A word to the wise, the way you start your day can dictate how that day goes. When it comes to the common foot condition Plantar fasciitis, those first steps in the morning are not exactly warm and fuzzy. “Good morning, owww! Who put those shards of glass under my heels!?” Yes, some do say it feels like stepping on glass. My clients have also said it feels like stepping on a pebble or a rock.
Even after standing up from sitting for a while some purport it’s like a hot searing poker being jammed into the bottom of the heel. The arch of the foot can also be a point of pain. The silver lining for many is that the pain doesn’t last with each and every step. It’s more like the first few steps are the most severe and then gradually improve with the following steps. Of course, there can be a certain point in the day when you think out loud “my feet can’t take anymore, I gotta get off my feet!”
So what exactly is plantar fasciitis?
It starts with damage to the connective tissue that courses from the bottom of the heel across the arch of the foot and fans out to each of the toes. Usually, a small tear occurs where this dense, tough tissue connects to the heel bone. Bone spurs may happen in this area, too. However, bone spurs don’t always cause pain. In either case, the conservative treatments are virtually identical.
What causes plantar fasciitis?
Plantar fascia tears can happen for a handful of reasons. Since the plantar fascia’s function is to create a fulcrum (windlass mechanism) in the foot to propel us forward like in the example of walking, it gets used when standing, walking, or other weight-bearing activity. If the tissue itself, the attachment point, or the surrounding tissue is overloaded, it will tear. Also, landing hard on the heels (ex. Jumping down from a truck bed onto concrete) could damage the tissue on impact. I’ve seen it happen in many cases from overuse. Simply, a person begins an exercise program or activity that causes repetitive strain on the foot. This is also the case in wearing poor fitting shoes or shoes that lack support in the right places.
How do you identify plantar fasciitis?
Other than inspecting clients’ footwear, I observe the structure of the foot, ankle, knee, hip, and back to identify imbalances. If the structure of the foot isn’t aligned properly then it will increase strain on the plantar fascia. Active postural support is often overlooked or just assumed to be normal in people with pain. Testing the strength of the muscles from the core down to the toes is critical in correctly identifying impairments. I show clients how they can strengthen and support their structure through specific movements with a focus on their weak points in the kinetic chain.
Moreover, if the calf muscle or the muscle on the bottom of the foot is shortened then standing up to walk after sleeping is enough in my mind to cause small tears (microtears) that get worse little by little. Being overweight also is a factor of significance with microtears. The more you weigh (or carry), the more impact the heel receives when walking or running. Over time, the tissue breaks down, resulting in inflammation and pain.
If you are new to plantar fasciitis then you may not know the pain pattern. It basically recycles itself to grow more and more in severity until you do the right things for it. Let’s just say it’s day one. You wake up, stand up out of bed, take a step, and cringe as you lift your foot up to relieve the pressure. Then after a few ginger steps, you can tolerate walking to the bathroom. The rest of the day is not really a problem. On day 2 you wake up and the same thing happens. After 1 or 2 weeks of not addressing the issue, the pain also happens when getting out of the car and commuting to work.
What’s going on inside the foot? The tissue is torn and then when sleeping it will naturally shorten. So this shortening can be worked out but remember it’s healing. When waking up in the morning, without pre-stretching you will stand up with all of your body weight onto a healing tear on the bottom of the foot. By stretching the plantar fascia before standing, you will have realigned the tissue and then can begin re-training it for literally, getting out of bed. Warm-up exercises also help and I recommend them to all of my clients with plantar fasciitis. Not only have I tested these with my clients, but I have also successfully treated and prevented my own plantar fasciitis from returning. The great news is that it doesn’t take long at all to feel relief.
What can I do to help my plantar fasciitis?
Treatment for plantar fasciitis really starts with you at home. Warm-up the muscles on the bottom of your feet, and gently stretch the toes and calf is the best way to start the day. These are to be performed before standing up. Remember, if you can start your day off on the right foot (or left, I’ll explain), your day will be off to a great start with more greatness to come.
Warm-up exercises for plantar fasciitis
Warm-up exercise: Toe crunches
Lying on your back with legs straight. Flex toes as if trying to make a fist, hold 1-2 seconds then release. Now extend the toes up and hold again for 1-2 seconds. Repeat flexing and extending the toes for 10 repetitions. It’s possible you will feel cramping in your foot, more likely in the arch. If you do cramp up, don’t worry, just pull the toes in the opposite direction to lengthen to relax. Work up from 10 reps to 15, 20, and 30. Congrats! you just exercised your plantar fascia! Follow this video for a guided stretch.
