When I consult with my patients about plantar fasciitis, the symptoms vary greatly. For some, it’s like stepping on glass when walking. For others, they only feel it when going on long runs. Most people have had it for a long time, which makes it difficult to treat with my expected fast results. It’s not my favorite thing to treat because of this reason, but results is something that I do get; it just takes time.
Because of a few recent cases of plantar fasciitis presenting to my clinic, I have been doing research on the condition more and more. My typical approach is to do what I can to improve the function of the feet and ankles, and to address the kinetic chain all the way up to the pelvis and beyond. I want to make sure that the 26 bones in the foot are gliding past each other with firm, but appropriate movement. I want to make sure the windlass mechanism in the hallux extension up to the knee is intact and fluid. I want to be sure that the patient’s mid foot is moving with the proper give, but without any instability. I make sure the calcaneus is in a neutral position, and inversion or eversion has their proper range of motion. I make sure the subtalar joint is dorsiflexing as it should, with proper rotation about the axis at the neck of the talus.
On the knee, I want to make sure the alignment of the tibia to the femur is true. I want to be sure there isn’t any orthopedic instability in the knee that causes your body to guard in any direction. I want to make sure that the proximal fibula is mobile against the tibia. and that the joint play matches the distal fibular at the lateral malleolus at the talus.
On the pelvis, I want to be sure there is even joint play at the sacroiliac joints. I check for asymmetries at the SI joints and the hips. I want to make sure the acetabular hip joints are moving through full rotation. I check my grind tests for an y orthopedic problems at the acetabulum. Even in the lumbar spine, I check joint play, tissue turgor, and muscle tone for anything that could be disrupting the normal action of the hip flexors originating at the lumbar spine.
We need to have your gait cycle normal again. It starts at the cycle in the feet where the feet need to relax and firm up with ever step. The arch needs to drop, but then it needs to rise up again as the big toe toes-off. It absorbs energy, and it transfers the energy back to the body as you push away from the step. There are subtle twists in the knee as it transfers forces back up to the hips. Nutation in the SI joints on both sides of the pelvis absorbs more shock and transfers the forces through the swinging of your thighs.
These all have to work in harmony for fluid, symmetrical gait.
But if you have improper foot mechanics, stresses build up over time. Irritation occurs at the enthesis where the tendon attaches to the heal bone. Inflammation happens. It becomes painful. Bone spurs form because of this irritation at the periosteum at the bone. Cells called osteoblasts lay down now bone matrix at the site of inflammation that create these bone spurs.
Weak intrinsic foot muscles cause bad biomechanics. Old injuries do too. Old injuries can also lead to weak muscles, but importantly, you have been deconditioning your foot muscles. You have been walking in cushioning shoes when you should have been going around challenging your foot muscles more. You should have been spending more time barefoot through the years. Be careful, though, because if you suddenly try to go barefoot to make up for lost time, you’re going to irritate your heels further.
Do some things to improve the flexibility of your feet. Do some short foot exercises. Learn how to exercise your abductor hallucis longs by telling your big toe to flare out away from the other toes. This muscle ties directly into the aponeurosis that is the plantar fascia.
Learn to walk barefoot again, but be careful. You need to understand the concept of hormesis. Hormesis is when you do small doses of something that is healthful and beneficial, but if you overdo said activity, you’ll injure yourself. Do some barefoot walking, which naturally strengthens the barefoot muscles in your feet, but only do a little bit at a time. The internet is full of comments where people tried to do barefoot running, and where this made them worse. Just like gyms across America are full of people trying to lift weights beyond their capacity, and left up with DOMS. Do a little at a time. Work your way up.
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