The “Plantar fascia” is a fibrous band running from the under surface of your heel to the ball of your foot. “Plantar fasciitis” is a painful inflammation of this tissue caused by chronic over stretching and mild tearing.
Plantar fasciitis is commonly associated with fallen arches of the foot. To understand how this happens, cup your hand to make a “C” shape. This represents a foot wit
h a high arch. Imagine a band running from your fingertips to your wrist. This represents the plantar fascia. Now, straighten your fingers to simulate what happens when the arch “falls.” When this happens in your foot, the plantar fascia is stretched and can begin to tear away from your heel.
Plantar fasciitis affects 10% of the population and is more common in women. Approximately one fourth of patients have the problem in both feet at the same time. People who place excessive stress on their feet by being overweight, standing for long periods, or participating in endurance sports are more likely to develop the condition as well. Shoes without adequate arch supports, including sandals or going barefoot, increase your chances of developing plantar fasciitis. Wearing high-heeled shoes or boots may contribute to the problem.
The most common symptom of plantar fasciitis is pain in the heel or arch when standing up after a period of inactivity, particularly first thing in the morning. When you are sleeping, the arch is in a relaxed or shortened state, and the plantar fascia is able to heal. When you stand up first thing in the morning, you stretch the fascia, once again tearing it away from its attachment on the heel. The condition may progress to the point that you experience pain throughout the day, even while resting. The pain often eases after you walk for a period of time, only to redevelop. You may notice some tenderness when you touch your heel, and you probably have tight calf and hamstring muscles as well.
Plantar fasciitis can be a frustrating condition, often lasting 18 months or more if left untreated. Fortunately, you may recover more quickly with proper treatment. One of the most important things that you can do is to make sure that you are wearing shoes with good arch supports on a consistent basis. A period of rest may be necessary to help you recover. Runners may need to temporarily decrease mileage or switch to less stressful activities like swimming, cycling, or using an elliptical machine. A splint or “Strassburg sock” worn at night will help to keep your plantar fascia in a stretched position while it is healing.
Here is a brief description of the treatments we may use to help manage your problem.
Your chiropractor has found joints in your body that are not moving freely. This can cause tightness and discomfort and can accelerate unwanted degeneration i.e. arthritis. Your chiropractor will apply a gentle force with their hands, or with hand held instruments, in order to restore motion to any “restricted” joints. Sometimes a specialized table will be used to assist with these safe and effective “adjustments”. Joint manipulation improves flexibility, relieves pain and helps maintain healthy joints.
We may apply electrotherapy modalities that produce light electrical pulses transmitted through electrodes placed over your specific sites of concern. These comfortable modalities work to decrease your pain, limit inflammation and ease muscle spasm. Hot or cold packs are often used in conjunction, to enhance the effect of these modalities. Another available option is therapeutic ultrasound. Ultrasound pushes sound vibrations into tissues. When these vibrations reach your deep tissues, heat develops and unwanted waste products are dispersed.
Overworked muscles often become tight and develop knots or “trigger points”. Chronic tightness produces inflammation and swelling that ultimately leads to the formation of “adhesions” between tissues. Your chiropractor will apply pressure with their hands, or with specialized tools, in order to release muscle tightness and soft-tissue adhesions. This will help to improve your circulation, relieve pain and restore flexibility.
Muscle tightness or weakness causes discomfort and alters normal joint function, leading to additional problems. Your chiropractor will target tight or weak muscles with specific therapeutic stretching and strengthening to help increase tissue flexibility, build strength, and ease pain. Healthy, strong, and flexible muscles may help prevent re-injury.
Fallen arches and faulty foot mechanics are common problems that can perpetuate your condition. Our office will carefully evaluate your feet and consider the need for a change in shoe style, arch supports or even custom orthotics.
Our office may recommend using a support brace to protect your ankle from further injury. Your doctor will discuss the specific type of brace and provide instructions for use.
After this initial course of treatment we will reassess your progress. We will determine the need for any additional care after your reassessment.
Your mattress and the position you sleep in may affect your condition.
✓ Choose a mattress that provides medium or firm support, such as a traditional coil spring or adjustable airbed. Avoid waterbeds, thick pillow tops and soft, sagging mattresses.
✓ Always sleep on your back with a pillow either underneath your knees or on your side with a pillow between your knees. Avoid sleeping on your stomach.
