Friend or foe?
Your feet. Are they are friends who help you walk, run, jump, high step, and dance or are they painful and complaining threatening you if even think about walking around on them?
Perhaps sometimes they feel fine, but then you add some extra activity one day, and then you wake up with your feet stiff and sore. And that stiffness and soreness starts showing up every morning!
What is Plantar Fasciitis?
Plantar fasciitis is a disorder of the connective tissue which supports the arches of the foot. Commonly people experience pain in the heel and bottom of the foot that is usually most severe with the first steps of the day or following a period of rest. Most patients I see with plantar fasciitis have it only on one foot, but approximately 20-30% experiences it on both feet. I have treated teenage athletes to grandmothers with plantar fasciitis, yet the majority of patients who develop this problem are over the age of 40. Maybe the most interesting aspect of plantar fasciitis is that the symptoms sneaks up on many people and usually come on gradually.
The plantar fascia is a dense, fibrous band that serves as a bio-mechanical stabilizer providing structural support for the arches of the feet. It is also a protector to the vulnerable neurovascular structures on the plantar aspect, or sole, of the foot.
Microscopic examination of this fascia (in symptomatic individuals) often reveals degenerative changes in the collagen fibers that give this structure its strength. Surprisingly these investigations often fail to find inflammatory signs that would be expected leading many, myself included, to believe it should really be called plantar fasciosis, as the term ‘itis’ denotes inflammation.
Most cases of plantar fasciitis resolve with time and rest. However, if time and rest has not resolved your symptoms, it is time to start some conservative (non-invasive) strategies.
What are conservative, non-invasive strategies?
Assessing footwear and adding necessary support – individuals’ arch dynamics are unique. Some arches are high, some are flattened and some people just need new shoes or appropriate supports. We will look at your shoes and supports and make sure they are not part of the problem. If custom orthotics are needed, we will assess your feet and get the best support for your lifestyle.
Foot restriction – We will assess your foot movement and address any restrictions that may be contributing to your foot problems. Both active and passive therapies will be used to restore your movement patterns and appropriate mechanics. You may get some home training to help promote healing and prevent future dysfunction.
Ankle restriction – We will assess your ankle movement to ensure you have appropriate dorsiflexion. A lack of good ankle dorsiflexion is common in foot problems including plantar fasciitis. We may need to apply both active and passive therapies to restore your ankle movement patterns so you have appropriate foot and ankle mechanics. You may get some home training to help promote healing and prevent future dysfunction.
Tightness in the calf or Achilles’ tendon – Overly tight calf muscles can also contribute to dysfunction in the ankle and foot. We may need to apply both active and passive therapies to restore your ankle movement patterns so you have appropriate foot and ankle mechanics. You may get some home training to help promote healing and prevent future dysfunction.
Obesity is an independent risk factor – Because excess weight places excess load on the feet, we may need to address and create strategies to decrease weight and alleviate excessive load.
Kinetic chain problems – ‘The ankle bone connects to the knee bone and the knee bone connects to the thigh bone’. Problems in the hip and spine are powerful contributors to mechanical dysfunctions in the foot. Again, both active and passive care strategies may be employed to address these ‘upstream problems’.