Plantar Fasciitis
Welcome! We are beginning a series of posts on some of the most common sports injuries that athletes encounter and ways that you, the patient, can manage them so that you are able to recover faster, and get back to doing what you love!
Plantar Fasciitis
I chose plantar fasciitis to discuss first because I've had multiple people ask me about this condition over the last couple of weeks. First, let's look at the anatomy and go over what fasciitis actually means.
Fascia is a layer of connective tissue rich with nerve endings that surrounds your muscles, giving them shape, and in many cases can form a connection or pathway from one muscle to another. Thomas Myers' book, Anatomy Trains does a wonderful job of describing these fascial pathways. One pathway, known as the Superficial Back Line, runs from the plantar fascia, up the back of the calf, thigh, back and up to the back of your head. So the case can be made that your foot and head are actually connected!
The plantar fascia itself is superficial to the muscles in your foot and runs from the base of the toes to the heel.
What Is Plantar Fasciitis?
Plantar Fasciitis occurs when this fascia on the bottom (or plantar) surface of the foot, becomes torn and inflamed. Signs and symptoms include a sharp pain on the bottom of the heel when walking, and it is especially worse in the morning getting out of bed or getting up from sitting for long periods of time. It usually becomes more bearable once the tissues have "warmed up", so it makes sense that the pain is worse when first attempting to move after long periods sitting still.
Why Does It Happen?
This is a tricky one and is completely dependent on the individual. Tight calves, weak intrinsic foot muscles, over-pronation, training too hard too fast, improper footwear for a given activity, and faulty foot biomechanics (the bones in your feet don't move the way they are supposed to), are all factors that can contribute to plantar fasciitis, many times in combination with one another.
What Can You Do at Home for Relief?
Your first move should be to consult with your local sports chiropractor, physical therapist, podiatrist or orthopedist so that a proper diagnosis can be rendered. Once it is confirmed that you have plantar fasciitis, here are some things you can do at home to help resolve the issue conservatively:
1. Foam Roll (self-myofascial release) - Remember earlier when I mentioned the superficial back line? This is an important concept because it means that tightness or dysfunction somewhere along the kinetic chain can be causing your problem elsewhere. So when you foam roll, make sure to not only hit the bottom of your foot, but also your achilles tendon, calf muscles, hamstrings, lower back, and upper back. A tube of frozen concentrated juice (or unfrozen canned food or soup) can be used to roll the bottom of the foot (as well as the product seen below). A regular foam roller can be used for the rest of your body.
2. Sleeping Boot - In some cases a boot may be useful in helping to resolve plantar fasciitis. These boots are made to hold the foot in dorsiflexion (with the foot pointed upward) to stretch the fascia so that it heals in a lengthened position instead of in a shortened contracted position (another reason why walking in the morning with Plantar Fasciitis hurts like heck!). However caution should be noted not to walk in the boot if you can avoid it, as it will significantly alter your gait and potentially lead to low back, knee, or hip pain at some point!
3. New shoes/arch support - This one will need the input of your healthcare professional, but in many cases, one of the root causes of Plantar Fasciitis is due to faulty biomechanics in the foot. This could be due to wearing high heels, having weak intrinsic foot muscles, or over-pronation, among other things. Check out this video from the gait guys on one of my favorite intrinsic foot exercises to help strengthen the midfoot and restore the medial longitudinal arch: https://www.youtube.com/watch?v=1iZg_e4veWk. If you wear high heels regularly, you may want to switch to flats for a while. If you over-pronate, your doctor can assist you in picking out a pair of shoes that will provide more support. Its important to note that pronation in and of itself is not a bad thing, but sometimes it needs to be slowed down to take less stress off the foot and ankle.
4. Relative Rest - This is a tough one for athletes to comply with. Athletes are wired to train hard and push through injury, but its important for recovery to at least dial back training slightly to allow the body to catch up and tissues to heal.
What can your sports chiropractor do?
Conservative treatments from a sports chiropractor include using Graston Technique, Active Release Technique, foot manipulation, stretching, electric stim, class IV laser, orthotics, and advice on lifestyle modification. Dry needling may also be helpful, but its use by a chiropractor will be determined by what state they are licensed to practice in (currently Georgia law restricts the utilization of dry needling by chiropractors).
An example of Graston Technique for Plantar Fasciitis treatment.
If a conservative approach is unsuccessful, the next step usually involves an injection such as a cortisone shot. The use of platelet rich plasma has also shown to be effective in early clinical trials.
Lastly, if these methods prove to be unsuccessful, surgery will need to be considered.
Recovery
Recovery times depend greatly on the severity of the case and patient compliance and can range from a couple of weeks to several months. If you suspect you are developing a case of plantar fasciitis, the chances for a faster recovery are better if you consult with a healthcare provider sooner rather than later. If this sounds like something you currently have or have had in the past, please don't hesitate to give us a call! Until next time....
- Dr. Drew