Plantar Fasciitis - More than just a foot problem

For this blog, I wanted to talk about plantar fasciitis. I see this condition frequently at my office and sometimes people come in specifically for the pain in their foot caused by plantar fasciitis. Other times, they just mention it as another symptom they have been feeling and they do not realize that I treat something like that. Chiropractors are able to treat more than just the spine as we also work on extremities including the feet.

A lot of times, I can tie back your plantar fasciitis to another issue not related to your foot such as your calf, hamstring, glutes, or even your neck. I say that it can be connected to a neck issue because sometimes if you have your head forward, it sends off your center of gravity and it causes a ripple down effect to your calves, which in turn creates a problem to the sole of your foot.

What Is Plantar Fasciitis

A lot of people think that any foot pain is plantar fasciitis but that is not the case. Plantar fasciitis is super common as one in ten people will experience plantar fasciitis at some point of their life. For some it can last for years and it results in them giving up some of the things they love doing such as running or walking for exercise. It is definitely something that needs attention thus this blog.

To define, plantar fasciitis is an inflammation of the plantar fascia, which is a fibrous sheet along the sole of the foot. It goes from the heel to the ball of the foot. The other thing that attaches at the heel is the Achilles tendon, which is your big and thick dense tendon at the back of the ankle. This is the tendon for your gastrocnemius and soleus muscles, which are both calf muscles. That thick tendon comes down and attaches to your calcaneus or heel bone and the plantar fascia attaches on the other side of the heel bone so they kind of talk to one another.

One symptom that people who have plantar fasciitis experience is tight calves. That makes sense because the tension on the calcaneus is going to have a reciprocal effect on the plantar fascia.

Generally, people with plantar fasciitis can have pain along the sole of their foot and their heel. If you feel pain on the top of your foot, it is not plantar fasciitis. If you have pain on the side of your heel, it is most likely tarsal tunnel syndrome.

Remedies That People Resort To When They Experience Plantar Fasciitis

There are some remedies that people resort to when they experience plantar fasciitis such as the boot, which promises to help with the condition, steroid injection, or surgery.

Some people come in the clinic and it is possible they have been in a boot for so many weeks or they cannot go without shoes ever even just by getting out of bed. The downside with the boot or using shoes, you have lack of range of motions so you are restricting the movement of the joints in the foot. This is not great for lubricating the joint.

For steroid injections, you run the risk of weakening the tendons and ligaments in your foot. This is because chronic steroid use will weaken these and especially if you are getting the injection around your Achilles as it can weaken the tendon as well. You do not want the tearing of those structures.

With surgery, anytime you cut an area, it is going to create scar tissue post-surgery.

What Is the Plantar Fascia For

More on surgery, you do not want to cut an area in the plantar fascia as it is there for a reason. It is meant to make your foot into this little nice shock absorber. It tensions out along with the sole of the foot and the arch comes up. The shock absorber mechanism is called the Windlass Mechanism. When you walk, the arch basically gets flatten out and then springs back up.

We want to have this nice, durable, healthy, and strong foot and arch to make ourselves have a pain-free and less-loaded gait. The plantar fascia is there for a reason and we want to use it how it is meant to be used.

The problem with modern footwear, supportive shoes, and having that big arch in your foot to artificially hold your foot up is that we do not have to work for it anymore. We just rely on the arch of our shoes to hold our foot up there and we get kind of lazy. So, in turn, our foot atrophies and we have this weak foot that is not supporting our gait like it should. Then, whenever you try to walk without that shoe, you will not be able to do it comfortably. So it is this terrible cycle of weakening the foot and becoming reliant on the footwear that we are wearing and supporting us.

How I Treat Plantar Fasciitis

I want to discuss how I treat plantar fasciitis generally. Note that every person is unique so there are instances when I need to make individualized treatments for them. But, in a general sense, I will talk about how I treat this condition.

