Today I am going to talk about Plantar Fasciitis. I just had this discussion with somebody at a health event the other day. The gentleman was a physical health educator and he explained how in his experience that the occurrence of plantar fasciitis amongst the athletically active health education teacher was an issue of "when" they would get and not "if" they would get it. He went on to explain that he had discovered the most efficient treatment for it that he knew of and was eager to share it with everybody, and essentially it involved wrapping his foot in ice packs for hours at a time.
I would like to talk about this topic a little bit more because we do see plantar fasciitis fairly often in practice. We see patients from other medical offices where they have had treatment already and they may have had some partial relief and these individuals are still distressed with pain and quite relieved to come somewhere where they find that the problem can be dealt with directly and forth-rightly without drugs or surgery.
Plantar fasciitis is a condition where there is essentially a tightening of the muscular-like tissue at the bottom of the foot that runs back and forth from the front to the back of the foot, predominantly in the arch area of the foot and usually what we find is very tight bands of spasm that may have progressed to a worse form of spasm, called fibrotic spasm or fibrotic degenerative spasm, as well as a form of tendinitis where the plantar fascia fibers, the muscular-like fibers, are pulled from their origins and insertions from their front and back attachments to where they insert into the bones of the feet. We call this pulling "micro-avulsion".
This literally is a "yanking out of place" and involves micro-tears of the insertions of the plantar muscular fibers. They are actually often torn out of their attachments into the bony areas of the foot and this is often the beginning of spur formation in those areas, resulting in pinpoint pain, usually back toward the heel area. Invariably the person with plantar fasciitis does describe pain along the bottom of the foot, often worse when they try to stretch that foot and curiously, from my perspective, one of the common treatments for plantar fasciitis is stretching, which usually is torturous and aggravating to the condition. I guess I have seen this mostly from the podiatrists and physical therapists.
The stretching of that musculature can bring people some temporary relief. Overall, I have not seen it be highly effective. The thought is apparently that since the musculature is tight, it should be stretched. It is my experience that this tightening, in most cases, is beyond stretching and that the stretching tends to cause a reactive defensive posturing of that musculature, tightening it up even more, and sometimes aggravating by increasing the pulling of the tendonous-like insertions and perhaps even bringing on greater propensity to ultimate spur formation. At worst, it just doesn't seem to get the kind of result that people would expect.
Instead, we generally recommend an approach that would involve loosening those muscular fibers and there are several different approaches that could be taken and one of them is called "spindle cell therapy" which is a highly specific kind of myofascial release technique that causes the muscular-like fibers of the plantar fascia to let go and relax down and loosen up in length and take some of the pull off of their insertions and allow for more flexibility without stretching therapy, so that when the individual does perform activities that lead to the natural stretching of the arch in order to function and move about, the stretching is well tolerated and not irritating.
Often orthotics are recommended for these individuals and again sometimes there is relief and this is highly variable. My thought about this is that the condition should undergo at least a certain amount of fundamental correction. It is not often that I find a foot/ankle complex free of other distortions when somebody has plantar fasciitis. We believe one of the causes of plantar fasciitis has to do with partial trapping of the nerve that feeds the plantar fascia through the ankle at what is called the tarsal tunnel, a tunnel-like opening like the carpal tunnel, at the ankle.
There is a major nerve that runs through there and when it is pressed upon by misalignment of the ankle, it will cause tightening of the plantar fascia at one point and ultimately can lead to abnormal relaxation but nevertheless, abnormalities of responsiveness of the plantar fascia due to compromised nerve control. So one of the first things we look for is misalignment in the ankle and the heel and get these corrected and then take the approach of going toward the plantar fascia, relaxing it appropriately through specialized myofascial release techniques, and then we can teach the patient some home vibrational massage techniques and then it would be appropriate to move forward with orthotics for the rehabilitated foot so that they could be supported in their healthier position.
These problems are often left unhandled, and, often people don't know of the choices that might be available in a chiropractic biomechanical setting and instead elect for procedures involving injections and sometimes, even surgery. If you are somebody who has had plantar fasciitis and would like to avoid injections and surgery and have not had a course of conservative care like I have described, I would certainly recommend that you find a chiropractor who is trained in this type of care and who can evaluate you and see if you are an appropriate candidate for that type of care and start you on a road to getting you better.
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