Plantar Fasciitis: A Real Pain in the Foot
Dr. Jared Gerston, DC
What is it?
Plantar fasciitis is a condition whereby the thick tissue on the bottom of the foot becomes strained and inflamed.
Often, pain is experienced at the heel. It is usually worse during the first few steps after rising from bed. The pain usually subsides after moving around, but returns if there is prolonged standing, or if strain is placed on the plantar fascia during exercise.
Who Gets Plantar Fasciitis?
Often considered an overuse injury, runners are susceptible to plantar fasciitis, as are hikers, dancers, or those who participate in aerobics or skipping. It is often associated to being overweight and middle age. Sometimes the shape of the foot can contribute to plantar fasciitis. Overly flat feet, and feet with a high arch can contribute to increased strain of the plantar fascia.
Soft tissue therapy, like massage and Active Release Techniques (ART®) can help to work out adhesions and scar tissue in the plantar fascia and in tight calves, as can Graston® technique. Graston® is a type of Instrument Assisted Soft Tissue Mobilization (IASTM) which utilizes a stainless steel tool to scrape the plantar fascia (or other tissue) in order to help break up any scar tissue or adhesions. IASTM helps restore proper mobility, and can aid in better healing. Acupuncture may be helpful, as might other modalities like ultrasound. The therapist might employ assisted stretching techniques to the calves, or may refer for orthotics to help correct foot mechanics. A home stretching and strengthening program is usually assigned. In tenacious cases, Shockwave therapy or even steroidal injections might be used.
Identifying the Cause
While the aforementioned techniques are effective, to enhance their effectiveness, it is beneficial to know if the plantar fascia is becoming tight or overworked for a reason.
It’s helpful to think in terms of movement patterns. Everything on the back side of the body is trying to arch backwards from the bottom of the foot (the plantar fascia) all the way up the calves, hamstrings, glutes/buttocks, low and mid back, neck, and continuing over the top of the head. If there is a deficiency anywhere along this chain, perhaps the plantar fascia (or calves, hamstrings, etc.) overwork to make up for that deficiency. Using Neurokinetic Therapy (NKT®), we can identify those compensation patterns, and use that information to guide treatment. For example, if the gluteus maximus, the largest muscle in the body, is not effectively extending the hip (pulling it backwards), the calves might take over to help make that motion happen. The overworking calves then place undue strain on the plantar fascia. Not only do the calves need to be released with massage and stretches, but the gluteus maximus must be strengthened so that the calves don’t get so tight again.
It’s also possible the plantar fascia is not directly compensating, but is just being taken along for a ride. In one example from my practice, a gluteus maximus muscle was overworking for a lazy low back muscle. This imbalance in the system created tension in the plantar fascia as a secondary compensation. In this case, we needed to relax the overworking glute with massage (ART®) and stretching, and strengthen the low back with specific exercises. In addition, we treated the inflamed plantar fascia directly with IASTM, ART and acupuncture. Interestingly, this case did not resolve until the glute/low back relationship was corrected. Once that occurred, the foot pain resolved very quickly.
If you’re experiencing plantar fasciitis symptoms, seek the advice of a healthcare professional. You can find a certified NKT® practitioner near you using this directory.
Dr. Jared Gerston is a chiropractor and the owner of Restore Chiropractic in Ottawa, Canada. He is an advanced (Level 3) NKT® practitioner. Read more about Dr. Jared on his profile page.