SYMPTOMS AND CAUSES
The first thing to note is that the causes of Plantar Fasciitis are often mixed up with the symptoms. Plantar Fasciitis is an inflammation of the plantar aponeurosis which presents as sharp or dull pain on the bottom of the foot, particularly first thing in the morning. It is the most common cause of heel pain.
Commonly, extension of the great toe and dorsiflexion of the foot increases the pain as it stretches the plantar aponeurosis (the band or sheet of connective tissue running across the sole of the foot). There is also typically a point of tenderness on the medial side of the heel near the proximal attachment of the plantar aponeurosis and the medial tubercle of the calcaneus. On X-Ray, there is often boney spurs on the heel (Calcaneal Bony Spurs) which will cause severe pain when walking. PF is often thought of as a foot problem and the cause often sited as an issue for runners and dancers wearing inadequate footwear. Read further to find out why this is misleading!
Although most treatments (especially those fixated on a medical model) focus on the foot, sometimes injecting it or even performing surgery on the fascia, this is misguided since it is looking at a fixing a symptom, rather than at the cause. PF is actually a form of tendonitis which is multifactorial in origin. Both muscle (especially the gastrocnemius and soles) and connective tissues are tight; there is inflammation of the fascia and nutritional insufficiency in the body, particularly dehydration and inadequate intake of protein which cause the wear and tear on the calf muscles and foot connective tissue to be slow to heal. The lack of hydration causes the Aponeurosis to become like a dry, brittle sponge. The tissues rest overnight but have not had the chance to warm up which is why morning pain is worse. Standing on the cold brittle tissues causes micro tears and injuries to the thick band of tissue that runs from the heel bone to the toes, which supports the arch of the foot. It often starts as a small ache that is ignored for months and can be exacerbated by running or standing for long periods, particularly if you are overweight.
The largest stress on the fascia is over-pronation of the foot (collapsed arches) which have a knock on effect on the rest of the body which can typically present as the syndrome we refer in Somatics to as the ‘Trauma Reflex’. This starts in the lower portion of the body and spreads upward in a chain reaction. The over-pronation causes an internal rotation of the lower leg, which in turn causes knee valgus (the knee turns inward).
This causes an internal rotation of the femur, which in turn anteriorly tilts the pelvis resulting in hyperlordosis which we have discussed many times in class. This will often cause Sacroiliac Joint subluxation and Piriformis Syndrone, drawing the shoulder up higher on one side and as a consequence, the head will tilt to compensate so that the eyeline is corrected.
There needs to be a functional approach to treatment since so many areas of the body are affected.
Since the foot fascia has become weak and irritated, initial comfort can be found from initial rest and reduction of swelling through ice – particularly useful is rolling a bottle that has been frozen under the sole of the foot. Strapping is also useful in the first stages of treatment.
Secondary treatment needs to involve correction of the over-pronated foot as well as Somatic Pandiculation techniques to release the calf and correct the other postural implications (as described above) and ensuring adequate nutritional support. The temptation is to stick overly padded shoes and arch supports under the sole of the foot, however this serves to anaesthetise the foot since it is unable to move correctly within the shoe. Propping up the weakened arch allows it to rest on it’s laurels and it soon becomes further weakened along with weakened proprioception and lower leg muscle weakness. Padded athletic shoes encourage a heel strike which causes a jarring of the spine and inefficient forward motion and the calf no longer acts correctly as a sponge for high impact, as it was designed to do.
The exact opposite approach is advisable. Shoes should be worn as little as possible once the initial swelling has reduced through the above suggestions.
The foot also maladjusts to rough terrain since it is being held in a stationary position by the shoe. The secret is to switch to minimalistic footwear over a period of training time so that the foot and calf can adjust correctly as the muscles become stronger. Then tight facial tissues need to be release through the use of a tennis or golf ball being rubbed along the sole of the foot to break up the hard tissue. The fascia is stuck and viscous, therefore toe curl exercises will help release the stuck tissue and help to “wake up” the foot.
The fascia can be further lengthened and encouraged to become elasticated by the use of a Yoga strap around the foot which is in plantar flexion.
Manual manipulation of the fascia can also help soften the fascia, particularly pulling back the big toe and pressing the inside of the foot with the other hand.
Kneading surrounding tissues and massaging the calves is also beneficial as is performing calf lengthening exercises. The foot pain will also be eased from performing balancing exercises on an uneven surface such as a wobble board or a rolled up Yoga Mat.
The take home message from this week’s blog, is to love your feet since they create some of the most magical moments of your life, particularly if you love hiking, running and dancing! Ensure that you are adequately hydrated and taking in enough protein for repair of micro tears in your foot and calf muscles, fascia and connective tissue. Avoid ignoring any dull aches in your feet, particularly if they are more present in the morning. Make sure you stretch your calves and avoid sensory motor amnesia producing heavily padded supportive trainers in favour of minimalist footwear and good old fashioned “Toga”!