Revisiting Plantar Fasciitis


Is this the best we can do?

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 symptoms:

1. Sharp, or non-specific pain in bottom or medial heel
2. Tightness/pain in the arch of your foot
3. Pain that is worse in AM and lessens during the day
4. Pain returns after sitting/standing for a long time

Common Causative Factors:

  1. Improper footwear
  2. “Flat” feet
  3. Female
  4. 40-60 years old
  5. Rapid increase in activity level, duration,and/or intensity
  6. 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.

Always evolve,

Mike

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.

Now that summer is ending, it is time to start thinking about lacing up the old running or walking shoes and burning off some of those hamburgers and hot dogs. Unfortunately, with the change in seasons, we usually shift away from getting a mix of activities like beach volleyball, softball games, and wake boarding. We tend to hit the treadmill or pavement, or throw our leg over a bike and endlessly drone away while the miles pass us by. Sure, staying active is always good, but it is important to avoid injuries from doing the same activity too much. That being said, it is crucial that we “stay in the game” through injury prevention. This month I would like to share a couple pointers in the prevention of plantar fasciitis (PF), a common condition of the foot, that usually occurs with overuse or a sudden increase in activity level. It doesn’t sound catastrophic, but PF can be one of the most debilitating conditions an active person can encounter.
 
PF is a tightening of the fascia, or covering of the foot muscles, that occurs when the muscles of the calf and arch are stressed more than they are used to. The fascia begins to develop small tears with every step you take due to this tightness.
 
If you have ever experienced PF you know how unpleasant it can be, but for the fortunate ones, here is a list of symptoms:
 
1. Sharp, or non-specific pain in bottom or medial heel
2. Tightness/pain in the arch of your foot
3. Pain that is worse in AM and lessens during the day
4. Pain returns after sitting/standing for a long time
 
Roughly 10-15% of the general population will suffer from PF in their lifetime. Those of you who are active, work on your feet, are female, have flat/pronated feet, have very high arches, or are 40-60 years old are at increased risk for PF.
 
On average PF will decrease people’s activity level significantly for at least two months, possibly longer. So what can you do to prevent this debilitating condition? It is really a combination of five simple things.
 
1. After any cardio or prolonged activity on your feet, it is crucial to stretch your calf muscles (gastroc & soleus). Hold the stretches for 30 seconds and perform three to five times on each leg. Yes, it will take about 5 minutes to stretch these, but it’s worth not being out 2 months!
  
2. Actively stretch your plantar fascia by performing Weighted Dorsiflexion
  
3. Proper footwear is essential. It is recommended that you consult your local physical therapist or experienced footwear specialist for a gait analysis and guidance for proper footwear selection. General advice: Flat/pronated feet usually like “motion control” sneakers. High arched/rigid feet usually prefer a well cushioned sneaker. Ladies, when increasing your activity level, or after being on your feet all day, limit your time in high heels.
 
4. A golf ball massage. Place a golf ball under your heel or arch and apply moderate pressure through your foot. This should not be comfortable, but you should be able to withstand three to five minutes of rolling in a circular motion. This massage will break up scar tissue that may be forming.
  
5. 10% Rule. When increasing any cardio distance or intensity, it is highly recommended that you stick to only 10% increases a week. Also, only increase your distance or your intensity each week, not both.
 
If you stick to these simple tips you are greatly reducing your chances of PF. However, if you do begin to get that sharp AM pain in the heel of your foot, don’t try to run through it. Get in to see your physical therapist, because like many injuries, the sooner you address it, the shorter time you will be on the sidelines. 
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10 responses to “Revisiting Plantar Fasciitis

  1. Pingback: Don’t miss these great links!·

  2. These eight recommendations work! Began with a wretched case of PF in both feet and six weeks later with the help of an outstanding physical therapist, I was ready to go dancing.

    • Hey Joel,

      Thanks for the kind words! I definitely think that we need to stop thinking and acting locally with most conditions and start seeing the global picture that is movement and prolonged positions. Like your post by the way!

      Mike

  3. Thank you for writing this. I couldn’t agree more when you said people aren’t bein told enough about PF. I am a nurse and experienced PF for the first time after starting a running regimen over 2 years ago. The first year i had it i tried everything from cortisone injections, massage, 3 custom orthotics, over-the-counter orthotics, ice, accupressure, vitamins, herbs, soaks, ovenight boot, casted boot by orthopedic surgeon, physical therapy x2 with painful graston technique therapy (18 sessions of that pain) and sooo many shoes! I was at my end and then i started receiving myofascial release treatments and the pain started to lessen. The MFR provider told me i have an unbalanced pelvis, tight IT banda and VERY TIGHT HIP FLEXORS!!! They worked on me and the pain started disappearing. I also started hot yoga which seemed to help strengthen my glutes and core as well as my feet.

    Pating attention to the pelvis, glutes and hip flexors is such an important aspect of treatment especially when all other treatments have failed.

    Thank you for putting it out there! I found too many doctors who wanted to perform surgery and i’m so glad i didn’t do it. I recently had a baby and unfortunately the PF has come back with vengence in my left foot BUT i now know what to do! Stretch, strengthen hamstrings, IT, glutes, hip flexors and MFR treatments!

    • Kim,

      I’m glad to see you avoided the surgical route (not many good results out there to back it up). The imbalances that occur throughout the body are wild to think about. Tight hip flexors causing PF? MDs and other PTs know that everything is connected, but sometimes dont want to put in a little extra effort in finding the CAUSE of a problem.

      The Relaxin that was released in your body when you were pregnant probably didnt help matters this time around, nor did the increase in weight through your hips and lower extremities. I have confidence that you know how to lessen it this time around. Best of luck!

      Always evolve,

      Mike

  4. Pingback: Gastrocsoleus complex | Lunchtrac·

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