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Plantar fasciitis affects approximately 2 million people per year and has long been known as a painful and tricky injury to treat.
There’s a laundry list of first-line treatment tactics, but what happens when that’s not enough?
To stop plantar fasciitis in its tracks, you need to look beyond the foot.
Learn the not-so-obvious causes of plantar fasciitis for a comprehensive approach to beat the pain.
- What is plantar fasciitis?
- Why is plantar fasciitis worse in the morning?
- Risk Factors for plantar fasciitis
- What’s the difference between plantar fasciitis and heel spurs?
- Common first-line treatments for plantar fasciitis
- Why focusing only on the foot doesn’t work
- Not-So-Obvious causes of plantar fasciitis
- What’s the best treatment for plantar fasciitis?
- How do I know which of these is causing my plantar fasciitis?
- How can orthotics help plantar fasciitis?
- Is there anything I can do to prevent plantar fasciitis?
- Wrapping Up
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What is plantar fasciitis?
To answer that question, we have to start with what is the plantar fascia?
The plantar fascia is a thick band of connective tissue that connects the heel to the toes. It functions to support the arch and transfer force through the foot and lower leg during movement.
When the plantar fascia is asked to pull more than its fair share, it’ll let you know, in the form of stabbing heel pain with every step.
Plantar fasciitis is an inflammation of the fascia at its insertion point on the heel.
Why is plantar fasciitis worse in the morning?
Hallmark signs of plantar fasciitis are pain first thing in the morning in the heel or arch. The pain may improve as the tissues warm-up and may worsen with prolonged walking/standing.
During normal activities, the tissues are warm and move through their full range of motion (ROM).
After sleeping for several hours with your feet in a more relaxed position, those first few steps are very noxious to the inflamed tissues as they attempt to warm-up and move through their full range of motion again.
Risk Factors for plantar fasciitis
Though it may seem like plantar fasciitis creeps up overnight, several background issues can contribute over time, sometimes for weeks or months.
- Anatomy/structure of the foot
- Poor footwear choices
- Altered movement mechanics (due to other injuries, tightness, or weakness) that change the way we walk
- Ramping up fitness activities too quickly, especially running
- Spending a lot of time standing/walking
What’s the difference between plantar fasciitis and heel spurs?
These two often become confused. It’s a common misconception that heel spurs cause plantar fasciitis, the truth is, it’s likely to be the other way around.
A heel spur is a bone or calcium deposit that grows in the heel (calcaneus) where the plantar fascia inserts, in response to repetitive stress. Heel spurs can develop in response to chronic plantar fasciitis, but the heel spur itself doesn’t often cause pain.
Common first-line treatments for plantar fasciitis
- Rest/activity modification
- Massage – rolling the arch on a tennis ball
- Calf stretching
- Ice (a frozen water bottle adds a nice contour to the arch of the foot)
- Night splints
These treatments can be a helpful starting point, but what happens when the pain doesn’t go away?
There may be more to the puzzle.
Why focusing only on the foot doesn’t work
Plantar fasciitis is more than meets the
eye foot. It can be easy to think, there’s pain in my foot, so I’ll treat my foot.
It seems logical, right? Except, it’s not.
Successful treatment is often a multi-pronged approach.
Yes, it’s important to decrease inflammation locally and improve foot/ankle range of motion. That’s where many of those first-line treatments come in handy.
But it turns out; the foot is connected to the rest of your body.
Many other factors can lead to pain manifesting as plantar fasciitis. If you don’t look beyond the foot, you’ll never find other contributors to the issue, perpetuating the chronic pain cycle.
Treat the actual problems instead of just the symptoms.
All the ice and foot massages in the world won’t fix the issue if there are other contributors, for example, the hip. It’s a delicate dance of decreasing local inflammation while restoring healthy movement.
Not-So-Obvious causes of plantar fasciitis
Any area of the body can change how we move and walk. When movements are altered in a dysfunctional way, it can lead to overuse issues.
Here are some examples of how other structures can contribute to plantar fasciitis.
Lack of extension at the big toe
I know, I just said you need to look outside of the foot. We’ll get there.
Extension at the big toe is a requirement for fluid walking and running and is often overlooked as a source of dysfunctional movement.
