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Treating Plantar Fasciitis

Updated: Aug 21

Over the last year I have had an increase in clients looking for help with plantar fascia pain. Your plantar fascia is a band of connective tissue that spans from heel to toes and problems in this area are generally labeled as ‘plantar fasciitis’. As with anything soft tissue related, plantar fasciitis has many causes and treating this painful condition is not a one size fits all protocol. In this article, I’m going to go over the anatomy related to plantar fasciitis (referred to as PF from now on), common triggers to look for, and tips

anatomy of plantar fascia

to help you find relief. 


I say PF pain is ‘generally labeled’ as fasciitis, because on people who I work with who have been diagnosed with this condition, I don’t palpate much inflammation, as the term ‘fasciitis’ implies. To me, inflammation refers to acute injury, hot,  red, sometimes swollen tissue that doesn’t benefit from much myofascial release or deep tissue. However, in all of the PF cases I have worked with, there has been positive physiological responses to these techniques. On these PF diagnosed feet, what I do feel is excess tension, bunching or contraction of fascia below the heel (the stirrup), and tight calf muscles . In the image on the left of the deep calf muscles, you can see how their tendons attach directly to the plantar fascia around the heel.

deep calf muscles

With PF there can also be an overstretched plantar fascia and upon further researching the condition, I have found that in many people there is a connection between PF, pelvic misalignment and tension around the lower lumbar spine. In cases where plantar fascia pain is due to a tear in the tissue or detachment of a tendon from a bony landmark, there would be more pronounced inflammation and the area would be super tender to touch. This type of issue should be treated as an acute injury, and that is not the topic of this blog. To understand how fascial tension, overstretched tissue, pelvic/lower lumbar alignment can contribute to PF pain, we need to go over a bit about the nature of fascia. If you want to dive even deeper into the role of fascia and how it functions in your body as a whole, I recommend a previous blog post of mine which you can find HERE


Your myofascial system is quite literally the connective tissue that holds everything together and in alignment (or misalignment) in your body. Cells, nerves, muscle fibers, veins, organs etc. are all surrounded in sheaths of fascia. Fascia is a hydro-collagen rich connective tissue that has piezoelectric properties - which means it stores energy, moves fluid (is a big component of the lymphatic system), and serves as a conduit for electrical (nerve) and endocrine messengers. Without fascia, your body would have no structure. Your fascia holds your organs, bones, muscles in place according to your daily/weekly/yearly patterned movements. For example, if you are someone who sits a majority of your day and doesn’t break up that pattern with opposing movements, your fascia will start to calcify, tighten and elongate to support the sitting position. This is why regular movement, strength training, stretching and bodywork is so important. All of these things help to break patterns of stagnation from repetition that leads to chronic pain, structural misalignment, arthritis, fascial dehydration and general inflammation. 


Depending on your movement and postural patterns, fascia can either constrict through bunching -  such as ‘knots’, where the fascia gets caught in a contracted state (imagine a  crumpled up piece of tissue paper), or elongate and become stuck in an overstretched and ‘taught’ state (imagine a rubber band stretched and held to its fullest capacity or a guitar string). Both of these manifestations are expressions of tension and can cause pain, limited mobility and other inflammatory conditions, such as arthritis or tendonitis, over time. In regards to PF, I have felt both of these types of tension manifest in different people and both types of tension respond well to general manual myofascial treatments, movement protocols and specific at home care. In all of the PF cases I have worked with, it is clear (as it is with other structural/myofascial pain patterns) that this is not an acute issue, but one that develops over time. Many people who go to the doctor with PF are told to RICE - rest, ice, compress, elevate - which is simply not effective for treating this type of condition, because it is not an acute injury! It is therefore important to take a look at your movement patterns during the day, your pelvic alignment and general posture, the types of shoes you wear and your overall foot health/mobility to come up with a treatment protocol based upon your unique disposition that gets you lasting results. 


