Plantar Fasciitis

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If you long for days when getting out of bed wasn't so tough on your feet, you may be suffering from plantar fasciitis.

Patients with plantar fasciitis often complain of such foot pain after standing up in the morning or after a long period of sitting. The pain originates just in front of the heel bone, but can spread over the entire bottom of the foot. Over time, inflammation associated with the condition can lead to the development of scar tissue, calcium deposits and eventually a heel spur, which is a bony growth that can cause a sharp stabbing pain every time people with the condition walk.

Plantar fasciitis often develops in people who have other foot conditions, especially pes planus (flat feet) and over-pronation. Flat feet are feet that have little or no arch, while over-pronation occurs when the foot rolls too far inward when people walk. Both of these conditions can cause excess stress on the plantar fascia and lead to a mild form of plantar fasciitis.

A number of factors can exacerbate plantar fasciitis in those with preexisting conditions, as well as cause plantar fasciitis by themselves. People who are constantly on their feet, such as nurses, teachers and waiters, are more susceptible, as are athletes who participate in foot-stressing activities such as aerobics, volleyball, running, basketball and tennis.

Many other factors also put excess stress on the feet and cause or contribute to plantar fasciitis. Sudden strenuous activity after a period of long-term inactivity, abnormal walking patterns, improper footwear, walking on hard or uneven surfaces, weak foot muscles, muscle imbalances and obesity are among the chief culprits.

The thing that unites these factors is that they overwork the plantar fascia, which is a band of connective tissue that surrounds the muscles on the bottom of the foot like plastic wrap. The plantar fascia runs from the heel to the forefoot, connecting the heel bone to the ball of the foot, supporting the arch, protecting the foot and absorbing shock. Any abnormal stress related to preexisting foot conditions or excess activity can strain the plantar fascia and lead to irritation, inflammation and severe pain.

Depending on which factors caused the condition, healthcare practitioners tend to care for plantar fasciitis with different techniques. And since everyone's case is unique, there is no specific timeline outlining when the foot will heal. Once your healthcare practitioner determines the underlying cause or causes, however, he or she will develop a management program that will quickly decrease inflammation, which is the first step to decreasing pain.

Anatomy

Your feet perform many complex functions. They support your body weight, absorb shock and work to balance and adjust your body to uneven surfaces.

A number of structures in the feet allow you to do this, and they're divided into three main areas: the forefoot, consisting of the toes and metatarsal bones; the mid foot, containing the tarsal bones and cuneiforms and the hind foot, composed of two bones, one of which is the calcaneus (heel bone).

The plantar fascia is a dense, flat material that runs under all these sections, from the front of the heel bone to the ball of the foot, just beneath and slightly down from the big toe. Like plastic wrap that tightly covers a sandwich and keeps it together, the plantar fascia covers the bottom of the foot and helps to protect it.

The plantar fascia's primary functions are to help support the arch of the foot and work with other structures to absorb shock and carry the body's weight. When we walk, it's normal for the arches of the feet to collapse slightly, but when we take weight off the feet we need the arches to return to their normal position. For this to occur, there needs to be some tension in the fascia and ligaments. This mechanism is similar to that of a trampoline. When you jump on a trampoline, the canvas stretches under the weight of your body and springs back to its original position once you're in the air. When the plantar fascia's working properly, it performs this shock absorbing function and helps protect the knees, hips, lower back and foot bones.

Problems arise when the plantar fascia is overworked and doesn't get a chance to rest. This can lead to excessive tension on the tissue, which can cause strain and micro tears. Overuse can lead to such problems, and that's why vigorous exercise, a sudden increase in activity, walking on hard or uneven surfaces, poor supporting shoes and obesity can lead to plantar fasciitis.

More commonly, the condition is associated with structural or functional problems in the way the feet work. Factors such as weak and inflexible foot muscles, muscle imbalances, abnormal foot functioning, improper walking patterns and decreased blood flow can adversely affect the feet. The most common causes of plantar fasciitis, however, as mentioned in the About section, are pes planus (flat feet) and over-pronation. Having flat feet means having diminished or nonexistent arches, which affects how the feet deal with shock, while over-pronation involves excessive inward foot rolling, which strains foot structures like the plantar fascia.

Over time, such strain forces the body to reinforce the plantar fascia with scar tissue, which can lead to another condition called a heel spur. Scar tissue is inflexible and causes an increase in tension, similar to what would happen if you coated a trampoline with paint. With increased tension, the plantar fascia isn't as slack and tugs on its anchor points with every step.

One of these anchor points is in the heel, and when the tense plantar fascia tugs on it, the anchor can start to loosen. The body then tries to secure it with calcium deposits. On the heel, these usually form in a thorn shape, and can cause pain similar to that you would feel when walking with a stone in your shoe.

Because plantar fasciitis is such a complicated condition, your chiropractor's first goal in caring for the condition is to determine what caused it and what problems it's causing. Following this, he or she will select from a number of options to alleviate pain and prevent the condition from returning.

