The collapsing of the arch is usually accelerated by ballistic exercising, i.e. running and/or playing shorts involving running and jumping more than the foot and lower leg can tolerate. It is also associated with a new or increased activity level, flat feet, pregnancy and obesity. Plantar fasciitis can also be a direct result of the normal process of aging, as we log 2,000 to 5,000 miles a year on our feet. Our feet gradually get flatter just from walking, as it creates one and a half times our body weight with each step taken. Pregnancy definitely accelerates this abnormality when the woman's body releases hormones in the second trimester primarily to loosen the pelvic ligaments, but indirectly all body ligaments are affected, especially the plantar fascia with the added weight gain. The impact on the feet is made worse by running on uneven terrain, uphill, downhill, or on hard surfaces. Improper footwear, inadequate shoe lacing techniques, including worn-out shoes can also contribute to plantar fasciitis. When the symptoms are only or predominantly on one side of the body, there is likely a longitudinal leg-length abnormality is involved.
Ultrasound therapy in water (hydrosound) will usually produce sharp pain if a fracture is present. MRI's and bone scans are sometimes used to help diagnose. Heel spurs are abnormal growths of the bone, small calcifications protruding from the calcaneus bone where the plantar fascia insertion is. These are a result of the long-term inflammation associated with over pronation, the resulting chronic plantar fasciitis and usually not the cause of the plantar pain. In fact, these heel spurs are common in geriatrics, with or without heel pain, who have 200,000 plus miles on their feet.
How I Diagnose Plantar Fasciitis
Plantar Fasciitis is fairly easily diagnosed by examination. This includes feeling or palpating the patient's foot and watching the patient stand and walk (gait analysis). The history, physical activity description and foot pain symptoms also help me identify the cause and make the diagnosis. I may use X-Rays of both feet and a scanogram, a special X-Ray of both legs, including the femurs and tibias. The average longitudinal leg-length difference in 98% of the population is 1/4 inch.
(Scanogram of Legs)
What is Plantar Fasciitis?
Plantar fasciitis is the inflammation and irritation of the origin of the plantar fascia ligament at its anchor point in the heel bone, the calcaneus. Symptoms include heel pain, especially during the first few steps in the morning after getting out of bed, arising from a seated position or after a period of rest. The pain usually subsides after a few minutes of walking and/or running. The plantar fascia is the connective tissue that runs from the heel to the toes. It is a fibrous bow-like band.
(Plantar Fascia of the Foot)
Injury to this ligament is usually the result of an accumulation of repetitive physical exertion or "over use syndrome." Plantar fasciitis is estimated to cost Americans 200 to 400 million dollars a year, from over 1 million visits to medical professionals and affecting an average of 2 million people, mostly middle aged males. Plantar fasciitis pain is usually felt on the inside or underside of the foot in the heel area and may create difficulty in bending the foot upward towards the shin, even occasionally causing knee pain.
What Causes Plantar Fasciitis?
The cause of plantar fasciitis is a loss of the foot's normal weight-bearing heel angle of 40 degrees, best visualized from the side. Basically, the arch of the foot has abnormally collapsed. This is also referred to as excessive pronation and results in the extra pulling of the fascia into the heel bone.
(X-Ray Side Views of the Feet)
How To Treat Plantar Fasciitis
The practice of Chiropractic involves maintenance of the structural and functional integrity of the human body. A doctor of Chiropractic may manipulate any and all of the body's joints, muscles and connective tissues. During the course of your treatment many physical agents, modalities, techniques and therapies are available to me as your chiropractor to assist in my treatment.
1. Chiropractic adjustments, especially to the lower back, stretching of the foot, calf and lower leg (hamstrings) along with the use of the " Strassburg Sock" during sleep. Hamstring Back Stretch techniques.
2. Special foot taping technique --- immediately shortens and supports the origin and insertion points of the plantar fascia, reducing the physical load on the ligament, improving the heel angle and reducing foot pronation. This is my Foot Pain Taping Technique.
3. Palliative (pain-relieving) treatment with ultrasound therapy to the painful area of the heel, especially if the foot can be submerged in water (hydrosonic therapy), magnifies the micro-massage and anti-inflammatory benefits of the sound waves.
4. Natural anti-inflammatory supplements:
5. Purchase the best shoes for you by using the techniques in The Right Running Shoes. Always use stability or motion control running shoes (NO CUSHIONED or MINIMALIST SHOES), even for walking activities, along with ice therapy few times daily (20 minutes crushed ice application and/or 10 minute Dixie cup ice massage), reducing intensity and/or frequency of ballistic activities and time standing on uncarpeted floors. NO barefoot walking or Barefoot Running!
6. Dr. Paul's Custom Orthotics with a special correction for the short leg and heel spur accommodation, if needed, is the best long-term approach to treat and prevent plantar fasciitis, as these orthotics put the feet in a normal alignment under the legs, correcting both the abnormal heel angle and excessive foot pronation and the true leg-length difference!
Dr. Paul R. Copeskey, D.C., C.C.F.C.