Ouch. . . My aching feet!

I have seen this topic come up a lot on some of my running group discussion boards.. . .the dreaded Plantar Fasciitis or Plantar Fasciosis. I have heard a lot of great advice on this topic and have also heard A LOT of bizarre things that may provide temporary relief, but will not get down to the root cause of the issue. Let's talk a little bit about the anatomy. . I know, I know. . .but to really understand what the deal with this plantar fasciitis we do need a basic understanding of what's actually going on in the foot. 

Here is the Reader's Digest version of the plantar fascia. The plantar fascia is a very thick and durable connective tissue that lives on the bottom of your foot. It connects to your heel (calcaneaus) and extends out to the base of your toes. This tissue is very important and does A LOT of work for us when we are moving. The purpose of this very tough tissue is to support your foot when you are toeing off (ie: when you are pushing your foot off the ground) and then will provide cushioning when you strike your foot on the ground. So, it's in a constant state of shortening (to provide support when your foot is off the ground) and needing to lengthen to its original length (to provide cushioning when your foot hits the ground). A visual representation may help you see what is going on. 

Mid Stance (middle pic) = Cushioning your foot, so it will stretch out. Propuslive(last pic) = Needs to shorten to provide support

As you can see, the fascia works pretty hard for your feet and we don't really even pay attention to it. . . .well, until it starts to hurt. We can't blame the fascia when things start hurting down there. The fascia is always trying to do its job of providing support and providing cushioning. When things are going wrong higher up in the kinetic chain (core, hip,ankle) the foot tries to compensate and that compensation may lead to the plantar fascia taking the job of some other tissues. There are a lot of reasons that you have plantar fasciitis, here are just a few reasons: reduced foot strength of the intrinsic or deep muscles of the foot, high arches, excessive subtalar pronation, misalignment of the lower extremity, sudden weight gain, decreased dorsiflexion of the ankle, decreased mobility in your hips, shoulder issues, etc

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Plantar fasciitis is typically an overuse injury. I have seen a plantar fasciitis that got symptomatic from walking up a lot of flights of stairs one day. But, it is commonly a running related injury. The most common presentation is  when you wake up, the first step out of bed is EXCRUCIATING. As you walk around, the pain will generally be reduced throughout the day. This makes sense when we think about what the fascia is doing. When you are sleeping, your feet are usually pointed and this will make the fascia be in a shortened state. When you take a step out of bed, you are drastically and immediately forcing that tight tissue to lengthen. This is where you get the mind numbing pain right as you are getting out of bed. 

What can you do for this condition? If you ask 10 people what you should do, you will get 145 different answers. :) The BEST thing that you can do, is to go to a Chiropractor or health care provider that understands the mechanism of your injury. Don't wait on getting treated. Chronic plantar fasciitis can cause a bone spur to form at your heel. The heel spur is formed because the plantar fascia is so tight that it is constantly "tugging" on your heel bone. This "tugging" causes the body to lay down more bone there to provide more stability. We want to avoid getting this heel spur, so see someone as soon as you notice pain. There SHOULD be a TON of soft tissue done to the bottom of your foot and to the calf muscles on the same foot. It will be extremely painful, but the fascia is scarred and adhered to itself. That tissue needs to be worked on to loosen it up and reduce all the scar tissue that has formed. They should also figure out WHY you have this injury. There are a ton of reasons, so the doctor should take you through some movement analysis tests to figure out if the issues with your foot are due to your hips or some other area. If you are just treating the foot, you aren't going to figure out the real reason for your injury and there will be a big possibility of recurrence of your injury. If there is a lack of dorsiflexion in the ankle, the doctor will be able to mobilize that joint and then will give you exercises at home to help increase that range of motion. The picture shows a great way to get mobility into the ankle. The guy is creating dorsiflexion into his left ankle. You want to gradually move your knee in front of your foot to force your ankle into dorsiflexion. You should be doing this several times throughout the day. 

There are other therapies that have been suggested for this condition as well. Straps that you wear at night, cortisone injections into the fascia, pain pills, rest for 6 - 12 months, KT/Rock Tape the foot, Icing and the dreaded BOOT. All these things may provide temporary relief, but again are NOT addressing the root cause of the problem. None of these modalities break up that scar tissue in the fascia or create mobility into the ankle/hip. . . well, they are just fancy bandaids that are given to people when the doctor doesn't truly understand WHY the person has plantar fasciitis. If you are given any of these modalities and then sent home. . . GO TO A DIFFERENT CLINIC. 

Plantar fasciitis is a very painful condition, but if you go to a knowledgable doctor you should start feeling results in as little as 2-3 visits. You will need to gradually increase your running mileage after you are pain free, but this condition shouldn't be something that you have to rest for a year or more. This condition is very specific to each person, and your faulty movement patterns will guide your treatment.