In this post, I want to give a fly by on what I consider to be the high points of a conversation on plantar fasciitis (PF) or heel pain. I want to give some common areas of misunderstanding on proper (improper?) management, and introduce a better way of evaluating and treating PF. First, let's consider two examples, unrelated to the foot. I think many of us can identify.
BACK BRACES FOR BACK PAIN?
Individual #1 has a low back ache when standing for hours without rest. What do we do? Go to the local drug store and buy a low back brace? While there may be a time for that, it's certainly not a classic first choice.
Or what about individual #2 with knee pain that is exacerbated with jogging 5 miles? Do we slip a knee brace on to take the edge off to make running more comfortable? If you ask me, absolutely not (yet). Instead, I would focus on muscle control of the problem area. I would want to find contributing factors (areas of "dysfunction") in the musculoskeletal system and treat them. The same Q and A applies to the foot.
So back to the foot, and plantar fasciitis in particular. Before we get too far, here's a quick anatomy refresher.
As you can see, the plantar fascia on the bottom of the foot goes from the heel to the front of the foot. (The heel is where it is classically the most sore, mornings in particular.) When we stand on our feet for prolonged periods of time, or do a good amount of walking/running, that connective tissue is stressed. And stressed tissue is obviously susceptible to soreness. It's going to be stressed MORE if the intrinsic and extrinsic muscles in our feet and ankles are weak. It's also going to be stressed more if the joints that you see above aren't oiled up and moving nicely!
After this heel pain goes on for a while, most people typically dabble around with new/different shoes or orthotics. While those can be good stress relievers for our feet, if we don't take it a step farther we've missed the biggest step yet; namely, having a Physical Therapist evaluate our foot. While some people may consider a Podiatrist or Medical Doctor, the truth is a Physical Therapist is the only professional in the medical community that looks deeply into the function of the foot and ankle. We don't just look at static position, we look at control. In other words, we don't get too concerned that some people have low arches and some people have high arches. What matters is how your foot functions when it moves. For example, can you make your foot have an arch? Can you make it flat, then raise it back up? Can you spread your toes? Can you perform consecutive heel raises correctly? Perhaps more importantly than that, we want to look into how the low low back, pelvis, and hip muscles and joints affect our feet. Not to mention nerve dynamics! (Yes, pinched nerves in the back and ankle can also mimic PF.)
TOP DOWN FUNCTION
As you can see above, if our left butt/hip muscle is inhibited or weak, it certainly will cause our leg to rotate in, flattening our foot (overpronating,) making our ankle joint stiffer, our big toe crooked (think bunion,) and more strain on the plantar fascia. Our bodies are very impressive in that they can sustain lots of "abnormalities" before they ever hurt, which is nice. But there is still an ideal that we would like to shoot for to prevent this stuff from getting out of control. Take the fella above and put an orthotic in his shoe. His (her?) foot might feel better short term but what about the true CAUSE for "flat feet?"
WHAT YOU NEED TO KNOW
I've mentioned a lot of possible dysfunctions and things we need to treat to have a healthy foot. But for simplicity, I want to conclude with some fundamentals that our Doctors will likely be assessing and treating when seeing someone with PF.
- Calf mobility? (If calf is tight, ankle won't bend. If it's weak, foot is weak.)
- Ankle joint mobility? (Ankle should bend at least 10 degrees, preferably more like 30.)
- Calf strength? (Weak calves really are tough on feet.)
- Intrinsic foot/arch strength (If we can't make and control our arch, we're really stressing joints and PF.)
These aren't in the video, but I can't NOT mention them!
- Strong butt? (If we're stable at the hip, we're more protected at the foot.)
- Big toe mobility. (If it doesn't bend backwards at least 60 degrees we're going to run into trouble.)
That starts to look like an exercise program doesn't it? Just like we have adopted the concept of core strength for healthy backs, we need to adopt the concept of foot strength for health feet. Shoes matter, orthotics matter, but function matters most.