✓ Keep your neck and back covered while sleeping to avoid drafts that could cause potential muscle spasms.
Ergonomics is the science of adjusting your workstation to minimize strain in the following ways:
✓ Maintain proper body position and alignment while sitting at your desk - Hips, knees and elbows at 90 degrees, shoulders relaxed, feet flat on floor or footrest.
✓ Wrists should not be bent while at the keyboard. Forearms and wrists should not be leaning on a hard edge.
✓ Use audio equipment that keeps you from bending your neck (i.e., Bluetooth, speakerphones, headsets).
✓ Monitors should be visible without leaning or straining and the top line of type should be 15 degrees below eye level.
✓ Use a lumber roll for lower back support.
✓ Avoid sitting on anything that would create an imbalance or uneven pressure (like your wallet).
✓ Take a 10-second break every 20 minutes: Micro activities include: standing, walking, or moving your head in a “plus sign” fashion.
✓ Periodically, perform the “Brugger relief position” -Position your body at the chair’s edge, feet pointed outward. Weight should be on your legs and your abdomen should be relaxed. Tilt your pelvis forward, lift your sternum, arch your back, drop your arms, and roll out your palms while squeezing your shoulders together. Take a few deep cleansing breaths.
To avoid extra stress on your spine while standing:
✓ Avoid high-heeled shoes or boots
✓ Use a footrest measuring 10% of your height
✓ To decrease stress on your back and feet consider leaning on a tall chair.
✓ If excessive standing can’t be avoided, consider shock-absorbent shoes or an anti-fatigue mat.
✓ When transitioning from a sitting workstation to a standing desk, begin gradually by standing 20 minutes per hour and not necessarily in a continuous period. Add an extra 10 minutes per hour each day as long as there is no prolonged stiffness or discomfort.
Improperly supported feet can affect the alignment of all of the structures above. To improve your overall comfort:
✓ Choose shoes with good arch support.
✓ Avoid going barefoot or wearing shoes that lack support (i.e. flip-flops). The following brands of sandals provide better than average arch support: Naot, Fit Flops, Orthoheels, Abeo, Vionic and Yellow box.
✓ Avoid high-heeled shoes or boots (keep heels to a maximum of 1½ inches, especially if you are going to be doing a lot of walking).
✓ “Cross-trainer” athletic shoes tend to provide the best all around support and shock absorption for daily activities.
✓ Patients with fallen arches should consider adding arch supports or orthotics.
✓ Repair or replace shoes with worn soles or heels.
Running shoes need to be replaced every 250 miles. There are three basic options:
✓ Motion Control Shoes – Designed for people with low or no arches, these shoes are for runners who strike the ground on the outer edge of their foot. Avoid overly stiff shoes as these decrease you perception of ground strike and lead to new injuries.
✓ Stability or Neutral Shoes – Designed for people with normal or average arches and running mechanics. The shoe contains some cushioning to absorb shock and prevent injuries and some rigidity to avoid pronation.
✓ Cushioned Shoes – Designed for people with high arched feet. Their footprint will typically leave a thin band along the foot’s edge. As they run weight is distributed from heel strike to the outer edge of the foot and small toes that bear the brunt of “lift off.” This shoe is more flexible and absorbs the shock created by the lack or rotation (under-pronation) created by their running style.
Exercise- Water Aerobics
“Water Aerobics” simply means that you are exercising in the pool. Water exercise adds resistance but reduces the effect of gravity, and is usually less stressful on your joints. Water Aerobics are better tolerated by people who have joint problems like arthritis.
✓ You do not need to be a swimmer to exercise in the water - most classes are held in chest-deep pools. Check with your gym or local YMCA to inquire about classes.
✓ Working out in a group class can help with motivation.
✓ As with all aerobic exercise, you should start gradually and don’t exceed the “talk test”- meaning you are still able to talk while exercising.
Sports creams come in a variety of styles that produce either a sensation of heat or cold. These creams do not speed healing, but may provide temporary relief. Their effect is to pleasantly irritate the skin by stimulating the highly sensitive surface nerves, so that your brain can temporarily "forget" about your underlying deeper pain.
✓ Sports creams have no known side-effects when applied in small amounts but do not apply more than a 2-3 of times per day unless otherwise directed.