Hey Guys/Gals, today I want to go over a very common injury/condition that we see in the clinic. If you’re someone that wakes up every morning and dreads those first few steps out of bed, has sharp in the bottom of the heel/foot, or has a hard time standing for long periods of time before needing to get off your feet – chances are you are suffering from a very common ailment known as Plantar Fasciitis. Now, before we dive into the underlying mechanics of this condition, it’s important to note that there are numerous causes for ankle or foot pain, and it is important to have an assessment performed by a professional to properly diagnose the condition. Once the true source of the pain/discomfort is discovered, the path needed to get to where you want to become much more clear.
What is Plantar Fasciitis and What Causes it?
The plantar fascia is a fibrous connective tissue extending from your heel bone to the base of each toe. Most people experience pain at the fascia’s origin on the heel bone, but it’s not uncommon to have pain across the entirety of the bottom of the foot. Now, the “itis” in the name suggests that this is an inflammatory condition, however, plantar fasciitis is actually an overuse or biomechanical injury resulting in the degradation of the collagen fibers that make up the fascia.
When we look at the foot, the plantar fascia plays a pivotal role in maintaining the arch of the foot as well as providing shock absorption when walking or negotiating stairs. During gait, our lower leg glides forward over the ankle and our big toe extends with each step. This position of the ankle and foot tightens the plantar fascia and helps to increase the height of the arch of the foot – giving you a stable base from which to push off. This mechanism is known as the “Windlass Mechanism” and is essential for maintaining a healthy and pain-free foot and ankle.
There are 5 main culprits which often lead to the presence of Plantar Fasciitis:
1. Lack of ankle mobility and strength
Remember that when we walk, our lower leg needs to be able to glide over our foot – this position is ankle dorsiflexion. When someone lacks dorsiflexion mobility, we then see that foot begin to over-pronate and the arch collapses. At this point, you’ve lost the ability to utilize the Windlass Mechanism, leading to excessive force and strain being placed directly on the plantar fascia. We also have muscles that work to assist the plantar fascia in stabilizing the arch of the foot and preventing excessive pronation. It’s easy to see that if these muscles are not as strong as they need to be, the fascia will have to pick up the slack and may become overwhelmed.
2. Too much Loading, Too Soon
When someone starts a training program to build up the strength of their muscles, they do so by starting at baseline and gradually increasing the weight/resistance. This gives their muscles, tendons, ligaments, and CNS time to adapt to the stressors being placed on them and become stronger. The plantar fascia is no different! If you’ve recently changed footwear, dramatically increased the amount of time on your feet, or started a new running or weightlifting program – chances are your plantar fascia received too much stress, too quickly, and are now kicking back at you.
3. You don’t spend enough time barefoot!
If you are someone that feels unstable with your ankles and feet if you’re not wearing shoes, you’re very likely to have developed plantar fasciitis. This is because the natural Windlass Mechanism of your foot causes the distance between the heel and toes to shorten when the arch is raised. This movement is impeded by most shoes and results in excessive compressive forces on the fascia. Shoes do not allow our feet to do the work they are designed to do, which inevitably leads to a weaker ankle and foot complex – resulting in pain.
4. Poor running, jumping, and landing mechanics
Poor biomechanics with running, jumping, and landing often results in excessive pronation of the foot, again leading to excessive compressive forces placed on the fascia.
5. Lack of hip strength/stability
Although your pain is isolated at the bottom of the foot, it’s important to remember that the body is one big kinetic chain with several moving parts that must work in harmony for us to move around pain-free. Excessive pronation at the ankle can be a result of an unstable or weak hip. To illustrate this point, try standing up and pushing your knee towards the midline of the body with the foot planted. What you will find is that the arch of your foot collapses (excessive pronation). The job of keeping that knee from collapsing in when running, landing, or jumping is done by the muscles of the hip!
How Do I Fix This Problem and Keep It From Coming Back?
1. First and foremost, you need to build a more bulletproof foot and ankle! This means increasing their mobility, strength, and capacity – which in turn takes excessive forces off the plantar fascia and improves the biomechanics of the foot. Start with the following exercises that focus on decreasing foot pain and improving mobility/strength of the ankle.
Lacrosse Ball on Plantar Fascia
Banded Ankle Dorsiflexion Mobilization
Calf Raises
Banded Inversion/Eversion
2. Next, you need to start building more single-leg strength and stability. With the following exercises, focus on keeping the core engaged (think “ribs down”), driving the knee out, and moving slowly as to really challenge your muscles to work.
Banded Kick Outs
Single-leg RDL
Single Leg Step Down
3. Lastly, try to spend more time barefoot at home.! You’re going to want to do this gradually because remember, our bodies can only adapt but so quickly. Spending more time out of our shoes allows our feet to work in the way they were designed. Although we have to wear shoes in public, try making dinner, doing the laundry, cleaning the house, etc, without shoes. As a side note, while sandals are very popular in the summertime, that pinching motion that we do between the big toe and index toe actually locks up the forefoot and impedes the natural biomechanics of the foot. Try opting for a minimalist shoe, rather than sandals. As far training programs for running, lifting, or other sports, remember that the body responds to progressive overload. This means that we give the body a controlled dose of exercise or stimulus, then we have super-compensation by the body which results in us becoming stronger and more fit. The rate of progressive overload varies for each individual and their baseline fitness and training history, however, as a general rule, you do not want to increase running mileage or total weight training volume by more than 10% per week!
Alright guys and gals! I hope this article sheds some insight on why so many of us develop this painful and debilitating condition, and what we can do to not only fix the problem but keep it from ever coming back again! Give these techniques and exercises a try, be consistent week to week, and I guarantee that plantar fascia pain will begin to subside. Have a great week and tune back in next month for another breakdown of a common musculoskeletal condition!
Dr. Brett Rolison, PT, DPT, CSCS