If you’ve ever experienced plantar fasciitis, you know just how painful it can be. This condition is the most common cause of foot pain, and it can be absolutely debilitating. Many people report that it feels like they’re walking on broken glass… especially for the first few steps in the morning. Not a good way to start the day.
On top of the pain itself, plantar fasciitis can initiate a cascade of other detrimental, even dangerous, health effects. I’ve seen this downward spiral happen countless times… Foot pain makes it hard to exercise, or even just walk. If you don’t exercise, you’re likely to gain weight. The weight gain can of course lead to other problems, such as elevated blood pressure, high blood sugar, and even depression. Plantar fasciitis can be the beginning of a long and winding road toward illness. That’s why I treat plantar fasciitis aggressively… to try to keep my patients away from that dangerous downward spiral.
One thing that many people don’t know about plantar fasciitis is that its name is actually a misnomer. The suffix “itis” is applied to conditions that involve inflammation, but despite the “itis” in its name, plantar fasciitis is not an inflammatory condition. Instead, it’s a thickening, or scarification (also known as fibrosis) of the plantar fascia, the strip of tissue at the bottom of the foot. Understanding this condition explains why steroids and anti-inflammatory drugs do not often work… inflammation isn’t the issue.
My treatment plan for plantar fasciitis is threefold, and it involves:
1. Release techniques
2. Stretches
3. Strengthening exercises
Release techniques
In order to perform release techniques for plantar fasciitis, you first need to find your trigger points, which are like small “knots” within muscles. It is common to discover trigger points in the muscles of the lower leg and foot when you have this condition. Deep pressure on a trigger point will cause a “hurts so good” feeling and will often cause a little flutter or twitch when you press deeply. Releasing the tension in these tender points can provide significant relief.
To find and treat trigger points in this region, it is very useful to have a golf ball. You can also use a frozen lime, a frozen water bottle, a foam roller, or a rolling pin, but I find the golf ball to be a simple go-to.
When you encounter a trigger point, apply direct pressure, or short strokes, directly to the point with the golf ball for 10 to 20 seconds, then release for another 10 to 20 seconds. Each area should be treated for 2 to 3 minutes.
The target muscles are:
– Intrinsic muscles of the sole: These muscles are arranged in layers as they run from the heel toward the toe. They support the main arch of your foot. Sit on the side of your bed with the gold ball on the floor and press your foot into the ball as you explore the bottom of your foot looking for trigger points.
– Tibialis anterior: These are the muscles located just to the outside of your shin bone. You can find them with your hands, or the golf ball, by pressing into the muscle.
– Peroneals: These muscles are found on the outside of your lower leg. Treat them similarly to the tibialis anterior muscles.
– Gastrocnemius/Soleus: The trigger points in the two dominant calf muscles are best treated by sitting on the floor, and placing each leg on top of the golf ball. Find your trigger points, and put your other leg on top of the leg you are treating to add some extra weight.
Stretches
Plantar fascia stretch: This quick, simple stretch should be done every morning before getting out of bed, and anytime you’ve been off your feet for an hour or two.
– Cross the affected leg over your other leg in a “figure four” position.
– Using the hand on the affected side, pull all of your toes back towards your shin bone.
– Using the thumb of your opposite hand, gently massage the tender area in small circular motions for about 30 seconds.
Calf muscle stretches: To stretch your calves, focus on the two large muscles in the calf: the gastrocnemius muscle and the soleus muscle.
– To stretch your gastrocnemius, step up onto a stair with the ball of your foot, and allow your heel to hang down. Keep your knee in a straight and locked position. You can also do a “runner’s stretch,” with your hands against the wall, the affected leg straight back, knee locked, toes pointed towards the opposite heel. Hold each stretch for 3 seconds, then release and repeat 8 to 10 times.
– Soleus stretches are very similar to the gastrocnemius stretches, however, they require your knee to be bent. Stand facing a wall with both knees bent. Place the involved leg back and gently lean toward the wall. Deepen the bend at the knee while keeping your heel on the ground. Hold for 3 seconds and repeat 8 to 10 times.
Strengthening exercises
Part of the problem in plantar fasciitis is that the tissue itself has weakened and become unable to handle the job it is being asked to do. There is some evidence that adding a very specific exercise called “high load strength training” can help to reduce pain and improve function. Here is how it’s done:
– Stand on a step or stable surface several inches from the ground.
– Set the ball of the affected foot on the step with the heel hanging off of the back.
– Place a folded sock underneath your toes to lift them up off of the surface.
– Slowly lower your heel toward the floor. Be careful and take your time.
– Slowly raise up as high as you can onto your tippy toes. Hold this position for 2 seconds.
– Do 3 sets of 12 repetitions with a short break in between each set. Do this exercise every other day.
– After 2 weeks, you can consider adding some weight to this exercise by wearing a backpack with a few books inside.
I hope this helps you get back on your feet… it worked for me!
– Dr. Joshua Levitt
