Plantar Fasciitis
Pain on the bottom of the foot, just in front of the heel that is worse than stepping on a Lego first thing in the morning is typically diagnosed as plantar fasciitis. The verbiage essentially indicates inflammation of the fascia on the bottom of the foot. This can be an acute thing, meaning it is quick to arise and resolve, or it can be a more chronic issue where inflammation has subsided, yet pain persists. In either case, it may be that the loads on tissues at the bottom of the foot have become too much or have lasted for too long and have generated a pain response. The fascia in the region may be affected, along with the muscles that attach to it, but ultimately it may really come down to weight distribution across the foot.
Loading of any tissue for a long duration causes change within the tissue itself. There is well established phenomenon that describe the ability for long duration loads to change the length and density of connective tissues. The plantar fascia has the same characteristics. Imagine for a moment that you are standing on your toes to reach in your highest cabinet, now stay there for a year. You may not feel so good when you come down to your heels again. That constant tension applied to the bottom of your foot changes the shape of all the tissues in the area to such a degree that blood flow may actually get reduced. If that is maintained for too long tissue breakdown occurs and we get notified via pain signals.
I use this extreme example only to demonstrate a point. It appears as if many of us walk around with an uneven distribution of our weight being placed on the forefoot, closer to the toes. Like walking around doing calf raises all day long. This has utility for short periods of time, or brief moments when we need to generate force quickly. However, over the long haul it can be detrimental to our foot health. The foot is not the problem; the issue can be due to a system-wide movement strategy. Our center of gravity (think belly button), can be out ahead of our feet, leading us to move faster. That position places the weight on the front side of our feet, resulting in tension through the plantar fascia and other components nearby. Potential solutions involve shifting things back toward the heel via exercises that help you unlearn and then move differently. Movements like floor pressing, wall squats and the warrior pose in yoga can all be coached to improve this issue, via weight shifting toward the heels.
Plantar fasciitis, like many other movement related issues, can often be due to a global movement strategy placing focal pressures on one tissue. Altering how we move systemically can pay huge dividends in removing those pressures and restoring tissue health. Finding those alterations is where a good coach comes in.
Austin Ulrich, Physical Therapist
