Plantar Fasciitis Look Beyond the Foot

I have many patients that are runners and marathoners, and oftentimes they come into my office with a severe injury. A common scenario may be that they have been training for a marathon for many months. There may be 6 to 12 weeks to go before the big day, and they hobble into my office with pain in their low back, hips, knees, ankles, feet or all of the above.

They say, psychically of course, "Get me better now, I need to resume training within one week, I'm perfectly healthy, I'm doing everything right, hurry up get me better, the clock is ticking."

Running is not just about the physical exercise, but it's also the one thing many have to channel their stress in their lives. I get it, when I've had an injury; I have also sought help and expected the practitioner to "fix me". When my activity level has diminished (hiking, biking, yoga, chi gong, dance, etc.), because of an injury, it has been challenging for me. So, I am especially sympathetic to my runners.

70 percent of runners get injured. That is a high statistic, which hasn't seen much of a change, even with all the changing running shoe philosophies (maximalist and minimalist shoes). Plantar fasciitis is a common injury amongst runners and occurs in about 1 in 10 of the general population. It involves pain and inflammation of the band of tissue, called the plantar fascia that runs across the bottom of your foot and connects your heel bone to your toes. Sufferers of plantar fasciitis, typically wake up with pain in the heel and arch, and feel it as soon as they step out of bed in the morning.

So, first things first, just because you are fit doesn't mean you are healthy. You may look like you should be on the cover of muscle and fitness magazine, but you can still be extremely unhealthy. One of the key factors that I look for in a healthy person is a low level of inflammation in their bodies. If you have plantar fasciitis, generally there are higher than normal levels of inflammation in your body. This inflammation can come from structural abnormalities, nutritional, and emotional imbalances.

Let's tackle the structural first. The foot may be where you have the pain, but the cause of the pain is very likely coming from certain muscles in the lower leg, like the peroneus longus and brevis, tibialis posterior and anterior, and others. By working on trigger points on the inside of the tibia bone, medial shin and the side of the calf muscle, these points may help to resolve plantar fasciitis. You may have a talus bone in the ankle or any other ankle bone out of alignment. The ankle bones can act like a shock absorber, so if they aren't moving properly then the soft tissue or fascia can get the brunt of the stressful gait forces. The knee and the hip should also be working properly. If they are not moving and are locked up, this will cause added stress into the fascia.

When patients come in to see me with plantar fasciitis, I show them the active trigger points that they can work on, and this helps to resolve their plantar fasciitis faster. Some patients do well with rolling their foot on a cold soda can for minutes a day. Other important homework is having patients pick up small objects throughout the day with their toes and scrunching a towel with their toes and picking it up as well. These help strengthen the muscles that aren't working properly.

The best exercise for foot and lower leg strength is the deep squat, which is done with the feet turned out about the width of a yoga mat. (You hold the squat for at least 30 seconds and can work your way up to 3 minutes). Ideally the heels are on the ground, but you can put a yoga blanket underneath your heels if this isn't possible. I always tell my patients to hit the medial arch very firmly with a stick or your hand for three minutes at least once a day, as meridian points in the foot are stimulated this way. This encourages foot strength and foot health.

This next question always comes up, what shoes should I wear? Ideally the shoes you wear should have less cushion, a low drop stack height. Stack height is how much material is between the bottom of your foot and the ground. Drop is the difference between the stack height of your heel and toes. Yes, that's right the less cushion and the closer your foot is to the actual ground the better it is for you. Too much cushion does not do what you think it does, but actually causes more force to be directed into the joints, not less.

There are many mechanoreceptors in the foot, which are not able to relay information to the brain the farther the foot is away from the ground. Shoes with too much support and cushion encourage a heel strike, which causes injury. Less supportive shoes encourage a mid-foot strike, which is what we do when we are barefoot. You should be barefoot as much as possible, especially at home. Anywhere else you can that is safe to be barefoot is encouraged to get your foot connecting to your brain more.

The nutritional side of plantar fasciitis can be anything from a deficiency in manganese, or other minerals to too much systemic inflammation in the body. Anti-inflammatory foods containing bromelain and increasing your omega 3s can help. Food sensitivities and toxicity can be causing this inflammation, so getting checked through nutrition response muscle testing is always helpful.

I have found that certain people with plantar fasciitis also have an emotional connection to this problem. Most dis-ease in the body has some emotional stressor associated with it. It may have to do with a person feeling they have difficulty moving forward with a major aspect of their life, like leaving a relationship or getting a new job, moving, etc. Someone may feel a bit stuck.

Most solutions to health problems lie beyond where the location of pain is. Look beyond the foot and usually it is here that you will find the answer to resolve plantar fasciitis.

Dr. Louis Granirer
NYC Holistic Chiropractor
http://www.holisticchiropracticcenter.com