Put Your Best Foot Forward

Do you dread getting out of bed in the morning for fear of those first few tender steps? You’re certainly not alone! Foot pain is a common ailment, but I’ve noticed the changing of the season seems to bring an influx of foot complaints into the office. Switching to flip flops in the summer and boots when the snow comes requires our feet to fend for themselves and some have trouble coping with the increased demands - especially in the first few weeks of the transition. Flip flops and boots generally don’t have the same support as say the hiking shoes, running shoes or good casual shoes that are worn more in the shoulder seasons.

One of the most common causes of foot pain is plantar fasciitis - in fact it’s so common it’s often the default diagnosis, but be forewarned, there are actually many causes of foot pain so a thorough exam should really be done to determine the correct diagnosis. But seeing as it’s the low hanging fruit, we’ll dip our toes into plantar fasciitis today!

The plantar fascia is a thick band of fascia (connective tissue) that runs along the bottom of the foot from the heel to the base of the toes. It offers support and shock absorption for the foot in addition to being critical for the entire function of the foot (like providing structural separation for muscle attachments and room for nerves and blood vessels to travel). The plantar fascia is able to provide support during motion while weight bearing - not an easy task! If we simplify the shape of the arch of the foot into a triangle, the plantar fascia would make up the bottom of the triangle if you are standing (if you recall back to geometry, you could say it’s the “hypotenuse” of the triangle). The mechanical model used to describe the role that the plantar fascia plays in walking and supporting the arch is called the “windlass mechanism”.  A windlass is a sort of winch-type machine that puts tension on a rope or cable to lift an object. As we transfer our weight to walk, the plantar fascia becomes taught, helping to propel us forward and also prevent the collapse of our arch, acting sort of like a tight cable in a winch. Without it, as we transfer our weight forward, our toes would shoot out away from the heel and we’d have sloppy feet and a difficult time propelling anywhere! 

In general, people with a higher arch are a bit more prone to having a tighter planar fascia and less shock absorption because this shape makes the foot as a whole a bit more rigid. On the flip side, people with a flatter arch tend to have a more sloppy foot and less stability because the plantar fascia can’t get quite as taught. Both can still develop plantar fasciitis though. To decipher some medical terminology, remember that “itis” means inflammation. Plantar fasciitis then, simply means inflammation (aka irritation and pain) of the planar fascia. On a physiological level, we think there are tiny tears that develop from repetitive loading and altered biomechanics that cause the inflammation. So what does that feel like?

Ouch. Is the short answer. There is often sharp pain, most commonly at the attachment of the plantar fascia into the bottom of the heel (the calcaneous). This pain is usually worst during the first couple steps in the morning. Why this unique time? Well, if we consider its function, the plantar fascia doesn’t work very hard when we aren’t weight bearing. It’s had a little break overnight, then when we take that first step down, it suddenly needs to stretch and contract while holding up against our weight. This in essence rips the scab off those tiny tears that were jussst starting to heal overnight - hence the sharp pain of the first few steps. The symptoms are not exclusive to the morning though, and are often bothersome after walking or standing for long periods of time, after a sudden increase in weight bearing activities, or at the end of a long day on your feet. The first couple steps after sitting for awhile can also be tricky, for the same reason as first thing in the morning. You’re not the only one who might protest suddenly getting called back to work when you think you’re on a break! As mentioned, a change in footwear, especially to something with less support can place a higher demand on the plantar fascia and aggravate it as well. 

So what to do? 

Fortunately, there are lots of conservative treatments available for this trouble maker. Manual therapy (like massage, chiropractic and physiotherapy), can be very effective. Modalities such as ultrasound, shockwave, or laser therapy can also be done by a healthcare professional and may help as well. Then, there’s homework you can do yourself. Here’s a few tips and tools to help you out at home if you’re struggling with this beast. 

Tennis ball rolling: this is one of my favourite tools for plantar fascia pain. In bare feet or socks, while you are sitting, gently roll a tennis ball from the heel to the base of your toes, back and forth for about 2 minutes, at least twice a day. In addition to mobilizing the small joints of the foot, this also gives a little stretch to the plantar fascia. Ideally, you would do one of the sessions before you take your first step in the morning. So sitting on the side of your bed, do some rolling before you stand up. This way, you can ease the tissue into a stretch rather than require it to go from 0 to 100 immediately when you step down. 

Stretching the calf muscles: the achilles tendon runs along the back of the heel and is the large tendon of the calf muscles. Though separate from the plantar fascia, due to the proximity of its attachment, this tendon has a strong relationship to it and tension in the calf can also result in tension of the plantar fascia. To stretch these, face the wall and place your hands on it for balance, take a giant step back with one leg. Lean forward into the wall, stretching the back leg while trying to keep your heel down. Be sure to do the stretch with your knee straight and with it bent in order to get a stretch of both muscles that blend into the Achilles tendon. 

Ice: ice can help to alleviate some of the pain. About 10 minutes as needed should do. Just keep in mind that you should plan ahead before you ice. It isn’t fair to freeze something and then ask it to work rapidly. Our muscle and connective tissue are the same as a steak. Steak in the freezer is not very mobile right? So don’t be icing and then immediately get up and walk. Also, please resist the temptation to roll your foot on a frozen water bottle. It can seem like you’re being efficient: mobilizing, stretching and icing at the same time, but those things do not go together. So don’t listen to Dr. Google on that one! Ice when you have enough time to allow your foot to return to “normal” temperature, before you make it work hard. 

Supportive shoes: wearing shoes with good support is important! True, maybe not high fashion, but wearing running or hiking shoes when you have plantar fasciitis can really help. If you’ve got a bad case of this, wear them in the house as well.

Strengthening: once the pain begins to simmer out, strengthening exercises can help engage the muscles of the foot so that they do their job and the plantar fascia doesn’t have to pick up all the slack. Here’s a couple: 1. Toe towel curls -  sit down in bare feet, place a towel on the ground and step on it with one foot. Keep your heel down and scrunch up the towel using your toes to grab it and pull it in sort of like a rake. 2. Ski jumper - ya know those (slightly crazy) folk who launch themselves off the long, steep ski ramp and fly through the air leaning forward further than you or I dare try for fear of face plants? We’re gonna do a version of that, but no ski jump or skis required! Standing with your feet about shoulder width apart, plant/root and engage your feet (grip the ground a bit so you feel stable), then,  keeping your legs straight, lean forward just like the ski jumpers. Keep going until jussst before your heels lift up or just before you’d have to take a step forward. You’ll feel like you’re living on the edge and the muscles of your feet will be turned on high! Try to hold that for 5-10 seconds and repeat a few times. 

Now that your feet are happy, the only other thing left to do is get back on em! You’ll be ready to put your best foot forward as you navigate your path to wellness. See you on the trails!