Jun 22, 2016Getting a Grip on Plantar Fasciitis
By Perry Nickelston, DC, NKT, SFMA
Got plantar fasciitis? Want to get rid of it? Plantar fasciitis is one of the most difficult musculoskeletal conditions to treat. Direct treatment to the site of pain is often unsuccessful in the long-term, because the diagnosis doesn’t take into account the cause of the pain. You must ask, why does the bottom of my foot hurt? Why just one side or why both? There is a reason your body is sending pain to the bottom of your foot. It’s communicating something to you. Pain is a request for change – a change in your habits. Two easy ways to respond to your body’s request for change is to adjust how you move and add different treatment options to help the body re-set. If you want results, you must offer patients options.
What is plantar fasciitis and why does it develop? Plantar fasciitis is severe irritation and inflammation of the plantar fascia on the bottom of the foot – hence the name. The plantar fascia (a.k.a. the plantar aponeurosis) is a sheet of connective tissue that stretches from the heel to toes, spanning the arch of the foot. It is basically an inflammation and thickening of the plantar fascia caused by chronic irritation of the arch of the foot due to excessive strain. The plantar fascia is actually connected to a long line of tissue in the back of the body known as the Superficial Back Line of fascia, which goes all the way up to your head. Think of it like a giant elastic band in the back of your body. The ends of the bands get too tight when there is inefficient function in the length of the band. Fascia is the primary force transmission system in your body. If it cannot transmit force efficiently, there is too much strain in certain places: the bottom of the foot is often one of the spots that takes the burden of the excess stress (resulting in too much strain).
Tightness and excess use of the calf, soleus, and toe flexors to maintain an upright balanced position during stepping is a significant contribution to the symptoms. Stability and force generation should originate higher up in the body from your glutei, psoai, quads, and abdominals. If they are inhibited or weak the lower leg and foot have to do more work. More work leads to pain and discomfort. The number one movement pattern dysfunction of plantar fasciitis is lack of strength and timing of the gluteus Maximus. Weak glutes are the killers of the feet.
- Release soft tissue in the calf and bottom of the foot
- Strengthen the psoas, glutes and quads
Once you optimize force generation patterns you move more efficiently with less effort. That’s a good thing.
A combination of targeted treatment to the site of pain and correctives higher up the movement chain will lead to more positive outcomes. The body will tell you very quickly what it likes and what it doesn’t like. If you feel better and it lasts you are on the right track. If you don’t, that’s a sign you need to change approaches. Combine laser therapy, taping, and proximal strength work and you will be on the right path.