Doctor of Physical Therapy, soma system® Master Instructor
Taking that first step out of bed in the morning is difficult enough for many of us. However, for the 10% of Americans who have plantar fasciitis, that first step can be excruciating–like a knife piercing the heel of the foot.
What is It?
Plantar fasciitis is classically defined as an inflammation of the plantar fascia, a thick sheath of connective tissue that spans the sole of the foot. Normally, the plantar fascia is elastic and able to support the arch as it transforms to accommodate the various stresses experienced from when the foot strikes the ground to the point of push off. It functions in tandem with the small intrinsic muscles of the foot that work to adapt and conform the bones to different surfaces and with the larger muscles of the lower leg that help to balance the ankle and support the arch.
Athletes, weekend warriors, and desk workers are all susceptible to plantar fasciitis. It does not discriminate. Athletes who train improperly or wear inappropriate footwear are more prone to poor biomechanics, which overstresses the plantar fascia. Desk workers may develop weakened stabilizers around the ankle and feet due to disuse, whereas people who work on their feet may fatigue these same stabilizers. Both of these situations can functionally remove plantar fascia’s allies, and leave it fending for itself. Overweight individuals also have elevated risk due to the increased weight placed through their feet. Plantar fasciitis, as with any injury, begins when the stress placed upon it exceeds its integrity, causing a tear in the structure. This can be a series of microtears or a single injurious larger tear, which lead to the initial inflammatory response and pain.
Thoughts about Treatment
Treating plantar fasciitis should be individualized based on feet structure, activity level, and body mechanics, amongst other considerations. However, there are several key methods that nearly everyone can benefit from.
Rest and/or ice an acute injury
Let pain be your judge…if an activity aggravates your foot, avoid it or modify it. Try an off the shelf arch support and/or heel lift temporarily as you work stretch and strengthen the muscles of the foot and ankle. Ice can help during the first few days or after any reaggravation such as a long day on your feet and a sudden misstep. However, in the long term, ice may only mask the pain and possibly delay healing.
Specifically your calf muscles and toe flexors…do this BEFORE your first step in the morning to avoid re-irritating the plantar fascia with the sudden weighted stretch experienced with that first step.
Roll out the bottom of your feet with a ball (ie. tennis ball, racquetball, soma system® myofascial 5-pack). Try to use a ball that offers some amount of give and work slowly from the ball of your foot towards your heel bone. Keep a ball on your nightstand and do this BEFORE your first step in the morning.
Keep your hips level, knee in line with your foot, and try to prevent your ankle and arch from falling inward…also try this without curling your toes. Taking all of these into consideration will help to strengthen your balancing muscles, from the gluteus medius in your hip to your posterior tibialis and fibulari in your lower leg.
Pick thing up with your toes
Use marbles, rolled up balls of paper, pencils, or anything else you have lying around. This will help you practice squeezing, curling, and spreading your toes which will develop and mobilize the intrinsic muscles of your feet.
Respect your feet. Each step you take is a balancing act. From your feet to your hips and upward, everything contributes to keeping you upright and moving along. Building up support for your plantar fascia is just the beginning.