Many people have to be on their feet throughout the day to do their jobs. You probably know or are someone that has complained of tired feet before. At times though, foot pain can be indicative of more than just worn out feet after a long day. One of the most confounding, painful, and immobilizing conditions of the feet is plantar fasciitis. This elusive condition can confound even the most experienced health-care provider. Hopefully I can help clear up some of the confusion. So what is plantar fasciitis? Let’s first take a look at where the plantar fascia is.
Where Is the Plantar Fascia and What Does It Do?
The foot and ankle complex biomechanically function to help lessen the effect of constant impacts over the course of the day on the structures of the foot. The longitudinal arch of the foot acts like an archway that spreads compressive loads across the base of the foot. The plantar fascia is similar to a spring, connected to both the heel and ball of the foot. So there is a lot of pressure put on the plantar fascia due to the body weight pulling on the two ends of it.
The plantar fascia is a narrow band at the anterior calcaneal attachment, but broadens under the arch and then splits into several attachment sites on the metacarpal joints. Extended periods of static load or increased tensile forces can cause chronic overload of the plantar fascia. Inflammation at the calcaneal attachment is thought to result.
Is Plantar Fasciitis Really Inflammation?
Plantar fasciitis has traditionally been treated as an inflammatory problem (“itis”), with the primary focus being the inflammation of the plantar fascia at the anterior calcaneus. But a better understanding of plantar fasciitis is beginning to emerge wherein, inflammation may not be as much of a problem as previously thought. There has been a paradigm shift in the understanding of tendon-overuse disorders in recent years. Research shows that tendon problems traditionally thought of as inflammatory (tendinitis; “itis” refers to inflammation) seems to be due to collagen degeneration instead (tendinosis, “osis” refers to disease of the tendon).
Is Plantar Fasciitis Caused Only by Issues in the Foot?
When it comes to foot pain, there are now two ways to look at the cause.
It is suspected that the main problem in plantar fasciitis is two-fold: biomechanical dysfunction in the structures of the foot—coupled with footwear impeding or altering the natural function of the foot. This can then lead to a host of other exacerbating problems: improper circulation, chronic tissue overload, resulting in degenerative processes that then produces pain in the bottom (plantar) portion of the foot and plantar fasciosis (heel pain).
The points about footwear are well taken. One of the test you can do to compare how well your foot fits your shoe is to pull the insole out of your shoe and stand barefoot on it. I think you will find that much the natural foot simply does not fit today’s narrow styles, even in athletic footwear. Of course, years ago there were more options for narrow, medium, and wide shoes.
Benny Vaughn is an athletic trainer and massage therapist who has worked with a diverse abundance of sports professionals for 40 years. He points to problems along the entire chain of the vastly complex fascial connections of the lower body that he believes also lead to plantar fasciitis. What is apparent to Vaughn is that the condition is not confined to the bottom surface of the foot and calf. Many physical therapists and chiropractic physicians are finding that adhesions present in the fascial planes of the body lead to pathological problems and altered biomechanics resulting in a myriad of fascia related problems: plantar fasciitis, Carpal Tunnel syndrome, back pain, neck pain, iliotibial band syndrome, this is just to name a few.
How Is Plantar Fasciitis Treated?
Often interventions and treatments such as physical therapy or simple stretching isn’t enough to address plantar fasciitis. While surgery is necessary at times to resolve the problems created by plantar fasciitis surgery isn’t always the best solution. In fact, often surgical intervention can result in long rehab times and at times the problem isn’t completely resolved even after surgery. I have found in my office that less invasive treatments often result in successes for plantar fasciitis and other fascia related problems. Treatments such as Active Release Technique (ART), Instrument Assisted Soft Tissue Manipulation (IASTM), deep tissue massage, etc. make sense because they do not have lengthy recovery time and have proven effective over time.
Treatments like those mentioned before are effective because there are fascial connections extending from the bottom surface of the foot through the posterior calf and thigh region that continue up the back and neck to the head. Thomas Myers identified these interconnections as the superficial back line and illustrates and describes these in his work “Anatomy Trains.” Tensile forces generated in tissues anywhere along this path can adversely affect the tensile load on the plantar fascia. Consequently, plantar fasciosis can routinely be linked to dysfunctional biomechanical patterns during gait, upper-body muscle tension from long static loads, or biomechanical imbalance in other portions of this kinetic chain.
Treatment Strategies for Plantar Fasciitis
Due to complex biomechanical relationships, it is important to keep in mind that no single intervention is likely to be effective on its own. A variety of treatment approaches is often most beneficial. Some treatments are more effective than others and some treatments do not work for everyone; treatment should be tailored to the specific needs of the patient.
I know this post is a little on the complex side compared to most of my others but hopefully this helps clear up what plantar fasciitis is. Regardless if your foot pain is due to inflammation or collagen degeneration and no matter what view you take, my advice is to find an expert like myself with experience in less invasive procedures to help you with this complex problem.