A Specific Note for Plantar Fasciitis

 

What Plantar Fasciitis is:

Structural and Functional Explanation:

  • The plantar fascia is thick connective tissue that gives structure to the sole of the foot.

  • Plantar fasciitis (‘itis’ = inflammation) arises because of a thickening, and drying out of the the plantar fascia.

  • The muscles are tight from stress patterns - pain, posture, injury.

  • The facia thickens under stress from being pulled taut

  •  When the fascia is pulled taut it gets dry, and less elastic, and more brittle.

  • When the facia is then put under stress from weight bearing it causes tiny micro-tears.

  • These micro-tears are repaired by the body laying down a cross-fiber mesh-type patch.

  • This fibrous repair patch works fairly well.  However it is not as elastic (due to the random orientation of the fibers of the mesh).

  • When it is put under stress some of the fibers align better but some also tear again, and too much can create more injury.

  • repetitive micro-tear injury creates an inflammatory cycle which causes swelling, heat, and more fibrous layering.  (hence the ‘itis’).

  • This can become a repetitive cycle.

  • Treatment interrupts this cycle.

Manual Therapy:

  • Lengthens fascia, releases fibrous adhesions, rounds out bone spurs, and mobilizes ankle restrictions.

  • Mobilizes the toes and ankles helping to restore the pliability of the foot and hence the fascia.

  • Lengthens the fascia keeping it from tearing as easily under stress.

  • Releases fibrous adhesions and aligns fibers to their more elastic orientation.

  • A bone spur at the bottom of the foot at the fore part of the heel bone can be very painful.  With my hands I can round out the spur and make it less piercing.

Home Care:

Stretching:  Foot problems can often be addressed by also stretching the back, hamstrings, calves and toes.  This is because the fascia at the bottom of the feet is continuous with the fascia throughout the whole body.  Stretching this "posterior chain" can effectively lengthen the facia at the soles of your feet.  This stretching aligns the fascial fibers making them more elastic.  Stretching before sleep can be especially effective.

 

Foot soaks: help hydrate dry and brittle facia, and it softens facia to become more elastic, and it increases the ‘sponge’ like padding of the sole.  I recommend using hot tap water into a plastic foot sized tub with a towel at the bottom of the tub - to let the feet rest on something soft.   I keep a kettle of water that has just recently boiled at the side so I can carefully dollop hot water into the bath to keep the water hotter.  A large bath towel under the tub makes a nice place you can put your feet after the soak.  You can add epsom salts, baking soda, or essential oils into the water as you wish, though the real value is the warm/hot water to the feet.   People also use a hot-tub or bath, but the foot-only soaks work better to bring circulation and healing attention to the feet specifically.

 

Toe exercises:  place your feet on a towel on the floor, and then “shred” the towel with your toes.  Ths action strengthens the foot and encourages the toes to activate their grip giving a more muscular support for the arch of your feet.  You can also lift marbles with your toes, for example.  Also, consciously use your toes for the push-off when you walk.  And wear shoes with a large toe box so you can move your toes around - spread them, wiggle them.

 

Wear soft soled shoes so that there is some cushion for a soft landing.  Cold tile can be especially hard on the fascia.  A pillow for your feet under the desk is good cushioning too.

 

TLC (tender loving care) to your feet first thing in the morning - before the first morning step - a bit of a massage, arnica cream, gentle stretching and mobilization.

 

Wear shoes that feel good - usually a soft sole and support for the whole foot, comfortable.  That allow you a balance between bending and moving your foot and feeling supportive.  Generally not heavy shoes.

 

Ice is ok in moderation.  Ice is good for reducing swelling if things are really hurting, and can help with pain management.  But in the long run it can reduce circulation and tighten fascia - so go easy.  If the fascia is really flared you can roll your feet on a frozen water bottle, maybe covered with a towel so its not too much of a shock.

 

Massaging the foot on a ball - can be good if you are gentle, and use a softish ball - it should not hurt (we can’t afford more injury getting out of the inflammatory cycle).  If you are out of the inflammatory phase you can use a harder ball.

 

Walking:  Gentle, moderate, thoughtful use of the foot while walking is beneficial.  Minimize irritation by not overdoing it.  Maximize ease by increasing frequency rather than distance.  Think of using your whole foot, your toes.  Stop to stretch the calves.  Consider walking softly - without a heavy heel-strike or stomp, find grace.  Walking barefoot on a sandy beach, slowly, fully - is great - the sand helps provide pliability to the fascia and the friction is restorative.  Be careful not to overdo it, as then we are back into the ‘micro-tearing’ and inflammatory cycle.

 

736 Kimbark Street   

Longmont CO 80501

JAYMI DEVANS  

 jaymi@mountainhands.com