If you come in and you have been rolling your foot with an iced water bottle, it is fine and it is not bad but it is not getting to the root of the problem. So typically, what I would do is to first address the musculature of your lower limb which includes your hip, hamstring, calf, and foot. I will look for any tightness or asymmetries in these areas and I will use any number of muscular techniques that we use in the office such as active release technique, NIMMO, and rock blades, which are metal tools that we use to gently scrape the area and it is related to brain perception.

I would not get too hung up with spending a lot of time at the sole of the foot. We would address it but with manual work with hands or the rock blades. Then, I would check more of the hamstrings, the glutes, and the calves.

With the strength of the arch that might not be there anymore, I really like to take a look at your posterior tibia muscles. First thing I check is the gastrocnemius muscle, the big superficial calf muscle that feeds into your Achilles, and we take a look at it as it is super important in the tightness issue you might be having. We then check the soleus muscle, which likewise feeds into your Achilles tendon, and it is the next layer we have to assess. Deep into that is the posterior tibia muscle, which is a tendon that comes down to your ankle and into the sole. It is involved with creating that arch in your foot. If I see that it is weak and inhibited, we will do some muscle work to it to try and stimulate it and try to see where we are having the issue.

Giving exercises to actually activate the calves is counterintuitive because we think that if it is tight, we want to stretch it. But really, that is not always the answer. So, we do the muscle work and active stretches that can help with lengthening, but we will let you do calf braces in different planes to load the tissues without causing pain. It is basically doing slow baby steps into being able to load the tissues again without creating that painful response from the brain.

We can also use vibration therapy to help with the muscles and I love to use it on the sole of the foot because it gives a ton of neural input, which is where we are trying to have the feeling happening. If you are experiencing plantar fasciitis, you are probably wearing padded, supportive shoes all the time so you are not getting good neural input into your foot. So, doing light vibrations on the sole of the foot helps with that.

I also put a piece of Kinesio tape along the sole of the foot. It has that gentle stretch to it and it is more of a long-term subtle neural input reminding your brain about that area that has been dulled by your socks, shoes, and boot. Such subtle neural input helps your brain reconnect with that area. Sometimes I even tape up to the posterior tibia muscle to help with that arch support.

We also work our way up to the hamstrings and glutes and see if we have an issue there. Another thing that might play into how your foot is working is the mobility of your ankle.

Just another topic in relation to foot pain, there are patients who come in and ask me why the top of their foot is so painful. I picked a trick up from Dr. Perry Nickelston called lumbar core release. It pertains to the little structural muscles in the foot and I access them by telling patients to use the head of a razor or their fingers and I have them work between the metatarsals and pinch in between them. They then have to wiggle them until they feel an electrical sensation in the spot where they are having issue. They then work from the toes all the way up to the tarsal bones. I have them do such twice a day to wake up the foot and bring the supportive nature that we need again with it.

Tips On Plantar Fasciitis

A way to avoid ever having plantar fasciitis in the first place is to slowly introduce yourself to wearing minimalist footwear, building foot strength, and doing strengthening of your arch such as short foot exercises. Do these before you even have an issue because it is very difficult to go from having plantar fasciitis and then wearing minimalist footwear. You already deconditioned your foot so if you go barefoot and wear minimalist footwear, it might be excruciating. You have to do the work before you can ever wear minimalist footwear again.

Doing baby steps in strengthening your feet will be the way you can eventually have strong enough feet to be able to support yourself again. Use the Windless Mechanism also to bring back that shock absorber to your foot.

Conclusion

We get a little shortsighted when it comes to plantar fasciitis because we only focus on the foot. The whole lower chain is really not going to work alone because you might be experiencing pain in your foot, but you do not know that you also have other problems in that lower chain.

We do see a lot of success with plantar fasciitis in the office and it is possible to treat it. However, it is still best to get ahead of it by strengthening your feet and your calves and this is something you might want to think about it.

You cannot do much if you cannot walk anymore so I hope this blog helped you understand more about plantar fasciitis.

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Thank you for listening and see you next week!