Plantar Fasciitis
Sore feet – many of us know the feeling after a hard day’s work on our feet or maybe a long hike. But if you have been suffering from a very particular type of foot pain that is localized in the arch or heel of the foot, you may be experiencing plantar fasciitis. Pronounced PLAN-tar fash-ee-EYE-tiss, this painful condition is very common for people who walk, run, hike, or stand on their feet all day. Plantar fasciitis is a repetitive strain injury that causes heel pain and arch pain, typically at its worst in the morning or after a similar period of rest. If you are suffering from pain in the front and bottom of the heel, it may be plantar fasciitis. The pain may also radiate through the entire bottom of the foot. Further, pain associated with plantar fasciitis can vary greatly. The pain may only last a few months, or it can be a chronic problem that lasts a lifetime. The pain might be a mild annoyance, or it could manifest as a debilitating condition that prevents you from walking. The condition can suddenly go away by itself, but it can reappear weeks or months later just as suddenly. It’s important to note that plantar fasciitis is distinct from heel spurs or flat feet, although the symptoms can be very similar. Traditionally, plantar fasciitis has been defined as an inflammation of the fascia (or aponeurosis) on the bottom of your foot. Your plantar fascia is a layer of tough, fibrous tissue that supports the arch of your foot. Your feet depend on this length of connective tissue for a lot, so it follows that your plantar fascia is one of the strongest ligaments in the body. While much of the information available recognizes inflammation as the main cause of plantar fasciitis, we will see that there are other possible explanations for the condition. Before you consider treatment options for plantar fasciitis, it’s essential that you get a proper evaluation of your symptoms and pain. At Ravenswood Chiropractic in Andersonville, our chiropractor can determine if you have plantar fasciitis or something else causing your heel pain. What are the Risk Factors for Plantar Fasciitis? But first, let’s take a look at some of the risk factors for developing plantar fasciitis. One of the primary risk factors for developing plantar fasciitis is prolonged, incorrect body mechanics placing abnormal and repetitive stress on joints, ligaments, and tendons somewhere in the kinetic chain leading up to your plantar fascia. Often when the body mechanics are corrected, the plantar fasciitis resolves. Many other things can make you vulnerable to developing plantar fasciitis, from your age to your occupation to a change in lifestyle or diet. Some of the other major risk factors include: Biomechanical Disadvantages such as: Wearing Poor Quality Shoes That: For a long time, plantar fasciitis was thought to be mostly caused by an inflammation of the fascia on your foot – imagine a sort of tendinitis like tennis elbow or carpal tunnel syndrome, but in your foot. And indeed, much of the information you will find about plantar fasciitis describes the condition something like this. However, it’s important to remember that the plantar fascia isn’t a tendon at all – like all fasica, it’s a flat piece of connective tissue that goes from heel to toes. So the fasica itself doesn’t become inflamed, or at least any inflammation isn’t the real problem. New research points to the real cause of plantar fasciitis as a degeneration and disorganization of the plantar fascia’s collagen. A study done by Lemont et. al. found that in 50 cases of plantar fasciitis, very little inflammation was observed. As the suffix “-itis” is used to describe inflammation, the study even challenged the name of the condition, stating that plantar fasciitis “is a degenerative fasciosis without inflammation, not a fasciitis.”i Other researchers have reported that the real issue isn’t inflammation at all, but instead actual tissue death happening in the plantar fascia that is “similar to the chronic necrosis of tendinosis.”ii Necrosis sounds much worse than inflammation, doesn’t it? Well, dying tissue might sound more alarming than inflammed tissue, but the point is to understand what plantar fasciitis truly is so you can understand the best treatment options. So now that we know what plantar fasciitis is, what is it not? Plantar fasciitis is not the same as a bone spur. A bone spur is a bony growth on the heel (also called a heel spur) that often occurs along with plantar fasciitis. You may have heard of others who have had to deal with bone spurs and thought “that must be awfully painful.” However, a bone spur isn’t quite as painful as it sounds. Many people have bone spurs without knowing it. One study found that the spur itself is rarely the source of pain.iii And while many people resort to surgery to remove what they think are painful bone spurs, study after study has confirmed that surgery is often unnecessary and ineffective at relieving plantar fasciitis pain.iv v So if surgery isn’t an effective option, what are some other treatment options? One of the best things you can do especially if your plantar fasciitis is chronic, recurrent or has failed to respond to other conservative care, is to get an examination by a chiropractor who is skilled in Functional Assessment to see if there are any biomechanical issues causing the stress. If stressors are identified, they can usually be easily addressed with chiropractic care and plantar fasciitis symptoms resolved. To help promote healing, our chiropractic physicians may use Radial Shockwave Therapy for chronic Plantar Fasciitis or Plantar Fasciitis that hasn’t responded to conservative care. Radial Shockwave Therapy uses pressure waves to stimulate blood flow and promote healing. Treatments last 5-10 minutes and are scheduled a week apart. At Ravenswood Chiropractic and Wellness Center we have found massage therapy especially helpful for treating the symptoms of plantar fasciitis. By incorporating myofascial release or deep tissue massage into your plantar fasciitis treatment routine, our team can focus directly on the tissue that is causing the pain. By focusing on the fascia itself, the Achilles heel, and even the calf muscles in the leg, deep tissue massage and myofasical release can relieve muscle tension and help to break up scar tissue and adhesions that can develop over time. Our expert team can help you decide if deep tissue