So how and why is the plantar fascia connected to the  pelvis, calves and lower lumbar spine? Well, it is actually connected to a whole myfoscial line that spans from the bottom of your feet to your cranial

superficial back line fascia train

bones. This myofascial line - also referred to as a myofascial meridian - is called the ‘superficial back line’ according to Thomas Myer’s work, Anatomy Trains. When it comes to myofascial meridians, tension and contraction in any part of that myofascial meridian can contribute to pain and restriction in a distant, seemingly unrelated, part. You can see in the image how the calves, SI joints, entire spine, sits bones, cranial bones etc. are all connected and work together to support you. There are all sorts of reasons why someone’s pelvis/SI/lumbar can get out of whack and why PF begins to manifest. It, again, comes down to your individual movement patterns, postural patterns and health history. Generally speaking, issues in this back line/posture that can contribute to PF are: 


-locked knees while standing

-a pelvis that is thrust forward/anterior tilting when standing

-looking down at your phone/computer/projects too much

-sitting for long periods  

-weakened/non-reflexive core muscles (which includes quads, glutes, abdominals etc)

-duck feet when you walk or stand

-restricted foot movement from narrow/non flexible shoes

-flat footedness (no or minimal arch)

-over supination/pronation of the foot (when your weight is unevenly distributed either to the outside edge of the foot or inside arch area)

-tension in the calves - which can often be a sign of needing to strengthen the calves and hamstrings so they can better support you.


Each of these patterns and presentations can lead to or contribute to the plantar fascia becoming tensed and painful over time. Because there are so many contributing factors, there is really no one size fits all remedy for PF. As you begin self treatment, you may experience a bit of a trial and error process in terms of what footwear feels best, what amount of exercise/walking feels good and doesn’t flair it up. Thats OK. 


I can, however, offer general recommendations based upon what I have seen work for people across the board, what helps fascial restrictions in general, and give some guidance as to what you can do and look for to help you move forward in your personal healing process. Just remember, unwinding fascial issues takes time. Consistency is key. You are re-working patterns here.


Of course as a bodyworker, my first recommendation is to receive myofascial release of the feet, calves, and entire myofascial back line. However, while getting a bodywork session to get the ball rolling on this issue and keep it moving is super helpful, it is equally important to continue to work on it at home as this will help you get the most out of your sessions and get you closer to resolution. In terms of at home care, here is a list of things I recommend to clients with PF:


-a nightly ritual of an epsom foot soak followed by rolling the bottoms of your feet on a massage ball/calf stretches, followed by a castor oil pack you wear overnight. You can also get a myofascial release tool or use a foam roller to release your calves/hamstrings and entire back line. 


-calf and toe stretches and strengthening exercises (I will link some YouTube videos below with exercises)


-toe spacers (you only wear these for brief periods of the day to help strengthen and retrain your feet) - bonus points if you wear them while stretching or doing some yoga.


-wearing shoes with a flexible sole and wide toe box to allow your feet and toes to splay naturally and push off naturally when walking. The amount of arch support you need is unique to you. If you are flat footed, getting orthotics or having shoes with a more pronounced arch is important. If you have a good arch or don’t have too much supination/pronation of your foot then you can get away with less ‘supportive’ shoes. You may find shoes with more of a cushion - like teva sandals - are more comfortable. 


-a daily movement/exercise routine that helps you stretch tight leg muscles and strengthens your core, glutes, quads and nourishes your pelvic floor muscles to help counteract any excess tension your posterior muscles and fascia are experiencing. 


-take breaks from sitting during the day with stretches and walks.


-I also do not recommend the use of ice to regularly treat PF. While icing has its place for reducing swelling, pain and inflammation when needed, adding cold to already tight/stagnant tissue doesn’t help it in the long run. You may get some pain relief as the ice numbs the area, but ultimately it only contributes to tissue tension.


While there are some medical remedies out there people have tried - different injections etc (Im not super well versed on these) - and gotten some relief from them, these remedies don’t fix the underlying postural, fascial and movement patterns that created the issue. When it comes to fascia, if you aren’t treating the whole of the system at play, the chances of long lasting relief are limited. Often, the issue will either re-manifest back in the same problem area or manifest somewhere else on the fascial chain. 


If you have any questions or would like a personal assessment/appointment to work with this or a related issue, don’t hesitate to reach out! I’ve pasted some links below to some YouTube videos for at home exercises/stretches you can do. Happy Healing!


YouTube:


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