Plantar fasciitis; Not a foot problem but a spring problem.
If you have had plantar fasciitis, you know the pain, the difficulties walking and if you are an avid runner, it can stop you from running altogether. Many specialists know the condition by name and many podiatrists will typically manage it with foot orthotics, injections and in the worst cases surgeries that often, do not solve the problem (but may alleviate the symptom until it again exacerbates). Physical therapists often will try to strengthen the lower leg muscles, massage them, and even use proprioceptive tape that also may give you short-term relief but may not alleviate the condition and prevent it from reoccurring. Even chiropractors have a solution of manipulation, soft tissue work, and exercises which may even work better, but may not solve the problem.
To solve plantar fasciitis, you need to first understand what the condition is. If you read the classical literature or Wikipedia, it will tell you the following;
“Plantar fasciitis (also known as plantar fasciopathy or jogger’s heel) is a common painful disorder affecting the heel and underside of the foot. It is a disorder of the insertion site of ligament on the bone and is characterized by scarring, inflammation, or structural breakdown of the foot’s plantar fascia. It is often caused by overuse injury of the plantar fascia, increases in exercise, weight, or age. Though plantar fasciitis was originally thought to be an inflammatory process, newer studies have demonstrated structural changes more consistent with a degenerative process. As a result of this new observation, many in the academic community have stated the condition should be renamed plantar fasciosis.” Read more here. Essentially, plantar fasciitis is a repetitive strain injury (RSI).
While the classical ways to treat the condition including night splints may relieve the problem temporarily, the mechanical cause of the pain is rarely addressed at all. In order to understand plantar fasciitis, you need to understand that the typical plantar fasciitis patient is a heavy heel striker (not necessarily someone who is overweight), may have either very flat feet or high arches or perhaps sa combination of both and is often but not always inflexible. In this author’s experience, almost all are built asymmetrically, which causes their core muscles (muscles in the mid section of your body) and the pelvis to distort. When this occurs, we lose the dissipation of shock that the pelvis provides, while the myofascia that surrounds the core will tighten in response to this now asymmetrical loading, resulting in a torqued core that is poorly trainable and will often result in back pain and even neck pain. When the core distorts, the legs will tighten as well, since they cannot function well when the gluteus medius (buttock muscles) are working poorly and the myofascia surrounding them has tightened. The legs and calves also are supposed to rotate and absorb shock as well, so when the fascia surrounding the joints tighten, the overall effect is a shortened gait (the way we walk), a high impact at the heel and foot and restricted motion at the foot, ankle and hip. This mechanism is a common reason people have heel, foot, knee, hip, and even back pain.
The pelvis is responsible for at least 50 percent of the motion of the body and it is where the body derives power and leverage from in an X pattern as we walk and do other activities. If the core is distorted, we will over and under stride from side to side, with compensation of this occurring in the upper body, which causes poor absorption of impact from the ground up.
Looking at your gait dynamically, when you heel strike, your foot is supposed to pronate (turn out a little) which brings you into toe-off. At the point of impact, the ankle should absorb shock through the heel, foot, the tibia, the gastrocs as they act like a spring, then there is a mechanism at the knee called the screw home mechanism where the knee rotates a little internally (which also absorbs the shock) and those same forces are then absorbed at the hip and pelvis.
Throughout a normal gait cycle, shock needs to be absorbed. Since most of us assume a more adult style gait from the time we are about 6 yrs. old, if we are tight or stiff from a lack of spring which will affect the tightness of the surrounding fascia and the muscular tissues, we believe that it is normal or normal for us. Frankly, there is no normal, however, there is a perception that a lack of pain is normal and pain is abnormal. This concept is explained in detail in the book Cheating Mother Nature, what you need to know to beat chronic pain.
Most healthcare visits are about your symptoms, where the symptoms are and treating the area of complaint, however, unless the functional reason for plantar fasciitis is addressed (lack of spring and repeatedly high impact) the condition will reoccur, or stress fractures may develop. Looking at the foot or the heel, without understanding that a lack of spring is the cause of injury and that this extends into your core is a frustrating path, since the problem of high heel and foot impact and its cause must be resolved to resolve heel pain and plantar fasciitis.
Most people who are heavy heel strikers are at high risk for plantar fasciitis. People who are high-impact walkers typically obliterate the heels of their shoes and are heard walking around their homes, since they will have a heavy foot strike at impact.
A better approach to the problem
You cannot place your profession first and use it as a lens to fix a problem such as plantar fasciitis. This is known as physician bias and is most likely why most people with this condition never fully resolve or have the condition return. If the solution is cushioning the foot or heel or foot orthotics only, with pain if you do not wear a cushion or a foot orthotic, the cause of the problem is still present. Your healthcare practitioner must look at your body mechanics, how you walk, your body symmetry and style of gait, and understand how you hit the ground. Your healthcare practitioner must evaluate the springiness in your feet and the fascio kinetic chain which can be done during a full biomechanical evaluation, which looks at passive leg movements such as flexion, internal and external rotation and understands if there are any restrictions to the normal spring mechanisms of gait on both feet.
Care must be given to restore normal shock absorption at the calf, knee, hip, and pelvis, and the secondary compensations in the upper body must also be resolved to successfully resolve the condition. Often the most effective way to treat and resolve involves myofascial release treatment, other soft tissue methods such as the Graston Technique which uses instruments and is superior in its ability to loosen fibrotic tissue restricting movement and manipulation of the extremities and pelvis which is most commonly done by chiropractors. After treatment, your doctor should retest to see if the springy end feel has returned to the joints in the foot and leg and to check to see if the firing patterns in the leg have improved (the coordination of movement) which will markedly decrease the likelihood of a reoccurrence.
While the medical establishment is trying to treat the condition, running shoe manufacturers already understand that if you decrease impact, the person feels better. Newer running shoes are being released that are maximalist (vs. minimalist, the recent craze that has come and gone) and spring is in.
While these shoes may not solve all your mechanical problems, they seem to control the foot more with a straighter last (ideal for overpronators) and a way of absorbing ground shock and enhancing your body mechanics as you walk or run in the shoes.
While barefoot runners believe that only a barefoot running style will properly absorb shock from their feet, they too have problems mechanically and end up with foot pain and running injuries, so shoes or not, the way your body functions at impact will cause the condition. Basically, you cannot change your running style away from tight myofascia, a poorly working gait cycle, and a compromised core.
The approach sufferers of plantar fasciitis should take needs to include the following
1. A proper musculoskeletal evaluation using active evaluation methods. This assures that the likelihood of an appropriate diagnosis which will lead to an effective treatment regimen.
2. Fascial manipulation using Myofascial Release (active release techniques is a style of this), instrument assisted soft tissue methods such as Graston.
3. Manipulation of the extremities, pelvis, and spine to assure proper joint play and alignment, usually done by chiropractors.
4. Active rehabilitation regimens with corrective exercises to retrain the gait cycle.
5. Hip socket stretching protocols if the joints themselves have tight hip capsules. This common compensation is seen in many plantar fasciitis sufferers.
6. A post-treatment treadmill analysis to evaluate gait asymmetries post-treatment and to evaluate the intensity of impact at the ground.
Using the methods is likely to assure the best long-term outcome and success. Most cases will fully resolve using this protocol, while some are more complex. The process of elimination is the best way for your practitioner to best resolve the condition, using the protocol known as treat test treat.
What do you think? As always, I value your opinions.
Read Cheating Mother Nature, what you need to know to beat chronic pain available through Amazon.com