Plantar Fasciitis – the REAL Cause

Uncategorized Aug 04, 2020

Plantar fasciitis is changing its name.  Unfortunately it’s not to something helpful like ‘agonising heel pain’, but plantar fasciosis.  This change – albeit still a tongue-twister – better describes what’s actually happening when someone suffers from this potentially very debilitating condition.  ‘Fasciitis’ meant that we thought the fascia was inflamed and therefore treatment was aimed at reducing inflammation, but this didn’t always work.  Some research showed not inflammation but actually microtears and necrosis of the tissues.  Necrosis is what happens when tissues don’t get enough blood flow and they start to ‘die’. 

The fascia of the foot is a thick band of tissue that runs along your sole.  It is so strong that it has been said that you can pick an entire body (granted, usually a dead one) with it.  That’s some strong flesh!  It helps create and maintain your arches, helps your foot absorb shock, and assists with normal foot function and gait when walking and running (assuming of course that we aren’t messing with our gait – see below).

Heel pain, particularly on standing up after resting or first thing in the morning are common symptoms.  “It’s like walking on glass” is one of the laments I hear on a regular basis.  It is incredibly painful and of course it means that there are a lot of things you’re not able to do – it’s not until your feet don’t work properly that you realise just how important they are.

The Cause(s)?

There are many theories surrounding the cause of PF.  The most common is that it’s an overloading or biomechanical issue.  That is you do something daft, like run 10 miles when you usually sit on the sofa and your feet get sore.  OR like one of my clients, she did a charity baking day with her friend and spent all day standing in her friend’s kitchen on a stone floor making cupcakes.  Her feet were decidedly grumpy about that decision and PF was the result. 

Being slightly more rotund than the average bear has also been cited as a contributing cause as excess weight in theory puts more strain on the sole of the foot. 

Over pronating and flat feet also get a mention – the theory being that both of these put a greater load on the fascia, but there is little in the way of research to back this up.

If, as the name suggests, Plantar Fasciosis is actually a reduction in blood flow – less blood flow means less oxygen to the tissues – then it would make sense to look at potential culprits that are squeezing quite literally, the life out of your feet.

Your Shoes

Whilst I love me a high (and I mean high, high) heel, I have, over the years, had to accept that footwear is indeed the devil and is likely to put many of us in an early grave.  I kid you not!  What you put on your feet matters.  It matters so much that I have no hesitation in stealing the phrase “foot coffin” from whoever coined it.  Your foot coffins can and do change how you walk, your posture, your foot function and therefore how your entire body interacts with its environment.

BUT dragging myself back to this blog post and how shoes can impact PF.  There are several shoe features which all have a detrimental affect on the foot and which can contribute towards various types of foot pain.  In no particular order then let’s delve in.

Heels from Hell

Most shoes – even those we would consider flat (a mean’s dress shoe or a trainer) have some kind of raised heel.  A heel in a shoe will do wonders for making your legs look longer and your butt look better, but the downside is shortened calf muscles, a major risk factor in PF.  It may seem like a strange thing to say but the more cushioning your shoe has the harder you’re likely to strike the ground (it is to do with the way your body senses the environment and what it’s walking over… another blog post).  Striking the ground harder with the heel is not going to be great for shifting the heel pain associated with PF.

Stiff Shoes = Cold Dead Feet

The stiffer and more supportive your shoe is the less movement your foot has to do.  The less movement your foot does, the less blood gets pumped through it.  Sure some gets through because of gravity and your heart doing it’s thang – you know this because your foot hasn’t gone black and dropped off … yet, but if you’re one of those people whose spouse refuses to get into bed with them at night because of the blocks of ice attached to your lower legs, then potentially that lack of circulation is contributing to the PF you’re experiencing.

Tight calves will also limit the blood flow to your feet and if your feet aren’t able to move then your calves have to work harder and therefore become stiffer… it’s a really painful vicious circle.

Blood flow is literally life to the tissues of your body.  Movement encourages blood flow to the tissues.  Those parts of you that aren’t moving regularly are literally being starved of oxygen and ‘dying’.  Movement really is LIFE

Ooh, I’m a little ray of sunshine in this blog post, aren’t I ? 😊

 Tootsie Twisting Toe Boxes

The toe box is the bit of your shoe that unsurprisingly your toes go in.  Have a look at it, you’ll probably see it narrows considerably towards the front of the shoe.  The ONLY reason for this is because we, as a culture, like a narrow-looking foot.  The shape of your foot should actually be widest at the toes.  The foot should splay as you land on it and recoil.  Having your toes wedged into a narrow shape not only contributes to bunions and bunionettes (yes, it really is a thing, it’s the movement of the little toe across towards the big toe),  but it probably now seems obvious that you’re adding to the compression and the lack of natural movement of the foot and therefore compromising blood flow blah, blah…

Springy Toe Boxes

If you look at your shoe sideways on, you’ll probably see that the toebox, discussed above, is actually angled upwards.  This is called toe spring.  When a shoe is inflexible and holds your foot essentially like a plank, then you need some way of walking without looking like… well, something whose feet don’t bend.

