Heel pain is a common symptom that seemingly happens out of the blue. To runners and weightlifters, the feeling of soreness in the front of the heel can leave a pit in their stomach. This is because plantar fasciitis, a condition that can be tough to improve, may be the cause. This leads us to ask, what is plantar fasciitis really?
What is it?
Plantar fasciitis is the inflammation or irritation of the tendon-like structure that attaches from the bottom of your calcaneus or heel to the ball of your foot. Your plantar fascia tightens and loosens to help create a stable foot every time you take a step. When over irritated, or stressed too much, this tissue can literally feel like stepping on a nail every step. To put this bluntly, it can seriously knock you on your ass, and out of your training schedule.
You may wonder, who really is at risk for getting this terrible sounding condition? Studies have shown increases in weight bearing at work with poor shock absorption are more likely to get plantar fasciitis. All of the professions that spend a lot of time on their feet such as construction workers, nurses, restaurant staff, garbage men, etc. Runners and people with increased body mass index are at risk at well, especially when ramping up exercising or running too quickly.
How do I know its Plantar Fasciitis?
Let’s say you have heel pain but are skeptical that plantar fasciitis is the cause. What makes plantar fasciitis stand out? Here are a couple factors from the latest guidelines created from multiple research studies.
Plantar Fasciitis symptoms:
- Pain on the inner front of your heel with pressure from your fingers
- Pain in the same area with initial steps in the morning or after sitting for a long time
- Reduction of pain after initial steps, but worsening with long periods of standing or walking
- Limited Dorsiflexion (ability to move ankle towards the sky)
Don’t have any of those symptoms? You may want to see a Physical Therapist or Orthopedic Physician for a closer look.
Your Foot Anatomy: It’s Complicated
Usually at this point I give some exercises and stretches to help treat the condition. With this condition, before I recommend a treatment approach, its important to understand how the foot works. Although the plantar fascia helps support your foot arch, there are a few other muscles that support the arch as well.
Your calf muscles attach into your heel and pull on the same connective tissue that your plantar fascia attaches into. The calf (made from your gastrocnemius and soleus muscles) can also have muscle knots that may refer pain into the foot arch, which should be addressed. Other muscles that help your foot arch are the ones that bend your five toes (flexor digitorum longus/brevis and flexor hallucis longus/brevis). There is even a muscle that attaches right into the foot arch to support it directly (tibialis posterior)!
This last paragraph may be making your head spin, but stay focused! Next, I'll show you some of the most important stretches for Plantar Fasciitis.
Self Treatment: The Stretches
We went over some of the risk factors for this condition and the overall anatomy of the foot and foot arch, which will explain why the following stretches are crucial.
Upper Calf (Gastrocnemius) Stretch:
Stand near the edge of the bottom step of your stairwell like you are about to walk up and slide your heels off of the edge of the step. Keep your knees straight and let your heels slowly sink downward.
Lower Calf (Soleus) Stretch:
Place the foot that needs stretched behind your other foot facing a wall. Bend your knee slowly on the stretching leg and keep your foot flat on the ground and you should feel a stretch in the lower calf muscle.
Toe stretch:
Stand with your stretching foot against the wall with the toes pointing up. Lean into the wall lowering your foot to the ground but keeping your toes pointing up to feel a stretch in your foot arch.
All of these stretches should be done at least once a day and perform each stretch 3 times holding for 45 seconds each.
Orthotics/Shoe Inserts
There is evidence to support that inserts for your shoes to support your arch can help, but there is no researched difference between custom and non-custom inserts being better for you. (custom inserts can cost up to $500!) One way of finding out if insert support can help is to tape your arch effectively relieves pain. If taping helps, most likely an insert or more supportive shoe will help. Remember that external bracing and support should not replace the quest for a strong and mobile foot!
What Can Physical Therapy Do?
Physical Therapists can go quite a bit further than just using stretches to treat plantar fasciitis. Manual therapy is a technique that has shown to be very effective in treating this condition. It can improve the muscle extensibility and joint mobility to take pressure off of the plantar fascia.
PTs can provide you with taping strategies to provide you with short term pain relief. Additionally, PTs can guide you with proper footwear for ample foot support. They can also provide advanced techniques such as trigger point dry needling to get rid of muscle knots in the calf and foot muscles. This may reduce referred muscle pain into your heel.
Exercises are given to strengthen the calf complex and especially into the foot arch complex. If you are a runner or a lifter, PT’s can break down your movement technique in the activities that irritate your heel. Physical therapists can also give you options to take pressure off the plantar fascia.
Remember, it is easy to find the tissue that is irritated and to get rid of the symptoms. It is not so easy to find the movement that is causing the irritation in the first place. Physical Therapy cleans up the tissue, restores normal movement and decrease pain, and gets you back to your activity at the fastest pace possible.
Physical therapy for plantar fasciitis in Columbia and Baltimore, Maryland!
If you have plantar fascia pain reach out to our office today!
