What is Plantar Fasciitis?
Classically plantar fasciitis is described as pain along the bottom of the foot, typically worse on the inside, bottom of the arch, as well as extending into the heel, especially on that inside of the heel.
True plantar fasciitis is a breakdown of the connective tissue that supports the arch of the foot, either where it attaches at the heel or along the length of the arch of the foot. This plantar fasciitis supports the arch of the foot and transfers the strength of your calf from the heel into the forefoot & toes. If you're asking more of your foot than and what the plantar fascia can support, over time it starts to break down. Ultimately you can develop plantar fasciitis.
There are also other conditions that can cause pain through the heel & arch of the foot. Nerves that run along the inside of the arch can mimic plantar fasciitis when they get irritated. Some joint mobility issues along the middle of the foot or the back of the foot that can also refer pain into a similar area into the heel. These situations can sometimes be mistaken as plantar fasciitis, and the treatments for them would be completely different from true plantar fasciitis. In this article, however we're going to just focus on true plantar fasciitis: a condition where that connective tissue is broken down.
Causes of Plantar Fasciitis
Typically what starts the plantar fasciitis is a situation where your foot structures are being asked to do more work than they can stabilize. This can look like a situation where you're not walking or running very much. Then you suddenly increase the time or distance you’re on your feet, especially over too short a period of time. In this case, your foot & calf muscles and the plantar fascia have to stabilize your foot much more than they’re used to. That sudden increase in what you're doing in comparison to your baseline can trigger plantar fasciitis.
Changing shoe type can also trigger plantar fasciitis. A shoe helps to support the arch of the foot, as well as the heel bone, your calcaneus. If you're used to a very supportive shoe and you make a quick transition to less supportive shoes, you can trigger plantar fasciitis. For example, let’s say you typically wear Hoka or Brooks (more supportive shoes) when you’re doing yard work but it’s a beautiful spring day and you decide to wear sandals for a few hours of gardening. Your feet are used to the arch & heel support of the Hoka/Brooks shoes but your sandals do not have that same level of support. Suddenly your foot is in a position where it has to support itself to a much higher degree on uneven & soft ground. The connective tissue and the tendons in the bottom of the foot end up doing much more work than they typically do. That can trigger plantar fasciitis. If you’re going to change shoes, make sure to shift shoe type slowly.
Another factor that can contribute to the development of plantar fasciitis is chronic overuse or calf tightness. If you're overworking the plantar fascia a little bit each day and don’t give it a chance to recover, the plantar fascia can gradually breakdown resulting in plantar fasciitis. With chronically tight calf muscles, the extra tension transferred through the plantar foot can irritate the plantar fascia.
With time, the body can grow a bone spur from your calcaneus into the plantar fascia. This is essentially your body's attempt to lengthen and support the tight, weak connective fascia. As you treat your plantar fasciitis by loosening the calf & strengthening the calf/plantar fascia, typically the area around the bone spur will heal.
Reducing Plantar Fasciitis Pain
When it comes to fixing your plantar fasciitis, I made an entire video & article you can find here! In general though, the first priority is to make sure you're asking the foot to do the right amount of work. If you can’t give the foot a chance to rest, it is very difficult to get ahead of the pain.
We want to limit how much standing and walking you’re doing on the painful foot. Give it a break!
A supportive shoe or one with an over the counter or custom orthotic will allow you to walk & stand more while still resting your foot. They will provide additional support to your foot, allowing the plantar fascia to get a break.
It can take some time to find the ‘sweet spot’ of how much standing and walking you can tolerate, but it is worth it! Once you can calm down the severity of the pain, you can move onto fixing the foot.
Making Your Calf & Foot Flexible & Strong
We want to stretch the whole connective tissue system from the bottom of the foot into the calf & hamstring (back portion of the thigh). If your calf muscle is really tight, it will add extra tension into the plantar fascia and tend to irritate the weak connective tissue. Stretching your calves, the bottom of your foot and the hamstrings can temporarily decrease the severity of plantar fasciitis pain. It can be a helpful thing to do before first walking in the morning, after sitting at your desk, etc.
Along with stretching, it's really important to strengthen the calf and the connective tissue through the bottom of the foot. In physical therapy, we would assess where your specific weak points and design a strengthening program to address them. In general, we want to strengthen both the foot & calf muscles. The specifics of your strengthening program will vary based on your individual foot anatomy and weak points.
Physical Therapy Specific Treatments for Plantar Fasciitis
In physical therapy, we will assess your foot type, leg & foot strength and flexibility. Combining this with your specific goals, we will strategize a plan to get you moving at your best. This will include stretching & strengthening to fit your specific needs, shoe wear & taping as you need to support your foot and modalities to decrease your pain through the recovery process.
We do quite a bit of hands on treatment in your physical therapy sessions to decrease your pain and increase your tolerance to stretching & strengthening. Tool-assisted massages like ASTYM or instrument-assisted soft tissue mobilization help greatly in decreasing severity of pain and increasing calf & hamstring flexibility. Counter strain and general massage into the calf and the bottom of your foot can also help to improve your comfort with walking & exercising. The more you can calm the foot down, the better you can move and do the strengthening & stretching to fix your plantar fascitiis
To summarize, with plantar fasciitis it is an overuse issue where the connective tissue in the bottom of the foot & calf gets tight and weak. We want to manage how much you’re on your feet to allow the fascia to rest and calm down. Hands-on techniques and stretching can further decrease your pain, so you can tolerate the strengthening and getting back into your everyday routine.
We would be happy to help you with your plantar fasciitis! Give us a call at 503-245-5710 to get started!