Plantar Fasciitis- How it Happens and What to Do

If walking causes severe pain in the heel of your foot, chances are you have probably developed Plantar Fasciitis. This is an inflammation of the plantar fascia that runs along the bottom of the foot. How does inflammation begin in these tissues and what can we do to resolve it?

Some Common Causes of Plantar Fasciitis

The plantar fascia typically becomes inflamed due to an overuse of the tissues without the tissue having a chance to rest and recover. We usually see this occurring when the foot is collapsed (flat feet) and has lost the ability to arch up to lock the foot. If, say, you are trying to reach your 10,000 steps for the day, that means one foot is not functioning properly for 5,000 steps a day!

Another issue that can instigate plantar fasciitis could be a bone spur. Bone spurs are calcium deposits that your body creates to structurally improve areas of bone tissue that are receiving a lot of wear and tear. Once again, this could be caused due to the tissue moving abnormally over the bone and your body deposits more calcium in that region in order to protect the bone. In these instances, typically minor surgery is needed to shave the bone spur down. You will then need to focus on improving the functionality of the foot so it doesn't come back.

Functional Movement Approach to Plantar Fasciitis

With knowing that plantar fascia pain is due to inflammation within the tissue, which could be caused by the issues discussed above, we need to figure out why the tissues are being overused and not functioning properly. Some of the biggest related culprits are mentioned below:

Hip Tightness

In our chair-born society, tightness of the hips is a pretty regular occurrence. This is seen in our lack of extension through the hip flexors (front hip) and an inability to rotate the hips. To quickly break down why length in the hip flexors and rotation of the hips is important, let's look at the roles these have during walking.

When the front foot lands on the ground, the arch should collapse, creating a "loosey goosey" foot. This helps to turn the muscles in the back of your hip to be able to support and stabilize you.

As the foot moves to become the back foot, this is where the extension in the front of the hip comes into play. If the hip flexors are tight, 3 things could happen:

  1. The back foot could rotate outward, keeping the arch of the foot flat and stressing the tissues.
  2. The knee could bend instead of straightening out, which will keep the arch of the foot flat.
  3. The stride length could be shortened, not allowing enough time for the foot to arch up and 'stiffen' in order to propel you forward.

Also, this is where the lack of ability to rotate in the hip can play a big factor in whether your foot stiffens or stays flat. The back leg should be rotating outward, which helps to move the heel inward and locks up the foot. If this isn't happening, expect symptoms of plantar fasciitis to arise at some point.

Thoracic Spine (Mid Back)

Another area of the body that tends to tighten up from being in a chair all day is the thoracic spine. This part of the spine is very important for activating your core during any movement. With its ability to bend forwards, backwards, side to side, and rotate, it activates all of the core muscles any way that it moves. However, when we sit for extended periods of time, and don't work to improve flexibility in this area, then we start to lose the ability to move all of these different ways. This will affect how the rest of your body moves and you may run into some of the issues stated previously in this article.

Sometimes one side of the body may be more tight than the other, causing an increase in rotation of your lower body to one side and not the other. This could make one foot consistently flat and the other stiff which would cause plantar fasciitis on one side.

We will discuss ways to improve the range of motion in these two areas to improve function all of the way down at the foot.

Improving Range of Motion in the Hip Flexors

Instead of looking at the body as specific muscles, we will be looking at the muscles more as regions of the body. When we talk about Hip Flexors in this case, we will be talking about the front of the hip, the front of the thigh, and into the groin area. This will make it easier to understand where stretching is taking place.

Below will be a series of videos related to stretching the "hip flexors".

In the first video, you will start off in a half kneeling position with the back foot elevated on a box of some sort. You will actively drive your pelvis forward and back for 10 reps. Then, bring your pelvis all the way forward and maintain that position as you sway your pelvis side to side. Finally, keeping the pelvis forward, try and rotate the pelvis around, creating an internal/external rotational component to the kneeling side. For added stretch, you can lift up the same side arm as the kneeling leg.

In the second video, you will take the same idea as the first video, but bring it more into a standing position with the back foot on a chair of some sort. In this position, you want to make sure your chest is up tall and you aren't arching too much from your lower back. If you have a big arch, either use something lower than a chair, or do it on the ground. Be actively trying to press the back heel away and behind you. Use the same pelvis moves as the kneeling exercise.

Improving Thoracic Spine (Mid Back) Movement

In these videos, it is important to assess and to address the "sticky spots" within your mid-back. Our goal is to create symmetry between the two halves of our body. If you feel one side needs more work than the other, take the time to improve that side!

In the first video, we will take you to the foam roller. Place the foam roller in the middle of your back, making sure not to rest on any floating ribs. While keeping your hips down on the ground, lean back and take a deep breath in and out before coming back up. Move the roller up a few inches and repeat. Once you do this all the way up the spine, try dropping your knees to one side and repeat the same process.

In the second video, we will utilize a broomstick while standing so we can assess how the spine moves in regards to taking a step. Start with reaching up and back with both hands on the broomstick, while taking a step. Alternate sides. Next, hold the bar directly overhead, and as you step, drop the hands towards the middle. Repeat the above directions, but drop the hands towards the outside of the body. After you have done this, hold the bar at shoulder height and as you step, rotate towards the stepping leg. Finally, repeat the above directions, but rotate inward towards the back leg. Do each exercise 5 times before moving on to the next.

Work the Fascia and Improve Foot Function

In this series, we are using a direct approach to the foot to lessen the strain on the plantar fascia. Both of these videos you can do on your own, but a practitioner can greatly help to influence the tissues correctly.

In the first video, the goal is to creating a "swelling" effect within the tissue by using an object such as a pen to press into the foot. It is best to press down to a comfortable level, but not too deep that it causes irritation. The goal of the "swelling" is to bring in essential nutrients to support cellular rebuilding while actively drawing out toxins from the cells. Once you add the pressure to the entire foot, use your fingers to help "pump" the fluids back out of the foot so that there isn't stagnant fluid buildup remaining in the fascia. Sometimes, I will use KT tape to help with the pumping action by applying it just under the transverse arch of the foot and to the top of the calcaneal tendon.

The second video is a progression of the first video. We want to help facilitate the "locking" or supination of the foot as it becomes the back foot in walking. Start by keeping the injured foot on the ground and do a rotational forward step with the other leg. Ideally you should see the foot start to arch and lock up. If this isn't happening, you can have someone use their hands to gently move the foot into an arched position. Follow this application with steps at a 45° diagonal angle and then with a crossover step.

Now just like any other advice you may find on the internet, all of this information may not directly pertain to the root cause of your plantar fasciitis. The only way to know for sure is to assess your own body when moving or to have a practitioner assess you to see if the foot is functioning properly during movement. In general, these are great places to start for your home exercise and stretch program!