10/13/09
Think On Your Feet - Plantar Fasciitis and Other Pains
I’ve recently answered a number of postings on sports medicine sites about plantar fasciitis and overall foot pain. This can be a very debilitating condition, and should be treated promptly if it occurs. It usually starts as a pain or ache near the front of the heel on the bottom of the foot. Typically it hurts the most in the morning, especially the day after a long or strenuous run workout.
Category: Your Body
Posted by: editor
The foot is often referred to as one of the most dynamic body parts ever created. It needs to transform itself from being a “loose bag of bones” to absorb the huge forces created during walking and running to an extremely rigid lever that propels the body forward throughout every stride. As such, it is placed under enormous stress throughout the day, especially you are someone who is cranking out the running and cycling workouts like the typical triathlete these days.
If the foot is not balanced throughout the stride, the dynamic forces placed upon it can accumulate quickly and cause an overload syndrome that ends up breaking down the connective tissue that supports the arch and controls pronation. A certain amount of pronation (the movement of the foot as pressures move obliquely from the outside of the heel on heel strike, to the big toe for toe off) is a good thing. However, too much pronation or pronation that happens too fast will cause a twisting force in the plantar fascia (that’s the strong connective tissue that runs from the front part of your heel forward into your toes and helps maintain your arch) and the small muscles on the bottom your foot.
It’s kind of like wringing out a washcloth – if you wring it out too vigorous too many times, chances are it will break down and you’ll soon need a new one. Unfortunately one can not purchase a new plantar fascia at any sports med shop that I know of!
The aforementioned torsional forces on the foot are not just the product of pronation in the foot. They are also created through excessive rotation in the hip. Weak hip muscles will allow the hip and knee to collapse inward quickly on every heel strike, and this forces the foot to pronate excessively as well. A mentor always told me, “Look to the hips if you want to fix the feet.” He couldn’t have been more right. The majority of treatment for plantar fasciitis needs to focus on addressing the causes of overpronation and abnormal hip biomechanics. An orthotic can be useful to artificially re-instate the arch and take the pressure off the plantar fascia.
If you haven’t changed your shoes lately, check how many miles you’ve done since the last pair of shoes was bought. Most shoes break down after 300 miles (or 480 kilometers) of training, depending on your weight and that they were new to begin with. Also check that the shoes fit properly and they are the right type of support for your foot. Some shoes today are designed to control foot motion while others are designed to allow for more foot motion. Being fit by a professional can make all the difference.
One other home treatment that is particularly effective is “golf ball therapy” - and I don’t mean working on your swing. Take a golf ball and put it by your bed. In the morning before you stand up on your feet (this part is critical), roll your foot on the golf ball from heel to toe for about 3 to 5 minutes, spending extra time on any tender spots. It’s critical to do this before standing up because the tissues of the foot will tend to contract and stiffen up during the night after the day’s stresses have accumulated. Therefore, the foot will “more arched” in the morning. Standing up on the foot flattens the arch and creates a large stretching force on the plantar fascia which, if already inflamed or injured, will be irritated again and the cycle will start over again.
Hip strengthening and balance exercises will also be helpful to promote increased rotational control in the hip and thereby any unnecessary stress from being transmitted through into the foot. Tight calves should also be addressed with consistent stretching to allow the ankle to move freely and avoid overloading the plantar fascia. This happens when the calves are tight because the foot will pronate to make up for motion that is limited by tight calves.
Of course, the regular anti-inflammatories and ice therapy should also be employed in combination with all of the above to give yourself the best chance of healing in the shortest amount of time.
Take care of your feet and they’ll take care of you!
Dr. Ryan Iverach - Vancouver, BC
http://www.ironguides.net
* * * Your best is our business.™ * * *
If the foot is not balanced throughout the stride, the dynamic forces placed upon it can accumulate quickly and cause an overload syndrome that ends up breaking down the connective tissue that supports the arch and controls pronation. A certain amount of pronation (the movement of the foot as pressures move obliquely from the outside of the heel on heel strike, to the big toe for toe off) is a good thing. However, too much pronation or pronation that happens too fast will cause a twisting force in the plantar fascia (that’s the strong connective tissue that runs from the front part of your heel forward into your toes and helps maintain your arch) and the small muscles on the bottom your foot.
It’s kind of like wringing out a washcloth – if you wring it out too vigorous too many times, chances are it will break down and you’ll soon need a new one. Unfortunately one can not purchase a new plantar fascia at any sports med shop that I know of!
The aforementioned torsional forces on the foot are not just the product of pronation in the foot. They are also created through excessive rotation in the hip. Weak hip muscles will allow the hip and knee to collapse inward quickly on every heel strike, and this forces the foot to pronate excessively as well. A mentor always told me, “Look to the hips if you want to fix the feet.” He couldn’t have been more right. The majority of treatment for plantar fasciitis needs to focus on addressing the causes of overpronation and abnormal hip biomechanics. An orthotic can be useful to artificially re-instate the arch and take the pressure off the plantar fascia.
If you haven’t changed your shoes lately, check how many miles you’ve done since the last pair of shoes was bought. Most shoes break down after 300 miles (or 480 kilometers) of training, depending on your weight and that they were new to begin with. Also check that the shoes fit properly and they are the right type of support for your foot. Some shoes today are designed to control foot motion while others are designed to allow for more foot motion. Being fit by a professional can make all the difference.
One other home treatment that is particularly effective is “golf ball therapy” - and I don’t mean working on your swing. Take a golf ball and put it by your bed. In the morning before you stand up on your feet (this part is critical), roll your foot on the golf ball from heel to toe for about 3 to 5 minutes, spending extra time on any tender spots. It’s critical to do this before standing up because the tissues of the foot will tend to contract and stiffen up during the night after the day’s stresses have accumulated. Therefore, the foot will “more arched” in the morning. Standing up on the foot flattens the arch and creates a large stretching force on the plantar fascia which, if already inflamed or injured, will be irritated again and the cycle will start over again.
Hip strengthening and balance exercises will also be helpful to promote increased rotational control in the hip and thereby any unnecessary stress from being transmitted through into the foot. Tight calves should also be addressed with consistent stretching to allow the ankle to move freely and avoid overloading the plantar fascia. This happens when the calves are tight because the foot will pronate to make up for motion that is limited by tight calves.
Of course, the regular anti-inflammatories and ice therapy should also be employed in combination with all of the above to give yourself the best chance of healing in the shortest amount of time.
Take care of your feet and they’ll take care of you!
Dr. Ryan Iverach - Vancouver, BC http://www.ironguides.net
* * * Your best is our business.™ * * *