If you are currently suffering (or have ever suffered) from excruciating heel pain known as plantar fasciitis, you also know it isn’t easily remedied. Marissa Oachs, a certified and licensed athletic trainer, offers tips for preventing and caring for plantar fasciitis. Thanks for blogging for me today, Marissa!

Plantar Fasciitis

What is it?

Plantar Fasciitis (plantar fash-ee-eye-tis) is a common problem both among athletes and non-athletes. Let’s first talk about what the plantar fascia (the cause of all these problems) is. The Plantar Fascia is a thick bundle of fibrous tissue that starts at the heel and ends at your toes. It assists in maintaining the stability of your foot especially when landing.

Causes

So what causes this condition? Well, unfortunately a lot of different things can lead to this condition – tightness of calf muscle, wearing shoes without sufficient support in them, running on soft surfaces, different leg lengths, tightness of arch of foot, and lengthening your stride too much while running. Now most of these causes can be fixed or altered to help plantar fasciitis and we will talk about that later.

Signs you may have it

Signs of this are very clear because most of the time – it is very painful! You will feel pain in the heel and it will spread down into the middle of your foot. It is marked by being particularly painful and bothersome in the morning when you get out of bed or when putting weight on your foot after sitting for a long period of time. However, as you walk a little ways, the pain will lessen. You can also test for this condition by pulling your toes and foot toward you (see Picture 1 below in stretching). If this elicits a lot of pain, this will usually point towards Plantar Fasciitis because you are stretching the aggravated plantar fascia.

Care

Keep in mind that you cannot nor will not fix this condition right away. It takes time for it to heal and also to fix the causes. It is not uncommon for it to take as long as 8-12 weeks for this to completely heal and symptoms to stop. It is especially hard to fix because it is a body part you most likely use fairly often. This slows down the healing process. Now that the depressing news is out of the way, on to the encouraging news of how to fix it! You will need to refer to the pictures to see how to do specific exercises.

REST: The first step you always want to take with an injury is rest. This is the only way the injury will get better. I know, I know. It is your foot. You must walk on it to get around. Well, seriously you may need to get some crutches. If it is so bad you must limp around, you need to use crutches, because once you start limping, other parts of your body will start hurting and you will have new injuries and have to start this whole process over again. Fun, huh? If you don’t have crutches (or refuse to use them) just try to stay off of it. Do not walk if you don’t have to, keep your foot up and elevated at all times.

STRETCH: This is a big one with this injury. You will want to do this as often as you can throughout the day and for at least 3 sets holding for 30 sec. Always do stretches gently and not to the point of pain. It should (almost) feel good!

Wall/Stair stretch - See Picture to the left. Find a stair or wall and put the bottom of your foot against it. You will feel a pull – do not push too hard – pain is not good!

Do it yourself stretch: If you are too nervous to try the wall stretch, just start by doing it with your own hand. See Picture 1 to the right. You must do it gently and still hold for 30 sec but you can control this one easier.

Picture 1 – Doing this will cause pain if you have Plantar Fasciitis. However, it is also a great stretch

Ball Roll: This exercise may be painful but pain is OK in this exercise because it is helping to break up the scar tissue and knots that have occurred. Find a ball or thick stick (something that rolls) and put it under your foot. Step down on it and roll it under your foot putting as much pressure as you can handle for at least 10 sec. Do it twice. Always do the stretches from above after and ice.

ICE/ELEVATE: You will hear me say these words a lot with every injury. But honestly, it will be your best friend. Ice the first 72 hours at least. Ice and elevate your foot at least 20 min at a time and do it as often as possible. Do it for sure after you do the exercises from above – because you will get sore!

IBUPROPHEN: Take as prescribed to relieve pain and swelling.

ORTHOTIC: Go to the store and pick out a cushion for your shoe. If this doesn’t work to relieve pain/symptoms you may need to go see a specialist to get a custom orthotic made.

PREVENTION

1) Buy good quality shoes – especially if you are on your feet a lot and/or exercise a lot. You should always give your shoes a 24 hour break for the cushion to re-cushion itself/spring back. So it is a good idea to have two pairs that you switch off each day. The sales people are usually pretty good at stores about knowing which shoes are good and bad. Ask for help – it won’t kill ya! Also, replace your shoes every 500 miles or so of use.

2) Always stretch – especially the calf/foot stretches I showed above. This will help prevent you from getting it again.

3) Maintain a healthy weight – this will help minimize extra stress being put on the foot and the plantar fascia itself.

4) Choose your footwear (or lack of footwear) wisely – Ladies: avoid high heels! Everyone – try to avoid going barefoot, especially on hard surfaces. All of these cause extra stress on your foot’s support system, a.k.a the plantar fascia.

5) If this injury reoccurs over and over for you, make sure to go get your feet checked out by a professional and look into custom orthotics. Many people have a foot type that predisposes them to this injury and if you don’t cushion your foot right, you will continue to hurt your plantar fascia and other parts of your body.

