What Is the plantar fascia?
The plantar fascia is a tough fibrous band of tissue that runs along the sole of the foot. It connects the heel to the ball of the foot. The role of the plantar fascia is to help to support the arch of the foot. It also plays an important role in walking as well as shock absorption. Over time the plantar fascia can lose some of its elasticity and can become irritated or inflamed with daily activities. The result is pain where the plantar fascia attaches to the heel. This pain is commonly known as plantar fasciitis.
According to the American Physical Therapy Association at www.choosept.com this condition affects approximately 2 million people per year. Despite the common nature of this condition, it can be difficult to treat. This is because the pain and inflammation are usually the result of many contributing factors. Just because the pain is in the foot does not mean that’s where the full cause of the problem lies.
Stretching has a place
A common treatment method focuses on stretching the plantar fascia. Often this is done with a night splint, a strap, even a tennis or golf ball to the bottom of the foot. This approach is helpful for most people, but for others it is not enough to have relief. For others additional areas need to be assessed due to the multiple factors that can be causing the pain. Going beyond a stretching program to address problem areas all the way up to the hip can improve long term symptom relief. Let’s take a look at some of the other factors that may be contributing to plantar fasciitis.
Disclaimer: this blog is for entertainment purposes only. This is not medical advice. You should consult with your physician or physical therapist to discuss specific concerns prior to starting any exercise program.
Beyond Stretching
A commonly overlooked source of increased strain to the plantar fascia comes from the calf. Tight and weak calf muscles will be less efficient when you walk. Weakness of these muscles will result in changes to the muscle fibers making them shorter and less elastic. In addition this will increase the force to the back of the heel (opposite the plantar fascia). The opposition creates a strain on the plantar fascia. When addressing plantar fasciitis it can be very painful to stretch the plantar fascia directly. Addressing underlying issues in the calf is often more tolerable and very valuable.
In addition to calf stretching, strengthening is a key component to decreasing strain on the plantar fascia. Specifically, weight bearing eccentric strengthening. This type of strength training promotes tissue remodeling. This remodeling can improve tendon and muscle health. The downside is the results are not quick. It will take several months of compliance for true remodeling to occur; however, pain reduction is usually seen sooner.
Additionally, foot strengthening and balance training play a role in recovery. The foot muscles support your arch. If these muscles are weak and the ankle does not have good balance strategies the result will be extra strain through the plantar fascia. This can result in overuse and inflammation at the plantar fascia where it attaches to the heel. Single leg activities can be very challenging for some people with balance difficulties. It is recommended that you see a physical therapist for an evaluation to determine which, if any, balance activities are safe and appropriate for you.
Hip strength
Another overlooked area is lateral hip weakness. The lateral hip muscles, most specifically the gluteus medius, play a key role in keeping your hips level when you walk. Weakness in these muscles is often seen as a Trendelenburg or “waddle”. The hip drop results in extra force on the inside of your knee and then further down into the foot and ankle. The collapse of the foot to the inside is known as pes planus. This position does not necessarily cause plantar fasciitis, however, it is a risk factor. This position will change the biomechanics and shock absorption through the foot. Strengthening the lateral hip muscles will help stabilize the hip and core. The result is improved biomechanics throughout the leg and decreased plantar fascial irritation.
The Importance of shoes
Finally, there are external factors that contribute to plantar fasciitis. Most common is shoe gear. Either wearing the incorrect shoe for your foot type or not replacing your shoes frequently enough. Good shoes are typically expensive. I understand the desire to want to get the most wear of out them that you can. However, this often results in wearing the shoes when they are no longer supportive. The cushion and stability feature of the shoe will often break down before noticeable wear and tear on the outside or sole of the shoe.
Finding the correct shoe type for you foot can also be challenging as there truly is not a “one size fits all” best shoe. My answer to the question “what is the best shoe?” is ” whichever shoe is the best fit for your foot”. Your local running store will be able to assess which shoe is the right fit and they are a wonderful resource for information. Locally, Fleet Feet in Pepper Pike has a wide variety of shoe styles and a very knowledgeable staff. You can find more information here https://www.fleetfeet.com/s/cleveland/in-store-fitting-appointments ( I do not receive any payment or incentive from Fleet Feet). I fully understand that shoes are expensive and can be or feel cost prohibitive, however I stress their importance as they are the only thing between your foot and the ground.
Plantar Fasciitis can be complicated and difficult to treat. Physical therapy may be able to help. Please see a physician or physical therapist to discuss which treatment options are best for you.
About the author
Danielle Jolliff is a licensed physical therapist in Solon, Ohio. She owns Stay Mobile Physical Therapy LLC, a mobile outpatient physical therapy practice that provides outpatient physical therapy in the comfort and convenience of your home. Contact her today:
danielle@staymobilept.com
(440)-462-9370
