For years, I have been treating athletes with the diagnosis of plantar fasciitis. From runners, to basketball players, to crossfit athletes, to desk jockeys, you name it, I have treated it. I would probably say it is the most common type of foot diagnosis that I treat and for reasons that not everyone agrees upon.
First, we will start with the plantar fascia and really try to understand where it is, what it does and its role in function. Because if we can improve our ability to truly understand these aspects, we can improve or decrease the amount of stress/strain that is placed on the plantar fascia during our activities.
The plantar fascia is primarily a thick connective tissue that spans the bottom of your foot from your heel bone all the way to the toes. And it is designed to assist in absorbing force, our body weight and mass in order to help propel, accelerate and change direction/position in space. Think of it as if I was to toss you a raw egg and said, “catch this”. You would catch that egg by reaching out with your hands and gently caressing the egg and going with the egg’s mass and momentum. Then to toss it back to me, you would slow down your arm and gently accelerate in the opposite direction (upward direction) to toss it back.
The same concept is applied to how the plantar fascia works in real life and during function. As we put weight on our foot, our intrinsic or internal supports (which includes all the bones, joints and muscles/tendons) in the foot and ankle need to be active and turn on enough to primarily “catch” our body weight, mass, momentum and “throw” our body into a different direction.
When parts of the internal supports are weak, fail, are deconditioned or not trained properly then the plantar fascia has to do more work and absorb more stress and strain than it is designed to take on.
It is almost like taking that same egg example, but now, let’s say there is a table next to you at waist height and when you catch that egg now, as you absorb the egg’s mass your hand stops prematurely by hitting the table and the egg ends up breaking. That table is your plantar fascia. So, I toss you an egg 1000x and you decide to catch it the same way 1000x, that spot on the table is going to wear down and begin to show some changes in the integrity of that table, especially in the spot your hand was hitting. That increase in stress/strain in that same spot, on the table, may cause some chips, discoloration, maybe create divots, etc.
Now those minor changes in the integrity of the table aren’t exactly the same changes that happen to your plantar fascia, but what it really results in is micro trauma tears, scarring, or even bruising.
Typically, the management for these conditions can be simple, icing, stretching and rolling. These techniques are good and helpful for symptom management because it helps stimulate blood flow to the fascia and restore some nutrients to the micro-tears so they can repair and heal. However, the key to getting better and ultimate relief is discovering the CAUSE of the increased stress/strain being placed on the plantar fascia. The factors that contribute to plantar fascia stress may be the same side foot and ankle, but it may lie somewhere else in the body. It could be same side hip strength isn’t up to par, opposite side foot and ankle stability is poor, hip mobility isn’t adequate, thoracic spine mobility is not moving well, the possibilities are plentiful.
So before you chalk it up to plantar fasciitis and go out and purchase an expensive insole or foot support, see a movement professional and figure out what is really leading to your foot pain.
Director of Physical Therapy
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