massage or myofascial release is right for your plantar fasciitis treatment. Even after performing treatment in our office, our massage therapist can teach you self-massage techniques to do at home between visits to help you feel better faster. We have also seen much success using acupuncture and gua sha for the treatment of plantar fasciitis. To treat plantar fasciitis, our acupuncturist will most likely focus on a point located in the center of your heel known as Shimian M-LE-5. Electroacupuncture needles may be used in conjunction with standard acupuncture needles. Other acupuncture points along the kidney and bladder channels have also been shown to be effective in treating plantar fasciitis. Just as our massage therapy team would also focus on leg muscles to help plantar fasciitis symptoms, so too will our acupuncturist. Acupuncture points along the back of the calf muscles may also be targeted to help reduce strain on the plantar fascia. Finally, our acupuncturist may determine that targeting other channels that help balance the qi and blood flow to certain organs will help heal your foot arch pain. Ice is a natural pain reliever. You can help reduce pain by applying ice directly to the bottom of your foot. This treatment option can help alleviate foot arch pain, especially if it is brought on by a certain activity, such as running or walking. Try applying ice for five minutes after activities that tend to aggravate your plantar fasciitis symptoms. If you spend your days on your feet, it probably won’t be difficult to narrow down the activities that are causing the pain in the arch of your foot. One of the first modifications to consider are the activities that you must do every day, i.e. such as what you do at work. If it is feasible, discuss modifying your work activities with your supervisor. If you absolutely have to stand all day at your job, consider purchasing an anti-fatigue mat that will help reduce strain on your muscles. If your hobbies or exercise habits are causing your plantar fasciitis, consider modifying your schedule to spread out your runs or hikes. Maybe you could replace a run with a lower-impact exercise, such as time on an elliptical machine or rowing machine. Our chiropractor would be happy to review your daily routine with you and discuss ways for you to modify your activities to alleviate your plantar fasciitis symptoms. Custom orthotics can be your best friend in your struggle against plantar fasciitis if you have flat feet or fallen | falling arches or another biomechanical issue that makes you a good candidate. Custom orthotics work much differently than store bought inserts (which we typically do not recommend). When your arch drops, or begins to drop, the plantar fascia begins to tear away from your calcaneal (heel). Custom orthotics are specially fitted by our chiropractor in our office to your actual feet and are specially designed by the lab at Sole Supports (also used by professional athletic teams and Olympic athletes) to correct your arch as well as completely support it. This support results in reduced stress, halts the process, and allows it time to heal. Many of our patients who receive Sole Supports custom orthotics to correct biomechanical causes of their plantar fasciitis experience a 50-70% reduction of symptoms in 1 month, 70-90% at 2 months, and 90-100% at 3 months. On average it takes 6-18 months to recover from plantar fasciitis. Continued use of our custom orthotics often prevents recurrence of plantar fasciitis. Custom orthotics can be fitted into athletic or dress shoes and can be quickly switched from shoe to shoe. But in the meantime, if you are wearing low-quality shoes, one of the best things you can do for your plantar fasciitis today is to find a pair that at least provides you with proper arch support. Raised heels are also important: the heel pads in your shoes should be at least 1/2″ when compressed. Remember when we discussed how plantar fasciitis might not be a result of inflammation but of collagen degeneration or tissue necrosis? Any injured tissue needs the right nutrients to heal properly. The only way that injured tissue can get these nutrients is through your diet, so it is important to properly assess what you are eating to make sure you’re doing all you can to help your plantar fascia heal. Our functional medicine team can help you analyze your diet to make sure that you are eating the right kinds of proteins and fats to give your body what it needs to heal. We may also recommend incorporating things like arnica gel, a homeopathic application that has been used to alleviate plantar fasciitis pain and promote healing. Our team will help you determine what path is right for your treatment plan. We recognize that each case of plantar fasciitis is as unique as each person. The symptoms may present differently, and the underlying causes are likely to vary from one patient to another. But our team, is dedicated to building a treatment plan that works best for you, incorporating elements that may include chiropractic, massage, nutritional counseling, and acupuncture. It’s important for patients to continue with the recommended home treatments to help you see improvements sooner rather than later. Don’t put off treatment for your foot pain any longer. Call us today at 773.878.7330 to schedule an appointment so that our team can accurately assess your foot pain and start working on an individualized treatment plan for you. i Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am podiatr Med Assoc. 2003;93(3):234-7. ii Young CS, Rutherford DS, Niedfeldt MW. Treatment of Plantar Fasciitis. Am Fam Physician. 2001 Feb 1;63:467-74. iii Osborne HR, Breidahl WH, Allison GT. Critical differences in lateral X-rays with and without a diagnosis of plantar fasciitis. J Sci Med Sport. 2006 Jun;9(3):231-7. iv Onwuanyi ON. Calcaneal spurs and plantar heel pad pain. Foot. 2000;10. v Fishco WD, Goecker RM, Schwartz Rl. the instep plantar fasciotomy for chronic plantar fasciitis. A retrospective review. J Am Podiatr Med Assoc. 2000 Feb;90(2):66-9.Plantar Fasciitis
PLANTAR FASCIITIS
Chronic Foot Pain? Do You Have Plantar Fasciitis?
So What is Plantar Fasciitis?
Chiropractic for Plantar Fasciitis
Massage for Plantar Fasciitis
Acupuncture for Plantar Fasciitis
Ice Application
Lifestyle Modification
Better Shoes and Custom Orthotics
Supplements and Functional Medicine
When Will My Feet Feel Better?
