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How to Fix Plantar Fasciitis

foot pain gait gait mechanics heel pain plantar fasciitis the pain free athlete Dec 15, 2021
Plantar Fasciitis is pain on the bottom of the foot.

Plantar Fasciitis is an inflammation and tearing of the connective tissue on the bottom of the foot. There is a central and a lateral plantar fascia, as you can see in the image to the right. This fascia connects the toes to the heel. The main symptom of plantar fasciitis is heel pain, which is often worse in the morning, following exercise, or after prolonged sitting or standing.

 

Risk Factors for Plantar Fasciitis

The Mayo Clinic lists several risk factors for Plantar Fasciitis, including:

  • Age (most commonly 40-60)
  • Standing Occupations
  • Exercise Type (running and dancing)
  • Obesity
  • Foot Mechanics (arch height and/or abnormal gait [walking] pattern)

Source: https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846

 

Standard Treatment

Typically, plantar fasciitis is treated at the site of the pain—the foot. To reduce inflammation and pain, the patient is generally prescribed icing, often being told to roll their foot on a frozen water bottle or golf ball. To correct arch position, orthotics or more supportive shoes may be recommended. To release tension in the plantar fascia, the patient is advised to stretch the arch, bottom of the foot, and calf. In addition, a night splint or boot is often used in order to hold the lower leg and foot in a flexed position. This will stretch the foot and calf while you’re sleeping.

Although doctors and physical therapists commonly and routinely recommend these treatments to patients to relieve their plantar fasciitis, the reality is that this treatment frequently doesn't work. Let’s consider the case of my client Marilyn, whom I describe in detail in my book. The following indented text sections are taken directly from my book. She described her situation like this:

“As an avid hiker I became very discouraged when I ended up with a SEVERE case of plantar fasciitis in both feet! I tried many treatments for my pain: two podiatrists, 4 or 5 eight-week physical therapy sessions, foot vibrator, icing my feet, not hiking for TWO years, rolling my feet on a frozen bottle of water, acupuncture, and many more methods. Nothing seemed to relieve my pain.” 

Marilyn is not the only one who has failed to recover through these standard treatments. I have seen many clients continue to suffer despite doing multiple interventions.

What’s the answer?

 

Foot Mechanics are the Key to Recovery

If you look back at the Mayo Clinic list of risk factors, the last item-–Foot Mechanics—holds the key to recovery. The full explanation of “Foot Mechanics” on the Mayo website is as follows: 

“Flat feet, a high arch or even an abnormal pattern of walking can affect the way weight is distributed when you're standing and can put added stress on the plantar fascia.”

Unfortunately, we often overlook this risk factor in the pursuit of quick pain relief. Could this treatment oversight be the cause of Marilyn’s continued pain and inability to hike? Let’s find out. Here is my analysis of her:

Upon evaluation, I found Marilyn's pelvis to be twisted and tipped forward. Watching her walk, I noticed faulty gait mechanics with a lack of flexion and extension in her hips, and feet that turned out and rolled sideways. I concluded that her pelvic misalignment and compromised walking pattern was likely contributing to her pain. Upon discussing my findings with her, she mentioned noticing stiffness and discomfort in her hips. Additionally, she realized she had more trouble with her left hip, which was the same side as her more severe plantar fasciitis symptoms. 

 

Connect the Feet to the Body

Obviously, our feet do not work independently of the rest of our body. How we distribute our weight through our feet and how the feet function when we move largely determine if we experience additional stress in the plantar fascia. It should be noted that other painful foot conditions—bunions, neuromas, hammer toes, corns, and more--can have the same cause. 

Due to the interconnectedness of our body, weight distribution and foot motion is not determined solely in the foot and lower leg, as Marilyn found out:

While doing an exercise to mobilize her hips, Marilyn noticed something that surprised her:

"As I moved my hips through a range of motion, I was surprised to feel pain in my feet. Perhaps my hips are an issue that needs to be addressed for my feet to heal?" 

She was right. However, the connection from her painful feet went up beyond her hips. In our work together, we also improved Marilyn's elevated left shoulder, left forward spine rotation, forward head posture, rounded shoulders, and extended rib cage. So here’s the bottom line. Repositioning her upper body was necessary to change how the forces were directed through her skeleton all the way down to her feet. And it worked! 

“After two and a half years of pain, Jessica found the magical exercise regimen for me! When I do the Egoscue® exercises, my feet do not hurt! What a relief!!!”

Following treatment, she was able to re-join her hiking group and enjoy regular walks in the mountains near her home.

 

Check Your Weight Distribution

Just in case you’re skeptical about the connection of the feet to the upper body (as I would be!), I have an assessment for you to try. Stand barefoot on a hard surface. Allow yourself to be as relaxed and natural as possible—no posing! Without judgement, simply notice how your feet are contacting the floor. Ask yourself the following questions, keeping in mind that the answers may be different for each foot:

Do I feel more weight on my right or left foot?

Is my weight more in the ball of my foot or located at the heel?

Do I notice that my weight is shifted to the inside or outside of my foot?

Is there anything else I notice?

