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Improving Plantar Fasciitis

September 21, 2011 Category: Guest Posts, Injury Prevention Tags: , .

Every now and then, I get people with a wild-hair who want to write a guest blog for the site.

Strangely enough, it doesn’t happen all that often, but if the person is serious about getting better and has a unique piece, I’m all ears.

Here’s a nice guest blog from Adam Rees on plantar fasciitis. I think Adam does a wonderful job of examining the local structures that influence plantar fasciitis, and it looks a lot like what I would do with someone that came to me.

If I could add one thing, it would be to make sure you evaluate the core/torso and hips for instability as well. In my single-leg training video, I discussed how instability in the hip can lead to an assortment of lower extremity injuries, just one of which is plantar fasciitis.

A lot of the lower extremity issues we see are the result of dysfunction up the kinetic chain, and I just want you to be aware of that going in.

And with that being said, I’ll turn this over to Adam!

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Plantar fasciitis is an interesting problem.

For as simple as the remedy is, in most cases, it still plagues two million people per year and it’s estimated that 10% of the population will accrue some type of symptoms during the course of their life. (This statistic is from Wikipedia so who knows!)

Regardless, I’d bet that 99% of people in the US know at least 1 person with plantar fascia problems, which means a lot of people.

Anything with “itis” in the name is referring to inflammation, and inflammation has many causes. In this case it’s occurring in the fascia surrounding the tissues in the bottom of our feet because we’re beating the hell out of them!

Inflammation occurs to bring more blood to help expedite recovery, but scar tissue has set in and more blood just means more blood, not more healing. That’s part of the reason surgery works; surgeons cut open the scar tissue so blood can come in and heal.

What we’re looking to do here is take care of the tissues on the arch and bottom portion of your foot so you can function normally without missing anything and without surgery. In so doing we’re also going to attack surrounding tissues and actions up the chain. Curing this problem actually has little to do with working on the tissues that are in pain.

Let’s start with a little anatomy to get you started.

Motions of the Ankle

Dorsiflexion is pointing your toes up towards your head. This is most likely an area where we are inadequate, and needs improvement.

Plantar flexion is the opposite. It’s when you point your toes down towards the ground or away from your head. The muscles that create this movement are probably too short.

The plantar flexors include:

  • Gastrocnemius,
  • Soleus,
  • Flexor Digitorum Longus,
  • Flexor Halicus Longus,
  • Peroneus Longus,
  • Peroneus Halicus,
  • Plantaris, and
  • Tibialis Posterior

An interesting point with plantar fasciitis is that it is not due to weakness in the muscles that perform dorsiflexion. Almost every time it’s due to tightness in the muscles that perform the opposing action (although this is not all too uncommon with issues like this, I’m still geek enough to think it’s cool).

Personally I feel simple is best and people usually remember 1 or 2 things and move from there, but it wouldn’t be me to not push it a little. I tried keeping it as simple as possible with a list of 4 steps that could keep your ass out of surgery.

It’s worth a try, but you gotta actually do them…EVERYDAY.

Four Things to Focus on to Decrease Plantar Fasciitis Pain

Here are the four things we’re going to focus on in this article:

  1. Soft tissue quality
  2. Ankle Mobility
  3. Strength
  4. Footwear

Soft Tissue Quality (should be done first)

  • Tennis/Lacrosse ball under foot and calf
  • Stick for calf: gastroc, soleus, and peroneals

This isn’t a hard concept – take a few seconds a day and roll out the bottom of your feet and calves.

Releasing tension in your lower leg relieves tension up the chain as well, leading to decreased stress and/or discomfort whether you noticed it or not.

According to Thomas Myers, author of Anatomy Trains:

The plantar fascia of the foot is often a source of trouble that communicates up through the rest of the line. Limitation here often correlates w/ tight hamstrings, lumbar lordosis, and resistant hyperextension in the upper cervicals.”

Who knew that all those steps you take each day could have a role in a headache, neck, lower back, or hamstring issue?

However, soft tissue work by itself is usually not enough. There are reasons beyond this that have a hand in the inflamed area.

Mobility Work

  • Prone calf stretch
  • Standing wall ankle mobilization

Performing either of these for one set of 12, 3-6x/day will go a long way in relieving plantar fasciitis symptoms.

  • Ankle mobility w/ band

Perform this 1-3x/day for 1-2 minutes each way will do wonders as well.

Strength

EQI Lunge (eccentric quasi isometrics)

We’re working multiple things while performing EQI’s:

  • Eccentric strength in order to absorb force better so our foot takes less of a beating,
  • body positioning,
  • flexibility through our hips,
  • proprioception of our foot on the ground,
  • balance, etc.

Start by going for 30 seconds per leg and build up to 2 minutes. If you can hit 2 minutes the first time:

A) You’re pretty good, and

B) Add some weight!

There is nothing wrong with multiple sets either. If you can only hit 10 seconds per side the first day, do 3 sets, alternating legs.

If I were to add EQI’s to an already existing program, I’d reserve them for the end of the workout, or do them completely outside of training times. For instance, first thing in the morning.

Here is more information on EQI’s, in case you’re interested.

A Better Way to Stretch

Footwear

Let’s make this incredibly simple, lumping shoes into two categories: Good and Bad.

Good

  • New Balance Minimus
  • Nike Frees
  • Merrell Barefoot
  •  Vibram 5 fingers. (NOTE: These are NOT my top choice. They aren’t meant for concrete or hard surfaces, and they were originally designed for rock climbing)
  • Earth Shoes (also not my top choice, they look dumb as hell, and I don’t completely agree with a ‘negative’ heel)
  • Toms (these shoes are straight ninja)
  • I could even say Sperry’s, Chucks and certain sandals. However if you have serious problems these will probably need to wait a few weeks until your ankle mobility improves.

Not Good

  • High heels
  • Nike Shox
  • Any type of shoe with an elevated heel
  • Any type of shoe that is overly restrictive to natural movement. For instance oversized, heavy, high top basketball shoes.

And while it goes beyond the normal scope, I’d love to add NUTRITION to this list.

Plantar fasciitis is quite literally inflammation of the plantar fascia so if we can reduce overall inflammation within our diets, it would seem that, in turn, this would improve inflammation in our feet.

But we’ll leave that one for another day.

However, Anti-inflammatory foods would include:

  • Grass fed beef
  • Wild, cold water fish like salmon, mackerel, sardines
  • Kale
  • Broccoli
  • Spinach
  • Turmeric
  • Curry
  • Garlic
  • And Supplements like Fish oil and Vitamin D3.

That list could go on, but I had to add something.

For more information on the healing power of foods, be sure to check this article out:

Injuries: Nutrition and Recovery

Summary

This write up was inspired by my mom who went under the knife 10 years ago before I knew what I know now.

If you have plantar fascia problems take 1 month (even if it’s February) and commit yourself to using at least 3 of these methods every day. Obviously I don’t expect everyone to go buy new shoes, but give it a shot and see what happens.

If you’re still having trouble after that, go use that insurance you pay into every month and feed the man. But stave it off until you have to, and remember this:

Surgery is not a cure, it’s a quick fix.

About the Author

Adam Rees is Founder of GRIT GYM, a gym based on results, creating a culture and lifestyle of performance, strength, health and freedom to live life on your own terms.

Adam attended Wartburg College, worked under nationally recognized Strength Coach Matt McGettigan at ISU and is generally a whore to information and improvement in all forms.

Feel free to email w/ questions, criticism, skepticism and w/e else you deem necessary to [email protected] and/or visit his free blog at AdamRees.blogspot.com

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 (Lead Photo Courtesy of Bark)

 

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