Plantar Fasciitis. What The Heck Is It? And Why Natural Foot Orthotics Work!

I am Dr. Rehm and started my practice in podiatric medicine and surgery in 1977. I will tell you that one of the most common problems that have come into the office consistently since I started practice has been a condition called plantar fasciitis. Because I know that many of you reading this right now are undoubtedly suffering from this painful condition I am going to explain what this condition is, what causes it, and what can be done about it.

Overview of Plantar Fasciitis

Let me start out our “voyage to the bottom of the feet” by telling you that the foot is comprised of 26 bones. They are anatomically shaped so that they fit together like the parts of a  jigsaw puzzle where each piece fits just right into its connecting pieces and kind of locks together; once it’s all put together.  When the bones of the feet lock together, like a jigsaw puzzle, this is called the natural or neutral position of the foot, the position that Mother Nature wants your foot to be in. This is the most stable position of the foot; and when the foot is in this position, it helps prevent the foot from over-moving and/or rubbing the foot on the inside of the shoe which in turn causes a myriad of problems including bunion and hammertoe pain, pinched nerves on the bottom of the feet (ouch!) and yes, painful plantar fasciitis. In order to prevent these problems from occurring, the foot has to maintain this jigsaw puzzle posture, where the foot does not over-move or rub on the inside of the shoe.  The Natural Foot orthotic, a custom-fit quality insert, is ideal for maintaining the foot in this desired Mother Nature’s jigsaw puzzle posture. The plantar fascia is a thick wide band of tissue, similar to a tendon or ligament that travels from the heel to the toes and helps to keep the jigsaw parts of the foot from becoming misaligned and out of place. If the foot over-moves, the plantar fascia over-stretches, pulls on the heel bone, and becomes inflamed and very painful. The Answer? A Natural Foot Orthotic which snugly hugs the bottom of the arch of the foot helps to eliminate the pull of the plantar fascia and all the problems it creates.

Meet Plantar Fasciitis: Getting Into The Meat of This Painful Problem

How do you know you have Plantar Fasciitis?

In order for someone experiencing pain in their feet to choose the appropriate remedy for their discomfort, they would need to know what is specifically causing their painful discomfort. In this case, becoming familiar with the signs and symptoms of plantar fasciitis would be a helpful 1st step. The most common signs and symptoms of plantar fasciitis include:

• Plantar Fasciitis pain on the bottom of the foot near the heel. Most of the time it involves only one foot but may include pain in both, where one foot is predominantly more painful than the other.
• Plantar Fasciitis pain has been described as a pulling tight stabbing type of pain, but the patient usually has difficulty describing exactly where the pain is. When examined the maximum point of pain is at the attachment of the plantar fascia with the heel bone on the bottom middle of the foot.
• Plantar fasciitis is usually accompanied by other problems caused by the same abnormal posture of the feet, such as nerve pain on the inside of the heel arch area and heel spur pain. A tight Achilles tendon is commonly part of the clinical picture.  It is important to identify these accompanying problems to assure a more accurate treatment plan.
• Plantar Fasciitis pain can be more intense with the first few steps after getting out of bed in the morning or after a long period of inactivity, such as after a long car ride.
• Plantar Fasciitis pain can become more intense after (not during) exercise or activity.
• In my practice, I have noticed that plantar fasciitis comes along rather suddenly after starting a new activity that involves significant arch stress such as playing tennis, running, or on your feet all day at your job.

What Causes Plantar Fasciitis?

The pain from plantar fasciitis is caused by inflammation. This inflammation is in turn caused by overstretching and pulling of the tendon-like structure on the bottom of the feet. Why does this tissue over-stretch? It over-stretches when the foot tries to balance the body by pronating too much. Pronation is defined as the natural inversion type of movement of the foot in an attempt to distribute and balance the weight of the body during weight bearing. When the foot moves in this direction too much, the plantar fasciitis is stretched too far, pulls on the heel, and becomes inflamed. The abnormal amount of this natural movement (over-pronation) happens when people:

• Are on their feet all day at work, for instance.
• Engage in sporting activities that would require over-ambitious movement.
• Participate in an activity for a prolonged period of time on a hard flat surface such as a cement sidewalk or warehouse floor.
• Are involved in ambitious weight-bearing activity without stretching or warming up first, causing a sudden jolt to the already tight plantar fascia.
• Wear shoes that do not support the arch or do not have the appropriate arch support in them.
• Do not wear any shoes at all and do strenuous weight-bearing activities barefoot.
• Have either a higher or lower than normal arch type of foot.
• Who are abnormally overweight or gaining weight rapidly.