Once you have a baseline of your relaxed weight distribution through your feet, do the following. Interlace your fingers and put your hands behind your head. Pull your elbows back so that your chest opens and your shoulder blades draw down and together. Make an effort to avoid over arching your lower back. In good posture the rib cage and pelvis are vertically aligned. Now, close your eyes and tune into your feet again. What you are assessing is if repositioning your upper body changes the weight distribution in your feet. For some people the answer is obvious. For others, it’s more subtle.

What did you find?

 

Exercises to Fix Plantar Fasciitis

As discussed above, the key to recovery from plantar fasciitis is foot mechanics. Further, foot mechanics, foot weighting, and even foot position are impacted by body misalignments above the feet. The following Egoscue Method© exercises address hip mobility and position first. This is followed by an integrative exercise that combines the improved hip position from the first exercise with pelvic symmetry and proper foot motion during gait. The final exercise is a static, standing position that includes lengthening of the back line of the body from the feet to the head while repositioning and strengthening a balanced upper body position. Hence, the order in which these exercises are presented is intentional and should be followed.

You can watch a video of these exercises below:

           

Hip Abduction & Adduction

  1. First, lie on the floor with your feet on the wall so that your hips, knees, and ankles form a 90-degree angle. Move your feet apart, starting at hip width. You can increase to a wider position (like in the image to the right) after doing a few warm-up repetitions. Notice that the feet are pointing straight up the wall toward the ceiling.
  2. Next, move your knees together until they touch. You know that your feet are too wide if you can’t touch your knees. This moves your hips into internal rotation.
  3. Now, move your knees out to move your hips into external rotation. You should feel your feet rotate from the inside edge to the outside edge. Keep your toes pointing straight up throughout the entire exercise. You will most likely feel a pull along the inner thighs. In addition, you may notice a stretch along the outside of your calf.
  4. Continue to move your knees in and out in a slow, gentle rhythm.
  5. Next, coordinate your knee movement with your breath. Inhale through your nose as your knees go out and exhale out your mouth as your knees come together. Feel the slight contraction of your abs on your exhale.
  6. Finally, notice the connection between your hips, pelvis, and spine. While your knees move away from each other, you should feel a subtle lifting (arching) of your lower back as the pelvis tilts forward. The opposite occurs as your knees come together. As the knees come toward each other, your back lengthens and the pelvis tilts backward.
  7. Perform 20-30 repetitions of this exercise.


NOTE: Pay attention to your upper body position. You want your arms to be in the same position on each side. If you hurry, like I did to get in position for this photo, you might end up with one arm farther away from your body.
Don’t do that! 

 

Rocking Chair with Pillow

  1. To begin, lie on your back with your knees bent and feet flat on the floor. Your feet should be hip-width apart and pointing straight ahead. Place a four-to-six inch block, pillow, or ball between your knees. 
  2. Next, gently squeeze and release the block 20 times. While squeezing, focus on keeping the contraction even on both sides. The effort and timing should be the same from right to left. These contractions will help to balance your pelvis though equalizing the length and tension between the inner thighs (adductors). You’ll know you are balanced when the back of your pelvis is contacting the floor evenly on both sides. You may need to do additional sets of the 20 squeezes to reach this balanced pelvic position.
  3. Now, gently squeeze the pillow to engage your adductors. Maintain this engagement throughout the exercise.
  4. Next, lift your toes so that only your heels are in contact with the ground. This is simulating the heel strike phase of the gait cycle.
  5. Now, roll your foot down and forward to press up onto your toes. Make sure you have good pressure throughout your toes and feel solid contact with your big toe. This is simulating the push-off phase of the gait cycle.
  6. Slowly roll your feet from heel strike to push-off. You may notice work in your calves, inner thighs, and hip flexors. Maintain a relaxed upper body position.
  7. Perform 15-45 repetitions of this exercise.

 

Modified Counter Stretch

  1. To start, stand facing a counter, desk, or table. The higher the surface, the easier this will be, and vice versa. Keep your feet hip-width apart, pointing straight ahead.
  2. Next, place your hands (as shown to the right) on the surface with support for your forearms out to your elbows. Your head will also rest on the surface. Thus, you might want to grab a small towel to put under your forehead.
  3. Now, walk your feet back and stretch through your spine by pushing your butt back. You want your ankles and hips to be vertically aligned. 
  4. Next, tighten your quad muscles by pushing your knees back. You will feel your kneecaps move upwards. Keep the quads tight for the duration of the exercise.
  5. Now, collapse your shoulder blades down and together, not up! Try to have your shoulder blades touch. Tension should be felt between and below your shoulder blades, not up toward your neck. Allow your head to rotate back as your chest opens and shoulder blades come together.
  6. Finally, attempt to put a small arch in your lower back by moving your pelvis forward into an anterior tilt. You may be limited in your ability to do this by calf, hamstring, hip, or back tightness.
  7. Hold this position for 1-2 minutes.

 

Summary

The treatment for Plantar Fasciitis needs to extend above the feet. The feet provide support for our entire structure. If our body position above the feet is imbalanced, this can create excess stress through our plantar fascia. Often standard treatments fail because they do not consider the interactions of the whole body and overlook dysfunctional foot mechanics. As you have read in this blog, foot mechanics start in the upper body. 

In order to realign your body and alleviate your plantar fasciitis pain, try the exercises provided. Although they may be challenging at first, you will improve with practice. Afterward, or at any time, let’s connect! Contact me if you have questions or would like to set-up a free, no obligation consultation.

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