ourselves with our glutes and we lose hip extension, all of which perpetuates the situation, and makes the gas/sol complex tug away at the plantar fascia.
Recommendations to reduce your chances of PF (some/most of these I use with my PF patient’s now):
1. Train(lift)/walk barefoot – Not only does this increase the feedback your brain gets from your foot, which increases proprioception, it strengthens the muscles of the arch, and the foot intrinsics, which are nature’s best orthotics. I did not say RUN barefoot (The jury is still out for me).
2. Perform single leg balance (barefoot of course) – Shoot for up to a minute, look in a mirror, and do not lose any height when you take a foot off the ground. You should feel your glutes going crazy!
3. Squat, deadlift, hip hinge, Glute-Hip-Raise, single leg bridge, or do something else that results in glute strengthening and reciprocal inhibition of the hip flexors. Also, stretch your gastroc/soleus/HF.
4. Get up throughout your day – Do I really need to explain this?
5. Strengthen your back. Sitting all day causes your shoulders to round forward too! This also results in a forward weight shift (see above). Seated rows, pull ups, bird-dogs, good planks, chin tucks, etc can all be mixed in.
6. Deep tissue massage – Gastroc, soleus, hip flexors (if tight), plantar fascia
7. See your physical therapist – There are many things that I have not discussed in either of these posts that a proper physical therapy evaluation can pick up on.
8. Sometimes orthotics are needed in the short term, but usually not enough to warrant getting $200 ones. Research has proven there is no difference between those exspensive ones and the cheap over-the-counter ones. Please read here. There are other studies too, sorry to those of you who make customs.
Disclaimer: I used to be all about prevention, but as I have become wiser, I think the correct term that should be used below is reduction.