How is Plantar Fasciitis Treated?

• Managing plantar fasciitis with at-home and over-the-counter remedies. If you are certain that plantar fasciitis is your problem then addressing your problem yourself in the following way might be helpful as initial steps at getting rid of your problem:

1. • If you are able to and have the approval of your healthcare provider and there are no contraindications, then over-the-counter anti-inflammatory medications would be appropriate.

1. • Making sure you have a very supportive shoe, such as a good running shoe with a shock-absorbing sole and heel, a proper pitch of the shoe, supportive heel counter, wide-enough toe-box, higher vamp, and a reinforced tip, sides and heel collar, among other features that make up a supportive healthy shoe.

1. • When plantar fasciitis first starts it would be helpful to

• • • Apply ice packs covered with a towel 10-15 minutes twice a day
    • Rest your foot and eliminate the activity that causes pain for about a week
    • Message your feet and stretch the affected arch
    • Strap the affected foot with athletic tape

1. • If the problem persists for more than a week or gets worse see a podiatrist for more aggressive and definitive treatment
     • The podiatrist may suggest taking x-rays, prescription oral anti-inflammatory medication, injections and professional strapping, or medical grade walkers or boots, prescription orthotics, and braces, different types of physical therapy modalities, and shockwave therapy.
     • Invasive or surgical procedures are available for the treatment of plantar fasciitis that is not amenable to more conservative therapy.

1. • If and When your plantar fasciitis improves or resolves:
     • Confirmation of the activity that was the permissive factor to allow the plantar fasciitis to occur
     • Realize that there is most likely an underlying problem of foot posture that was instrumental in causing this problem
     • Address all these underlying factors
     • Realize that over-pronation is most likely the culprit and consider over-the-counter, custom-made, or custom-fit orthotics, such as the Natural Foot Orthotic
     • Focus on your goal, getting back to or modifying your activity, and PAY ATTENTION TO PREVENTION!

Preventative Strategies for Plantar Fasciitis

The best strategy for the prevention of plantar fasciitis is a mindset that involves: your health, your activities, and your goals.

Your Health:

The pain that is caused by plantar fasciitis involves inflammation. This inflammation is caused by activity-specific micro-injury combined with a person’s individual inflammatory response. This inflammatory response is different for everyone and depends on a person’s body chemistry. Some people have high inflammatory responses and some have low and are often related to a person’s overall health status or conditions. Maintaining overall health, such as eating a low-inflammatory diet, weight management, maintaining minimal stress and good sleeping habits should all be part of this effort.  Maintaining foot health and having regular checkups by your podiatrist and primary care provider is essential to your preventive strategy; as well as having healthy footwear which includes supportive shoes and quality arch supports or orthotic inserts, a healthy and appropriate workout and exercise schedule focusing on core and lower body muscle strength, balance, and flexibility. Exercises should support your choice of activities. For instance, if you are a runner or a skier, there are exercises and training that will support these activities. Also, know there are many health and other foot issues that can show up similar to plantar fasciitis. It’s important to contact your podiatrist and physician to get a complete and accurate diagnosis.

Your Activities: “Support Your Sport”

Choosing activities that are appropriate for your age, physical condition, body type, and schedule are essential to preventing conditions such as plantar fasciitis. Exercise should support your activities, that is, be in shape for your sport. If you go skiing for instance make sure you are in shape for this activity. Whatever sport or activity you engage in on a regular basis for it to prevent injury and to be sustainable and advantageous, it must be consistent, regular, organized, measurable, enjoyable, and consistent with a plan of what you want to accomplish.

Your Goals:

In order for an activity to be injury free, one has to have a mindful attitude. Do your activity or sport knowing the risks and benefits; and perform these on-purpose, controlled, organized, planned, orderly, and intentionally; as well as being proactive instead of reactive and helter-skelter. It is best to outline your desired outcome and then design a gradual program with attainable goals in mind. Now that you are without your plantar fasciitis, there is no excuse! You can now jog your heart out, go back to the gym, or even attend to that long-standing honey-do list. Keep Your Feet… Healthy! Dr. Kenneth Rehm Learn more about various foot ailments and how to treat them from Dr. Rehm