PLANTAR FASCIITIS

Ouch!  Even the term Plantar Fascitis will bring a cringe to anyone that has ever suffered from this issue. Competitive Runners world-wide run in fear at the whammy of this injury that has been known to sideline runners for months. Rest assured, this issue is treatable and if you are willing to put your time into some basic and at home rehab and exercises you can speed the healing of this issue up considerably. This is a condition we see in the office a lot and have had good success with it, but it is not usually a “quick fix” issue where one treatment makes a huge difference.  You need to understand the issue if you want to fix it and you really need to understand the rules of treatment and know what you are trying to accomplish. This issue as much as any other condition we see is OVERLOADED with mis-information.

 

At the heart of the problem with treatment of PF is the name itself – collectively, Fascitis (as well as any –itis) has multiple, different issues that are collectively called Plantar Fascitis – see the picture above and how large of a tendon, fascia and muscle we’re dealing with?  Technically, almost any issue to this area with cause inflammation of some sore (itis) and now you’ve got a diagnosis. This problem with this is that 20 different issues are all called the same thing, and 20 different injuries need different treatments if they are going to be successful. That’s why at Armadillo Sport Chiropractic we tend to dive deeper than just the diagnosis of Plantar Fascitis.  We want to know what is happening that is screwing up the function of the foot… IE: “what is causing the –itis?”

 

It’s not that your friends, magazines, therapists OR hear-say is wrong – it’s just not specific – its giving you general information and you may not have the exact same condition, it’s just called the same thing!

 

So if you’re looking for, “Doc, what exactly do I have to do to fix this?” I can’t help you on this brochure – it’s going to take a little trial treatment and a lot of homework to get us to the right protocol for you. We will however give you some basic ideas that seem to really help out the healing time and speed up recovery – at ASC we want you BACK IN THE GAME or ON THE ROAD OR TRAIL QUICKLY!

 

OK, so let’s dive in.  In almost all causes of PF it’s not so much the pain, but the lack of proper function of the foot that is a major obstacle in the recovery of the issue. Get the Function back to the foot and you tend to get results faster.  That’s why you won’t hear us push orthotics, braces and long term rest as part of our treatment protocol.   We’re not saying there isn’t a place for these but our theory at ASC really pushes function and mobility as the key component to recovery.  Let’s face it; Function and mobility need to be present before proper stability and healing can occur. Let me repeat that, Function and mobility need to be present before proper stability and healing can occur. Read it again and memorize it…that’s what our in clinic and at home rehab focuses on.

 

The 5 ASC rules of at home treatment

Ice – I prefer a frozen water bottle so you can strip out the fascia at the same time. This needs to be done DAILY. And keep working it until numb, usually 8-10 minutes. Work the fascia out with the ridges and contours of the bottle. You will get to the stage you might not need to do this, but you can’t go wrong here – if the foot is inflamed you need help putting the fire out! Don’t use flip flops while there is pain.  Look, flip flops aren’t great. They make your big toe move incorrectly and then the foot is screwed up. I get it though, we live on the coast, they are practical and a common part of our days- people just won’t give them up.  They also force the foot to bend as one piece at the push off phase and this limits motion and rotation. This keeps the function of the foot less than optimal.  Keep the flip flops if you have to but save them for when your foot is fixed. Limit your orthotics – this is where I get the most resistance in my office – these things are expensive, most likely ordered from a pro and you like them – I get it. But, the built up arch supports limit full ROM.  This really helps with pain initially but keeps perfect and proper motion while trying to fix the issue. Same reason I’m not a huge fan of the slings and braces - I want motion! There are a few main arches in the foot and we want them mobile and functional, not limited! If you guys are in love with these things, keep them with you but try hours on and off and see what works better. Remember these are general rules of rehab, not laws and absolutes, everyone is different, but this seems to work in our clinic much faster than staying in them 24/7.

 

ABC’s with your foot – Especially first thing in the morning –first two steps hurt? Get back into bed and put your foot through a full alphabet of movement. This isn’t a fix but at least you put the foot through all kinds of great ROM and it helps move the tendons, bones and fascia. This usually at least gives notable relief on the first agonizing steps out of bed. Force foot motion – Really exaggerate your step and the roll from the heel to the toes.  I tell clients, start on the outside of your heel, really roll your foot and force a push off with your big toe, not all the toes at the same time – this will take practice – if you’re in pain, I will bet you can’t do this correctly.  Usually ten steps in a row a few times a day and you’ll notice a ‘release’ and freedom of motion in the arch. Using the therapy balls – use motion in all planes – look again at the picture of the foot and the different arches. Think of the inside of the foot, navicular bone specifically and the outside of the foot, the 5th metacarpal and cuboid bones. 

 

Follow these steps: (with ball) Barefoot is best as these specific balls (TAK BALLS) have some grip and work the fascia better than a Lacrosse ball or tennis ball.

  1. Roll the ball from the front to the back – the length of the foot (not back to front however)

  2. Heel down, toes up – pivot shift side to side on transverse arch

  3. Inside of arch (navicular) – Smash and Shimmy then extend foot and toes

  4. Outside Mid Foot  - Smash and Shimmy then extend foot and toes

  5. Ball of Foot – Clamp Down and squeeze ball

  6. Separate Four toes and Big toes – separate squeezing

  7. Heels Down, Toes up- pivot and shift on ball of foot

  8. Using your hands – work the toes, foot  - knead and separate

 

This is at least a 5-10 minute process – work it, love it – Get your feet back

Usually there are other issues such as low back, hip rotation issues, calf and anterior tibia strength ratio issues and others. If you need help with this, use us, that’s what we do. See how the heel bone (the calcaneus) is the attachment for both the plantar fascia as well as the Achilles. It’s almost impossible to just have one single issue with this condition. Just like everywhere in the body, one thing leads to the next. There is a systematic and bigger approach to fixing this condition than just attacking where it hurts. We say in the office all the time, “The victims scream, but the Culprits hide!”  We want to go a little larger in our search for the culprit and correct any factors that affect the area of pain. We will look at all these things when you come in and we will really get specific on fascia release, joint mobility and function and typically we will work with you 5-6x through a month of treatment but the majority of this condition takes homework. Stay with this condition, we’ll work with you and get back into your routine! 

 

Remember that 20 different issues are all called the same thing they are all PF and these 20 different injuries need different treatments if they are going to be successful.