Plantar Fasciitis

 

What is it?

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 due to pain, posture, and/or 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 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 patch mesh.

• When new fibers of fascia are put under stress, some of the fibers align better but some will tear again.  Too much tearing, can create more injury.

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

• This repair and re-injury process can become a repetitive cycle.

• Treatment interrupts this cycle.

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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 re-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.  Treatment can round out the spur and make it less piercing.

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Home Care:

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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: Soaking your foot/feet helps hydrate dry and brittle facia, 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 that lets your feet rest on something soft.   I keep a kettle of hot water nearby so I can carefully dollop hot water into the bath to keep the water warm enough.  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 to the water as you wish, though the real value for your feet is the warm/hot water.  You can also use a hot-tub or bath, but the foot-only soaks work better to bring circulation and healing attention to the feet specifically.

 

Icing:  Icing is ok if used in moderation.  Ice is good for reducing swelling when things are really hurting, and can help with pain management.  But in the long run, icing 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, perhaps covered with a towel so its not too hard, or too much of a temperature shock.

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Toe and foot exercises:  

Provide some TLC (tender loving care) to your feet first thing in the morning, before your first morning step.  Try a bit of a self-massage, rubbing in some arnica cream, gentle stretching, and mobilizing your toes and arches.

 

You can try placing your feet on a towel on the floor, and then use your toes to “shred” the towel - scrunch it up with your toes, and use your feet to pull it apart.  This action will strengthen your foot, and it encourages the toes to activate their grip, giving a more muscular support for the arch of your feet.  You can also, for example, try lifting marbles with your toes to activate and strengthen your feet.

 

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.

 

Massaging your foot on a ball can be good if you are gentle, and use a softish ball.  It shouldn't hurt.  You can’t afford to inflict more injury when you are trying to get out of the inflammatory cycle.  Once you are out of the inflammatory phase you can use a harder ball.

 

If you spend a lot of time sitting at a desk, a pillow for your feet, under your desk, is good cushioning, and provides comfort that allows for healing.

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Choosing the right shoes:

Wear shoes that feel good.  Look for a soft sole combined with support for the whole foot.  Look for comfortable shoes that provide you a balance between moving and bending your foot, and feeling supportive.  And in general, not heavy shoes.

Look for shoes with a large toe box, so that you can move your toes around - spreading them or wiggling then.

Try wear soft soled shoes, so that there is some cushion for a soft landing. 

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Walking:

Cold tile can be especially hard on the fascia.  Avoid walking barefoot on cold, hard surfaces, especially first thing in the morning.

Gentle, moderate, thoughtful use of the foot while walking is beneficial.  Minimize irritation by not overdoing it.  Maximize ease by increasing the frequency of your walks, rather than adding distance.

Think of using your whole foot as you walk.  Consciously use your toes for the push-off of each step.  Occasionally stop to stretch your 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 sand friction is restorative.  Be careful not to overdo it, as then we are back into the ‘micro-tearing’ and inflammatory cycle.