Plantar Fasciitis: Is It Really True Foot Pain or Coming From Somewhere Else?

Plantar fasciitis; what is it? The plantar fascia is a thick band of tissue that is found along the medial arch/plantar surface of both feet. It helps to support the arch during weight-bearing activities, like standing, walking, running. Sometimes this tissue can become inflamed and tender. Most patients who’ve experienced this state that it feels like “walking on broken glass” and it’s typically the worse first thing in the morning. 

Why first thing in the morning when we take those first few steps out of bed? You see healing occurs with sleeping. Also, when we are sleeping at night guess what’s not a factor that can make foot/arch pain worse? Gravity. During the healing process, the body lays down scar tissue/adhesions to help repair the micro-tears along the plantar fascia. Well, adhesions aren’t very “sturdy” if you will, meaning that the minute we bring gravity back into the picture and take those first steps, guess what? Pop goes the adhesions, further causing micro-tearing, inflammation, and pain. See the vicious cycle??

Signs/Symptoms:

• Pain first thing in the morning
  • Pain with weight-bearing activities such as walking/running/standing
• Pain around the heel and along the bottom of your feet
• Tightness in the calves
• Initial pain can feel like a bruise or an ache

Who is at increased risk??

• Runners
• Individuals that wear footwear with inadequate support
• Individuals who are overweight
• Foot mechanics unique to each person
• Occupations that keep you on your feet for long periods

So, how do we treat it? Well, if you read my last blog post, I spoke about the sacroiliac (SI) joint that joins both sides of the pelvis to the wedge-shaped sacral bone in the back. Once again, we have to look at the patient from a whole-body perspective. Back to the analogy I used involving a table with four legs, a stack of plates in the middle, and a bowling ball on top of the stack of plates. When all the table legs are the same length, there’s typically not an issue. What happens with one of the table legs is shorter/longer than the rest? Well, the table top has to shift against gravity, compensating to maintain that the bowling ball stays at the center of the table. 

“That’s great Dr. Mckenzie, but how the heck does this explain why my foot hurts so bad!?!?” Glad you asked! Going back to our analogy, that’s why it’s so important to maintain stability and level surface of your table top (your pelvis), which will keep your head over your center of mass (the sacrum), which will equally distribute your body weight plus gravity down both hips, both legs, and down to the floor. Make sense? So if you have instability in your pelvis/SI joints, it actually causes a leg length discrepancy, which is going to alter your walking mechanics throughout the day, further contributing to the pain in your foot. Sometimes you’ll see this problem with runners that habitually run on the road. What does the road have to do with it; paved roads are crowned in the middle, which helps with rain runoff. This uneven surface can also cause instability in the pelvis!! Which is why we always investigate this question: yes the pain in your foot is very real, but the root cause might be coming from somewhere else, reiterating the importance of looking at patients as a whole person, not just the symptoms!!

I’ll leave you with this last little tidbit of information: what constitutes a good shoe?? Here are a few little tips: 

• You want to look for something that has adequate arch support. In the shoe world this is known as a ‘pronation-controlled shoe’. Some examples would be Asics, Brooks, New Balance, and Mizunos to name a few. 
• Next, you want to see how “bendy” your shoe is: take off your shoe, hold it from heel to toe between your hands and give it a little twist. A good supportive shoe should have some “give” to it, but you shouldn’t be able to really twist it OR be able to fold it in half. A foldable shoe is a non-supportive shoe!

If you are living with plantar fasciitis, contact us today! We can help get you back on your feet and get plantar fasciitis out of your life!