A Pain in the Foot!

Plantar Fasciitis… not something you get from the shower at the gym but what is it?

Plantar Fasciitis is inflammation of the thick tissue on the bottom of the foot called the plantar fascia. It creates the arch of the foot by connecting the heel bone to the toes.

How do I diagnose it?

There are several key symptoms including pain for several days which can become chronic if left untreated, a lack of trauma but sometimes new shoes can cause it to start. Also, the patient often has increased pain when they first stand up and walk or run, which then seems to improve as activity continues. The pain then again worsens at the end of the day. Some patients experience a tired achy feeling, foot cramps and these are often worse at the end of the day. From my own experience and what my patients tell me, the symptoms are better with rest and avoidance of the activity.

How do I treat it?

For acute cases, I encourage my patients to rest, use ice and NSAIDS if there is any swelling. I will use the Ultrasound machine to provide deep tissue ultrasound which decreases the inflammation as well. I will perform soft tissue massage, Myofascial release [Active Release technique], Graston Technique, adjustments [posterior calcaneus, taus, inferior navicular, pelvis and lumbar]and then encourage use of a  TP kit or foam roll lower extremity and or a donut pad/soft pad under heel, silicone pads can be helpful. I will not just treat the foot itself but all the connective tissue such as the calf muscle, hamstrings and Achilles tendons since they connect and become the plantar fascia and when tight are often the root cause of Plantar Fasciitis.

For more chronic cases, ice and heat will not help much but I will use ultrasound, work the calf muscles, strengthen the inverter [tibialis anterior & posterior] & intrinsic muscles of the foot with exercises, perform deep soft tissue work, and recommend Bromelain instead of NSAIDS for inflammation. I will possibly recommend that the patient consider orthotics, posterior night splints and will insist on a daily routine of rolling with TP kit, ball or foam roller. I will most often encourage my patients to avoid steroid injections as they may lead to neurosis, weakening of the connective tissue and/or scar tissue buildup and fat pad damage.

If you are a runner, I would recommend making stretching and rolling a top priority and try adding yoga and Pilates to your routine. Yoga provides all around stretching and strengthening. It helps our core by involving movements that are not always linear and follow one plane of movement (sagittal), but instead encourages multi-planar strengthening (frontal, sagittal, transverse) which we use in real life movement and which allows us to hurt less and play more.

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