Wednesday, February 4, 2015

Plantar Fasciitis and Foot Pain

I’m not quite sure how I feel about the fact that my brother’s birthday pancakes inspired a blog about Plantar Fasciitis, but I think it just speaks to the power of pancakes. Let me explain….

It was Sunday morning and I was walking through the North End to the nearest grocery store on a mission for milk, eggs, and Bisquick. We were celebrating my younger brother’s birthday so of course the world’s most delicious pancakes were on the menu. I was almost to the store when the bottom of my foot started to bother me, so obviously I felt the need to self diagnose. I went back through my activities of the past few days, thought about all of the walking I had done, and had an epiphany! Since moving from Atlanta, my primary mode of transportation has completely changed. You see the people of Atlanta love their cars. Sure, public transportation exists, and people do have legs to walk on down there, but do most use their legs or the train? No way. The train system isn’t exactly efficient, and to give you an idea of how pedestrian-friendly the city is, I’ll share with you the very first piece of advice I got from my older brother when I arrived: “If you value your life, you will only cross the street when that little flashing Walk signal lights up, and even then keep your eyes peeled.” Nice, right? My point is that walking is not a way of life in Atlanta, and I’ve learned very quickly that it is in Boston. You walk to work, to the grocery store, to the T, from the bus, and then back again. Your feet carry you wherever you need to go. My two feet certainly aren’t used to this kind of action and I was starting to feel it. So there I was on Sunday flipping pancakes, stretching out the bottom of my foot, and thinking about Plantar Fasciitis. In case you too are feeling some foot pain, let’s talk about how this particular condition presents and what you can do about it. 

Plantar Fasciitis is the inflammation or irritation of the plantar fascia; the thick connective tissue band that runs from the heel to the toes along the bottom of your foot. Some have even attributed the discomfort to degeneration of the fascia at its attachment points. Either way, think of the plantar fascia as a bowstring along the bottom of the foot that supports the arches, bends and flexes to help our foot propel us, and acts as a shock absorber for movement. When irritated, it results in pain/tenderness in the heel, discomfort underneath the foot, and even tightness into the Achilles tendon and calf. It can be really uncomfortable and stubborn as all get out. It’s usually worse in the morning upon waking because it’s had the chance to stiffen up without use all night. It might relax as you go about your morning routine, but quickly regresses with activity, even if that ‘activity’ is simply walking. 

Typically, the pain flares up with excessive walking, running, jumping, or use of stairs, especially when we increase the amount of those activities in our day. Flat shoes also pose a problem as they lack arch support and cushion, while tight calves change your foot orientation and your arches. Maybe you started a new cardio kickboxing class, got a new pair of flats, made a New Year’s resolution to walk more, or changed your route to work. Now your foot, or heaven forbid feet (plural), are in pain. For me, the inciting incident was obviously ditching my car in a snow bank to tackle the streets of Boston by foot. All of these activities strain the plantar fascia, tugging, pulling, and stretching it such that its attachments at the heel and toes become irritated. You can even develop micro tears in the connective tissue. I don’t know about you, but that doesn’t sound like my idea of a good time. At the very least, the connective tissue increases in thickness, and decreases in flexibility and strength, perpetuating the problem and leaving you in pain. A little worse is the opportunity for your feet issues to affect the rest of you, throwing off your knees, hips, pelvis and back because their biomechanics have changed. Now you’ve got more issues!

So what do we do about it? How do we tackle the very annoying plantar fascia when it decides to become a real pain in our feet? Well, there are a couple of easy things you can do to address it if you feel like I’m talking to you:

·      Rest: Laying off any aggravating activities for a couple weeks can actually give the fascia a chance to heal and repair. Of course if “aggravating activities” include walking, I realize that’s kind of difficult to avoid.
·      Shoes: Make sure the shoes you’re wearing most of the time support your arches and cushion your foot. They help absorb shock and take stress off the plantar fascia.
·      Ice Massage: Because ice is a natural anti-inflammatory, it works to squash any inflammation that may be causing discomfort. Try freezing a water bottle and rolling it under your foot for 5-10min after activity. This also helps to loosen up the muscles/connective tissue.
·      Deep Tissue Massage: Done by a professional, this can help target the problematic tissues to release them. They may also pay attention to the calves in order to loosen up the muscles and prevent them from tugging through the Achilles and down into the heel. If you have a Runner’s Stick, you could also use that along the bottom of the foot.
·      Kinesio Tape: This method of taping is very different from traditional athletic taping. It allows full range of motion of the foot/ankle while supporting the arches and providing back-up stabilization to the soft tissues that need it. Ask your chiropractor if she knows how to Kinesio Tape.
·      Graston: This soft tissue technique uses lotion and a stainless steel tool to break up adhesions/scar tissue in the plantar fascia and soft tissues of the foot that are contributing to decreased mobility and preventing them from effectively doing their jobs. It sounds like medieval torture, but it’s pretty effective in producing relief while treating one of the causes of your discomfort, instead of just masking the pain. Ask your chiropractor if she is Graston certified.
·      Chiropractic Extremity Adjustments: Sometimes the joints of the feet aren’t moving like they should. This throws off the way the soft tissues respond and develop, and can even affect the way you walk. Getting your chiropractor to evaluate your feet for these restrictions, and put some motion back into the joints where necessary, can let soft tissues relax, arches maintain their integrity, and allow you to walk properly.
·      Orthotics: Orthotics are shoe inserts that reinforce proper biomechanics of the foot and retrain the muscles, soft tissues, and arches accordingly. They are helpful for both people with low arches (flat feet) or very high arches depending on how they are made to fit your needs. Proper structure and function of the feet means less tugging, pulling and stress on the plantar fascia. Ask your chiropractor if she orders orthotics for her patients, or where you can go to get some made.  
·      Night Braces: Another approach is to invest in night braces for the feet. These work to stretch the feet and calves while you sleep to promote flexibility and prevent them from tightening up overnight.

More extreme ways of treating Plantar Fasciitis involve corticosteroid shots and surgery. While a small percentage of people will need to explore these options, my goal is to help you avoid them if possible. I don’t know about you, but the idea of getting shots in the bottom of my feet is like my own little version of a nightmare.

So to recap today’s discussion: Plantar Fasciitis is typically diagnosed by a patient’s report of symptoms, along with physical examination of the soft tissues of the foot. Imaging isn’t helpful in this case, with the exception of ruling out bigger, badder problems. If you’ve got some foot pain and you feel like you fit this description, try some of the home remedies and check with your chiropractor to see how she can help. Plantar Fasciitis is stubborn, stubborn, stubborn, so if you’re unable to tackle it on your own don’t be afraid to bring in reinforcements. Remember, the other option may be needles in your foot… That being said, I think I’ve got an appointment with a frozen water bottle, some Graston tools, and some gluten-free pancakes.

-Dr. Doscher