Warm-up exercise: Toes Raises
Lying on your back with legs straight. Lift your foot up as if you were trying to touch toes to shins. Hold for 10 seconds, then relax. Repeat 5 times. This will activate the shin muscles and on top of the foot. It will also elongate the calf muscles. Foot lifts are important because the calf muscles attach to the heel at the Achilles tendon, connecting to the plantar fascia. Follow this video for a guided stretch.
Warm-up exercise: Foot swings!
Lying on your back with legs straight. Turn both of your feet in so the soles face each other, hold for 1-2 seconds. Then release the hold and turn the feet in the opposite direction leading with the little toe. Hold 1-2 seconds and repeat swinging the foot in and out from each other for 10 repetitions. The ankle is complex but this side to side motion stimulates the main balance muscles of the lower leg to keep us from falling over. Follow this video for a guided stretch.
Starting your day with Plantar Fasciitis
- Sit up and dangle your feet over the edge of the bed
- Scoot to the edge of the bed so your feet touch the floor
- Place your feet on the floor with most of the weight forward towards the ball of the foot
- Gradually stand upright and keep pressure on the heels light
- Shuffle step of the first 6 steps and then gradually walk normal
Additional (Remodeling) exercises
- Calf stretch
- Plantar fascia stretch
- Resisted plantar flexion
- Inversion (Resisted)
- Resisted eversion
- Self Myofascial release
Modifications for everyday life
- Footwear: wear, support, household, sneakers “yes”, high heels “no”, flip flops “no”, arched sandals “yes”
- Exercise program/activity
- Standing mats
- Foot orthotics
- Weight management
Other healing techniques
- Ice
- Hot compress
- Deep tissue massage
- Dry needling
- Cold laser
- Shockwave therapy
- Iontophoresis
- Surgery
Can plantar fasciitis happen on both feet?
Yes! Unfortunately, it can. I remember one client came to see me with reports of both heels hurting. Her feet were really hot and red. The inflammation was not in question. At that time we used a technique called Iontophoresis which pushes a medication through the skin using a special electrode. It had some good effects, though temporary. Her job was on her feet as a flight attendant which made managing bilateral plantar fasciitis a challenge. In fact, it was chronic for a few years by the time we met.
I haven’t used that Iontophoresis in years but it’s simple to instruct clients on how to perform independently at home. Just need a prescription for the anti-inflammatory medication in liquid form. The combination of treatment (that is always performed on clients in physical therapy) that worked for this client also included foot orthotics, myofascial release to the calf and foot muscles, as well as dry needling.
Does plantar fasciitis also cause knee pain?
No more than yes. I’ve seen plantar fasciitis contribute to knee pain. The reason we came up with was the change in how this person was walking from the heel pain. His gait pattern (the way he walked) had a limp. So every time the painful heel was compressed when taking a step, he quickly shifted his weight to the other foot and this created a quick step. The step was so quick, that it wasn’t landing in a proper alignment for the knee. You see, the heel pain on one side of this body created pain in the opposite knee. Same-sided knee pain can also occur. To be honest with you, the lower back and sciatic nerve are more vulnerable to plantar fasciitis than the knee.
Can I have sciatica and plantar fasciitis?
Maybe you want to ask, is my plantar fasciitis really sciatic? I say this because many a time clients come to see me with complaints of heel pain. They saw the PCP and the podiatrist who say they got plantar fasciitis and go to physical therapy. This is when I get to point out a significant finding to the client, they actually have sciatica not plantar fasciitis. Sciatica refers to irritation of the sciatic nerve, which forms from the lower back and collects into a thick cord about the diameter of your pinky finger, running from the buttock, down the back of the leg and into the heel and toes.
If the nerve is “pinched” then pain can be experienced just in the heel or bottom of the foot. Just like some people have pain on the outside of the ankle and wonder, “I don’t remember rolling my ankle, why does it feel like I sprained it?” Referred pain is the term to describe this. Treating heel pain that is cuse from the lower back or sciatic nerve often involves techniques to decompress the nerve like spinal traction, nerve flossing, and core strengthening.
When do I need to go to physical therapy?
If you are hurting now or are in between painful flare-ups, now is a good time. I start all new clients off with an initial evaluation. This gives us a chance to learn about your story, examine, explain and begin care. At My PT, we cut right to the chase because I work for you, not the insurance company. After I figure out what you are doing I’ll tell you what you need to be doing and what, if anything, I can do to help you in addition. On average, clients spend about 8 sessions working with me on a schedule that works for them. If you didn’t follow through with the suggestions above then you can give it a try.
If you want to save yourself some time trying to self-diagnose and treat the wrong thing, book an appointment with Dr. Tom.