Chiropractic Care

The plantar fascia is like a rubber band in many ways. It expands under tension and retracts to its original shape once the pressure eases. If, however, someone regularly stretches an elastic band beyond its capacity, the band will either break or lose its elasticity. This is similar to the plantar fascia, the only difference being that, unlike an elastic band, the plantar fascia will regain its form and function with proper care.

If you have plantar fasciitis, determining what care to provide will be your chiropractor's first goal. There are many different causes of the condition, so there are many management techniques that your chiropractor can use to help.

For starters, your chiropractor may recommend you use a cold application on the plantar fascia to reduce pain and inflammation throughout the rehabilitation process. A cold application, such as an ice pack, can reduce blood flow to the affected area, which will decrease inflammation, and numb pain receptors, which will reduce discomfort.

If problems with your feet have led to troubles in other parts of your body, your chiropractor may also need to perform an adjustment. An adjustment is a quick, strategic thrust with either the hands or a special tool called an activator that can help restore joint function and the health of surrounding tissues. Your chiropractor can perform this on dysfunctional joints in the foot, knee, hip and low back. When you walk, these joints must work together to allow you to move efficiently. When movement of any joint is altered, it can affect other joints that work with it.

To help you understand this process, think of your body as a long chain connected by links. If one of the links is broken than the other links can't provide the same stability that they did before. Your chiropractor can restore the links by applying a force or thrust to dysfunctional joints, shifting them back to their original placement, restoring their motion, relaxing tight surrounding muscles, increasing blood flow and decreasing inflammation.

Soft tissue therapy, such as muscular release technique, is also quite beneficial when rehabilitating a tense, scarred plantar fascia. As mentioned in the Anatomy section, when muscles in the foot become fatigued and weakened they can become strained. In order to keep them working, the body lays down new tissue quickly over the muscle to help reinforce it. This new tissue, however, is scar tissue, and doesn't have the same properties as original muscle tissue. Over time and with continued use, the muscle will become tight and painful and dysfunction will set in. By performing muscular release technique, your chiropractor can strip away scar tissue and allow healthy tissue to grow in its place.

Your chiropractor may also manage your plantar fasciitis with physiotherapeutic tools such as ultrasound and electrical therapies, which can help loosen a tense plantar fascia and promote healing. Ultrasound refers to any sound wave that has a frequency above the range the human ear can perceive. To produce these waves, chiropractors use a machine that channels electricity through a crystal located at the end of an applicator. The crystal vibrates in response to electricity, and the machine allows users to alter the electrical current to affect the waves' frequency. Depending on the frequency, this can increase blood flow, decrease pain, reduce muscle spasm, lessen nerve irritation, break down scar tissue and speed healing. Overall, the entire procedure is painless, and while some patients who receive therapeutic ultrasound report a warm, tingling sensation, others feel nothing at all.

Electrical therapies like interferential current (IFC) and transcutaneous electrical nerve stimulation (TENS) work in similar ways, but instead of sound waves, they send an electrical current through the body. Machines send these painless mild currents through the skin into nerve fibers below, which causes the body to produce endorphins, its natural painkillers. By aiming the impulses at stiff tissues in your foot, your chiropractor can cause endorphins to interrupt the flow of pain signals from the affected tissues to the brain. In addition, electrical therapies help decrease inflammation, which speeds up the healing process.

While all these modalities will help restore function in your feet, they won't be entirely effective unless you make lifestyle changes as well. If your occupation involves constantly standing, your chiropractor may recommend you purchase proper footwear that provides excellent support for your arches, space to breathe and thick soles. If you participate in a lot of activity that puts strain on the plantar fascia, proper footwear is also essential, and your chiropractor may even recommend that you look into lower-impact activities such as swimming or biking until the plantar fascia has had a chance to heal.

If you have flat feet, or over-pronate when you walk, your chiropractor may also suggest custom functional orthotics, which can help decrease the strain on your plantar fascias. Custom functional orthotics are shoe inserts which help to normalize abnormal foot motions. They cushion, support, align, and correct arches and structural problems, which promotes healing and helps prevent injury, deformity and the progression of foot conditions.

Lastly, excess body weight can contribute to a strained plantar fascia, so you may need to improve your diet and participate in regular exercise to decrease the strain on your feet.

Successful rehabilitation of plantar fasciitis will also involve a variety of exercises that will help decrease pain and fix the underlying problem. Your chiropractor will probably prescribe stretching and strengthening exercises focused on the plantar fascia and the surrounding structures that work with it. These exercises help break down scar tissue that has formed over healthy tissue, allowing new, healthy tissue to grow in its place.

Conservative care like this is usually effective. However, if your condition doesn't respond to these techniques, your chiropractor can refer you to a medical doctor, who may recommend cortisone injections to help reduce inflammation, casting to help immobilize the foot and allow it to heal or, in severe cases, surgery.

Regardless of the management you receive, it's best to follow your chiropractor's advice when trying to heal from or prevent plantar fasciitis. Many of the things you do or don't do contribute to the health of your feet, and once you realize what these are you can change bad habits and take a step in the right direction.

Plantar Fasciitis

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