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The Plantar Problem

OH MY ACHY FEET: Addressing the Plantar Problem

By Fortino Gonzalez, PT, Dip MDT, FAAOMPT, OCS

 

It seems like every other person with foot pain has plantar fasciitis, whether they have been diagnosed by a medical professional or self diagnosed. Plantar fasciitis is the second-most common reason why a person sees an orthopedic surgeon, according to the American Board of Orthopedic Surgeons. Plantar fasciitis, a pain disorder, can be a debilitating condition that results in pain in the heel and the bottom of the foot that is usually most intense in the frst few steps of the day, after prolonged sitting, or following a period of rest. In severe cases, pain may also be frequently brought on by prolonged walking or standing, especially at the end of a long work day on your feet.

Science Matters

By definiton, plantar “fasciitis” implies that there is inflammation in the plantar tissue; however, if you have had symptoms for more than 28 days, inflammatory cells are seldom found in this tissue/ tendon, according to world leading anatomists. The true condition is what we call plantar fasciosis. Fasciosis implies that the tissue is now healing and that scar tissue has formed and is continuing to form.

Even though leading therapists, physicians, and researchers are in agreement that this condition is the result of biomechanical issues, many people will often try to treat it with what we call the “bag of tricks.” Out of desperation, people often try massage, orthotics/insoles, trendy tapes (neon in color), ice bottle massage, rolling pin self-massage, or some special “deep penetrating” gel or ointment that claims to solve the world’s problems. To add to the confusion, if you go to the injection person, you get an injection. If you go to the orthotic/insole person, you get an orthotic. If you go to the surgeon, well, you get the point.

So what gives? Why does it hurt so much when I step out of bed in the morning? Why are the soles of my feet so tender to touch? Why is it that when I wear my favorite chanclas, my feet are “killing” me the next day?

The Leg Bone's Connected to the Foot Bone

Because of the way our body’s muscles are connected, a weakness in one muscle group affects the stresses placed on other tissues/muscles in ways that may surprise you. Biomechanical dysfunction is at the root of most plantar fasciitis pain but is often misunderstood. So, if this is the case, then this issue must be treated bio-mechanically. This problem is not only treatable with the proper diagnosis, education, and treatment. More importantly, it is preventable. With an understanding of how the foot and leg interact, you are empowered to make the right choices to build flexible, strong, happy calves and feet that support your whole body’s full range of locomotion.

Biomechanics of Locomotion

Your lower leg muscles are designed not only to propel you and create motion but also decelerate your movement by absorbing shock. The motion disorder that leads to heel pain is caused by tight and/or strong calf muscles with weak shin and/or foot muscles, which ends up creating a tug-of-war between these structures with the calcaneus/heel bone left in the middle. In this scenario, the stronger calf muscles overpower the smaller, weaker foot muscles, causing abnormal stress over the origin of the plantar fascia. At that point, it’s only a matter of time before the tissues break down, causing pain and inflammation, which lead to the scenario described above.

For more about how to treat and prevent plantar fasciitis/ fasciosis, click the image below to go to the McAllen Physical Therapy YouTube channel, where you will find a short video in which we demonstrate some simple exercises that may save your feet. If you have trouble with the image, you can also use this link: https://youtu.be/MeFmRnT4YdY

Demonstrating a stretch to help with plantar pain.

Fortino Gonzalez, PT, Dip MDT, FAAOMPT, OCS  

McAllen Physical Therapy