**And remember, always go and get checked out by a medical professional if home treatments do not work. This article is not meant to be a diagnosis or treatment plan for you or your injury. You must be looked at by a professional to know what is exactly wrong. **

Marissa Oachs is a certified and licensed athletic trainer. She has worked with high school & Division I athletes, but also loves to work with the general population or the “athletes of life”. She loves to help people feel better and stay better! She also loves to play sports off all kind, spend time with her husband and 6-month old son, and write for her blogs. You can check out more about injuries and health in her weekly blog series, “What’s Wrong Wednesdays” in her blog “The Hardest Job on Earth” She also has a blog where she talks about her favorite products and books, “The Review Stew”

I have an aunt who, throughout my adolescence,  was kind enough to remind me repeatedly to stand up straight. True, it may have been annoying at the time, but I now appreciate the advice. I would also like to thank my yoga instructors who, over the years, have helped reinforce this mantra. Truth be told, the spine can only handle poor posture for so long. Over time, the rest of the body will adapt to an odd curve as “normal,” and oh, the money you’ll spend to fix your aches and pains later. Again, SO thankful for my repetitive aunt

Quickly, let’s review what good, standing posture is:

knees over ankles, hips over knees (knees slightly bent, ankles slightly dorsiflexed), tail bone pointed slightly down, pelvis tilted slightly back (think of the pelvis as a bowl – tilted forward you’d spill you soup), core engaged (lower pelvic floor tight, lower abdominals engaged, and mid-lumbar relaxed), shoulders even (not pulled up to your ears) and rolled down and back, as though you are tucking your shoulder blades into your back pockets.

And good, sitting posture is:

both feet on the floor, weight of the body squarely over the sitting bones, core engaged as above, lower back slightly tensed and mid-back relaxed, and head and neck in a straight line extending from tailbone to skull. True, this is not practical for many scenarios, but it gives you something to think about while driving a car and sitting at your desk. Also, try to keep your butt relaxed. Out of habit, we tend to tense everything, and there is almost never a good reason to do so. So relax your butt, and often the rest of your muscles will follow the lead.

If you have been practicing poor posture for many years, correcting it will take some time, but you will eventually learn what “normal” feels like and your body will prefer this position.

Brush up on posture basics with these “best of” Blue Sky Gym blog posts:

9 Pointers for Improving Posture

5 Ways to give your back the heave ho

The Devil is in the Details

A Primer on Pilates

After the last post, I collected a number of emails from folks who regularly receive treatment in some way, shape, or form, for their back and back-related issues. I also talked with people I know personally, and did some research. What I found: there is more than one way to skin this cat (and I mean no harm to animals in saying this – it is what it is). Different treatment options work for different people. The back is tricky, but before I dive into fixing it, let’s circle back to why it is important to have a strong back.

Your back is a channel through which all of our nerves enter and exit, and enables us to be mobile. Something my chiropractor said recently keeps striking a chord with me: “The back bone is like the frame of your car. When it is aligned and straight, you can drive fast, smoothly.” This probably hit home with me because my car’s alignment is off, and at 65 mph, it shakes. I can only imagine the needless wear and tear on the car due to the misaligned suspension (its spine), then I thought about my own back, which, thankfully, is in pretty good shape…most of the time, which is why I visited the chiropractor in the first place. I think we can all agree – a strong back and a strong body go hand-in-hand.

There is another saying trainers toss around, that “you are only as strong as your weakest link.” What we are now  learning is that often, the weakest link isn’t really the weakest link, but rather the first place you notice a problem when the back is out of whack.

Example: A knee that hurts when you go jogging could be due to uneven hips, which could be a result of a misalignment somewhere in the thoracic spine. Often, the jogger is told to strengthen the quads, stretch the calves more, and wear a knee brace, or they assume there is cartilage damage and stop jogging altogether. If the spinal misalignment is corrected and stabilized, which may also include some work on the soft tissues surrounding the hip to help ease it back into its proper location – knee pain will likely disappear. If it returns, it can be a cue that “maintenance” is required on the spine, and a readjustment is needed.

I could give gobs of examples, but I’ll spare you the redundancy…suffice it to say, a straight, strong back is the building block for a strong body. This is where the term “core” training comes from, so get the image of six-pack abs out of your head when you hear the words “core strengthening” – what (trainers) are referring to are the spine, and all muscles that stabilize and flex/extend the spine. But those “core” muscles can’t be fired up if there is a weakness in the spine.

Identifying the weak link

This is the tricky part. Many trainers are highly skilled at identifying biomechanical weaknesses, but don’t rely on your trainer alone. If you suspect a misalignment, first visit your general practitioner, who may order a set of X-rays.  From there, there are several avenues to take, including Chiropractic, Physical Therapy, Myofascial Massage (deep tissue), Acupunture, or any combination. Correction may take anywhere from a couple of weeks to several months depending on the nature of the problem and how long it has been neglected. The next few posts will cover the various treatment options and I’ll lay down the resources that will (hopefully) help you make an informed decision about treatment.

Here are a couple of resources to supplement this post, and as always, if you have comments or questions, fire away!

Core Stabilization Exercises
Best Exercises for a Strong Back
The Functional Knee”: Excellent article about the biomechanics of the knee joint!