I won’t insult your intelligence by asking you what effect you think having your toes constantly held an inch off the ground might be having… needless to say it’s not good.  Oh go on then I’ll spell it out.  When you’re toes are pointing upwards you’re stretching the plantar fascia the whole time; the toes are supposed to contact the ground, ‘grip’ and therefore help to stabilise the arch as it’s popping back up after absorbing shock; the toes assist with balance and propulsion when you’re walking or running and in theory this toes up position interferes with how the foot would normally behave when walking – which is to land, soften and flatten, i.e. become mobile and pliable to absorb shock, and then become a rigid lever as the toes extend and you push off with them… and, of course, they’re not moving, so compression and cutting off of the blood supply is again a possibility.

Goldilocks and the Perfect Load

Whilst we can all intellectually process the fact that if you put too much stress on a muscle/tendon/ligament/joint etc. it might tear, break, become overused or arthritic, thicken and/or the potential for other injury increases.  It might seem completely counterintuitive then to consider that not placing ENOUGH stress on those same tissues can have a similar effect in that it leaves those tissues open to injury or degeneration.  The old adage ‘use it or lose it’ really does hold true.   When body parts get weak and unused, then they’re just as liable to getting injured or hurting in some way as parts that we over-abuse.

By severely limiting the range of movement of the 33 joints we have in each foot, we aren’t just creating weakness, we are setting ourselves up for the potential for other injuries and problems.  The feet are our foundation, we need them to balance and get through the world, but their role in how we sense our environment cannot be overstated.  By wearing shoe we are essentially placing a blindfold on one of our major senses – the foot cannot ‘feel’ the ground and our body/brain ability to respond is compromised.  That’s really how the elderly finish up shuffling, not able to balance, falling over… ‘nuf said.

What to do…

Well, here we have a little bit of a dilemma.  There are shoes on the market that are more minimal in style, you can of course go barefoot more often and therefore improve the strength and mobility of your feet naturally.  However, I strongly suspect some of you who have PF and who are reading this will be shouting at the screen, “How on earth can I go barefoot when my feet are crippling me?” 

Bear with me, take a calming breath… yes, prevention is always better than cure.  But if you are one of those people for whom taking off their shoes is a complete no-go, do not despair.  It’s like any other body part that you rehab or strengthen, it takes time.  Little and often is better than all at once.  Can you spend a few minutes a day rolling your feet on a soft massage ball, stretching your calves and going for a little wander without shoes on a grassy or sandy surface?  Then the next day a few minutes more.  At some point you have to bite the bullet and start to rehabilitate your feet because if you don’t then things will only get worse until something else goes twang.

What About Heel Lifts and Orthotics

A lot of foot problems are approached with the use of an orthotic, which might be a heel lift (with the purpose of offloading the heel and alleviating pain), or an arch support (with the theory of providing support).  I am firmly of the opinion that in some situations orthotics are useful in the short term, a bit like breaking your arm and putting it in a cast is useful in the short-term – it immobilises the bone, provides support and protection and allows some healing to occur.  What would not be useful is deciding to keep the cast on for an extended period of time, well beyond the length of time taken to alleviate the pain and allow the bone to heal to a certain degree.  In fact, by immobilising and artificially supporting it beyond that time it would get weaker and weaker.  Whilst some foot problems require the ongoing use of orthotics, support and stiffer shoes, PF is usually not one of them.  At some point you have to get your tootsies out and introduce them to the world… they need to stand on their own two feet eventually 😊

Hold your Horses

So before you run out and invest in some minimal shoes, throw your orthotics in the bin and jog down the street with your bare tootsies wild and free, remember that too much too soon is going to be just as bad as keeping your feet in their foot coffins for the remainder of their lift. 

For some people freeing their feet can have a profound effect not only on a condition like PF, but also the pelvic floor, knee, hip and lower back pain.  BUT it isn’t a magic wand.  You do actually have to put some effort into rehabbing and strengthening your feet, particularly if they have been in shoes for the majority of your life.  As always some people will progress and strengthen quickly and easily and others will feel stuck and fed up at their progress, but healing and changing and adapting is constantly happening in the body, if we let it.

Remember that shoes are not the only factor in the health of your plantar fascia, how well the rest of you moves, your sitting, standing and other movement habits, the tension in your feet, ankles, lower legs and hips also impact how your feet feel and behave and whether your arches are intact.  As with most things that go wonky in the body, it’s not usually one thing that ‘causes’ it, it’s usually a combination and/or a culmination of things which can take a little bit of unravelling before you get to the true cause.

So go slow, listen to your body – and by that I mean do a bit of work on your feet, then weigh up how things feel 12-24-36 hours later.  If things are a bit worse then you’ve done too much.  If not and particularly if they’re better, then you’re on the right track. 

If you want some individual tailored support and all the exercises to go along with ridding yourself of PF and any other foot, core or pelvic floor issue, then get in touch.

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