Lack of extension range of motion here can contribute to a host of overuse injuries at the foot/ankle and beyond.
Calf muscle tightness
This is a common cause of plantar fasciitis.
Tightness in the calf muscles (gastrocnemius and soleus) can restrict ROM of the ankle into dorsiflexion (pulling the foot toward you).
Limited dorsiflexion can affect your stride length (how long of a step you can take) and flexibility with activities like going down stairs or even squatting. This can place additional strain on the plantar fascia.
To learn different methods to stretch the calf muscles, check out the ankle/foot flexibility library.
Hip/Core muscle weakness
It seems like core strengthening is some magical fix for everything doesn’t it?
The glute max is the most powerful hip extender in the body, and also a common muscle group to find weakness, especially with prolonged sitting.
Glute max helps propel you forward while walking. Weakness in the glutes can contribute to a host of issues, including plantar fasciitis.
But the hip is so far away from the foot!
Sounds crazy, right?
It’s not that far fetched from a movement perspective. Remember, it’s all connected.
The body will keep moving down the line (or up the line), looking for other tissues to pick up the slack. After a while, these tissues become overworked and inflamed.
Hip flexor tightness
The hip flexors function to propel your leg forward while walking and to bring the knee toward your chest. Psoas, the major hip flexor, also plays a role in core stability.
Tightness and weakness are usual suspects in those with sedentary jobs, spending extended hours sitting.
Lack of full ROM of the hip flexors can limit how far your hip extends (the opposite direction of flexion). Hip extension is essential for walking. If it’s limited, that can create extra work for the calf and foot.
Spoiler alert, it may even be on the opposite side of the body!
For ideas on how to stretch the hip flexors, check out the hip flexibility library.
Limited rotational mobility of the spine
Have you ever wondered why we swing our arms when we walk? That reciprocal movement helps us walk easier and with more fluidity.
Now try taking a few steps holding your arms at your sides, keeping your upper body still.
You may have noticed you didn’t move as fluidly, and you had to work a little harder to get going, which was more work for the feet and ankles.
Check out the spine flexibility library.
What’s the best treatment for plantar fasciitis?
It may be beneficial to team up with a podiatrist and physical therapist simultaneously for the best results.
Because, everyone’s different.
If the condition is chronic, it’s likely there is more than one issue at play.
Plantar fasciitis is one of those injuries people like to ignore in hopes the pain will just go away!
How do I know which of these is causing my plantar fasciitis?
Unless you have another injury that you can trace back to, it can be challenging to figure out the underlying cause.
Which came first, the chicken or the egg?
The world may never know, but if you don’t address all the causes, you’ll spend years rolling your foot on a tennis ball, wondering why the pain never goes away.
It’s essential to get evaluated by a physical therapist that will assess your movement as a whole to call out these underlying offenders and design a comprehensive program.
The longer an injury lingers, the more difficult it becomes to resolve. Inflammation becomes chronic, tissue damage occurs, and bad movement patterns breed more bad patterns, leading your body to feel this is the new normal.
How can orthotics help plantar fasciitis?
Custom orthotics and over the counter insoles can be a great option along the plantar fasciitis journey.
They support the arch of the foot, which also has a positive effect on other joints of the body.
If you have particular needs, you will need to see a podiatrist for custom orthotics. The downside is they can be costly (in the neighborhood of $400-$600 per pair). Insurance limits how many pairs you can have if they cover them at all.
For over the counter affordable, high-quality insoles, I recommend Superfeet.
They offer different types of insoles for all activities and are cost-effective enough to have several pairs to go around in your shoe collection.
Is there anything I can do to prevent plantar fasciitis?
- Choose proper footwear with good support and replace at regular intervals
- Add orthotics or over the counter insoles
- Maintain a good balance of flexibility and strength for healthy movement
- Don’t ramp up training too quickly, for example, significant increases in running mileage
- Maintain a healthy weight
- Don’t let injuries linger, seek care sooner than later.
Human movement and mechanics are extraordinarily complex. Treatment requires a multi-disciplinary approach and some trial and error.
Other than ignoring the pain, the worst thing you can do is the same failed treatment repeatedly and wonder why you’re not getting results.
It’s definitely worth it to explore all conservative options before jumping into more invasive treatments.
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