Plantar Fasciitis Management
I have found that plantar fasciitis is becoming an epidemic with many middle-aged people. Why is that? Well, there are a few different reasons: over-training, or under-training in some cases, constant contact with hard or irregular surfaces, repeated stress to the foot (running), obesity, and what I think is one of the biggest culprits, improper footwear. According to Dr. Perry Julian (a foot specialist for the 1996 Olympic Games athletes),
“One of the most common causes of plantar fasciitis is tightness of the calf muscles and the Achilles tendon.âÂVbCrLf For women this can come from wearing high heals. For men and women this can come from excessive pronation of the foot without enough support of the arch. Over time, as the muscles become fatigued, the structures of the foot become compromised. Muscle tightness is usually traced to trigger points.
When the feet become tired and fatigued, the surrounding muscles become compromised Muscle support and motion are hampered. This makes the surrounding tissue more likely to develop trigger points. Trigger points are sore, knotty contractions of muscle bundles. They prevent a muscle from relaxing properly and recovering. Trigger points can develop in any muscle tissue. When you develop trigger points in the calf or soleus muscle they can refer pain to the bottom of the foot. That is why trigger point therapy of the muscles of the lower leg is essential in the management and prevention of plantar fasciitis.
Step One about 30 Seconds: I typically start therapy by using the Stick on the lower leg. The role of the stick is to improve blood flow to the area that is spasmodic, and to break up the adhesions that the muscle has developed. The best way to roll out the muscle area is to begin by rolling outside the shinbone, using short, specific back and forth strokes. Then roll lengthwise starting below the knee down to just above the ankle. When finding a trigger point, spend an extra 10-15 seconds on that area. Follow this procedure for all of the muscles of the lower leg for 30-45 seconds per muscle group regardless of there being any trigger points (See figure 2). Then stretch the muscles of the lower leg by doing foot drills.
Step Two: Start by walking 20-30 feet forward on your heals without touching your toes to the ground. Then walk on the outsides of your feet about 20-30 feet,; again, don’t touch your toes to the ground. Lastly, walk on the inside of your feet the same way as the outside of your feet. Next, walk on your toes in a straight line 20-30 feet without allowing your heal to touch the ground. Repeat on the outside of your feet, then on the inside of your feet 20- 30 feet without touching the heel. The goal of this procedure is to 1): stretch the muscle of your lower leg and foot; and 2) to strengthen the muscles that support your feet. An excellent byproduct of these exercises is that they are beneficial in preventing shin splints, calf strains, and Achilles tendonitis.
Step Three: Use a foot wheel or a golf ball to roll out the bottom of your foot (See figure 3). I recommend placing the wheel or golf ball on carpet or a thick towel. Support your weight on the opposite side, and begin rolling the bottom of your foot. Use gentle but firm pressure to locate and breakup trigger points. When you locate a trigger point spend 15-20 seconds on that area. If no trigger points are found, roll the foot for about 45 seconds working from the inside to the outside of the foot. I find that these work as an excellent preventative tool for plantar fasciitis. It takes about 3-5 minutes, and should be done twice a day.
What to do when Plantar is inflamed?
My typical treatment protocol is to spray the foot with anti-inflammatory spray, and wrap it for five minutes. This helps to drive in the anti-inflammatory properties. Next, I will cold laser the foot for 3-5 minutes. Cold laser has shown to be effective in speeding up tissue healing. Sometimes we will do some active release to speed up scar tissue breakdown.
Dr. Robert Irwin is an avid distance runner and is the team chiropractor for the Albany Conquest Arena Football team. A member of the vaunted Willow Street AC, Bob was the winner of the 2007 Sheraton Hyannis Marathon in 2:36:04. Dr. Irwin can be reached at 456-8805 or by email at firstname.lastname@example.org
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