Plantar Fasciitis- the dreaded heel pain...
Plantar fasciitis is a shortening of the connective tissue in the arch of the feet (fascia) that attaches to the back of the heel.
I am going to give you the most common information on how it is caused and how to treat it, however there is two very important peices of info that helped me more than anything else to rid this and keep me on my feet running (oh and just doing day to day activities)!
First of all, PF is not just a condition runners get. Anyone can get it. Here are some of the reasons:
excessive weight load on the foot due to obesity or prolonged standing
mechanical imbalances of the foot
osteoarthritis and rheumatoid arthritis
sudden increase in body weight (e.g., pregnancy)
sudden increase in walking or running
tight calf muscles is a very common cause of the disorder
wearing shoes with poor support, including flip-flops
Another cause of pain is the shortening of the plantar fascia overnight due to the ankle bending, causing the toes to point towards the ground (this is called plantar flexion).The plantar fascia stretches in the morning when you stand. The act of lengthening it causes a great deal of pain. This point is so important to understand as this will become the basis on the BEST way to treat PF. This act of plantar flexion is not just limited to an overnight occurrence though - it can happen any time the foot is flexed (i.e., pointed) for extended periods of time. For example, driving in the car for long periods can cause fasciitis in the right foot, which steps on the accelerator.
So how to treat? As a therapist, my first advice to my clients is to try and remove the offending activity as best possible to stop further aggrivating. If this is not possible, then one needs to understand it is going to take a much longer time to heal and you will need to ice the inflamed area every time you aggrivate it.
Here are some other ways to treat it:
as mentioned, icing the affected area
inserting custom-made orthotics into your shoes
massaging the plantar fascia (not during the flare up stage though as it will make it worse!!!)
nonsteroidal anti-inflammatory drugs (NSAIDs)
acupuncture
strengthening the foot
wearing a night splint ( I use a Strassburg sock and will further explain this)
wearing shoes with arch support
physical therapy
stretching the calf muscles
These methods certainly help and can clear up the condition quicker than if left untreated. In my experience though as an RMT and having suffered though this, there is something that I believe supersedes. It is changing the foot position while sleeping. I touched on this already about sleeping with feet in plantar flexion and the shortening of the connective tissue of the feet. Unfortunately most of us are unaware how our posture is while we sleep, and most of us point our toes (plantar flexion) for many hours of the night while sleeping. Example, side sleeping most people point as they curl up in a fetal position. Stomach sleeping (the worst) the feet are 100% in plantar flexion resting on the bed. Back sleeping is good however if you have a heavy comforter/duvet, it will press down on your feet, once again putting them in plantar flexion.
If you really want to heal PF, you need to find a way to get your feet to point toward your body (dorsiflexion).
How to do this? There are a few different ways. As I mentioned, I use the Strassburg sock (found at all running stores). It has an adjustable strap to pull your feet up. There are also boots/splints- not as attractive but hey we are talking about healing a tricky condition!! You can always put something at the base of your bed like a heavy pillow or some kind of box that you can press your feet against (only will work with side and back sleepers). Or if you have to sleep on your stomach (so bad for you!!) then try and move your body down the bed so you can hang your feet off the endge allowing the feet to be in dorsiflexion. Honestly, this tip helped me more that anything else to 'heal my heels'!! Due to the plantar fascia shortening in the night while we sleep with our feet in plantar flexion, this is how the tissue will heal. Once you step out of bed and put your foot in dorsiflexion on the floor, the tissue will tear and that is what causes the pain. If however, you keep your feet in dorsiflexion as long as possible during sleep, the tissue will heal more aligned and the tearing will not occur once you take your first few steps.
ONE LAST POINT!!!!! Please do not walk around in barefeet in your home, especially if you have hardwood or cermamic tile floors. Get yourself a good pair of slip on indoor shoes with support. This is also a huge factor in my not getting reoccurance of PF!!
Good luck and come and see me for a PF treatment
Alice Ficko, RMT
