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In part 4 of our series, we are going to turn our attention to plantar fasciitis. This is a common malady of runners and athletes of all shapes and sizes and can impact your ability to function in significant ways.
In order to understand plantar fasciitis, we should first consider that it is often a catch-all diagnosis used by athletes for any sort of heel pain or sole of the foot pain. While pain in these areas is common, in order for it to truly be considered a plantar fasciitis, you would expect to have pinpoint pain directly at the medial calcaneal tubercle. Here’s a picture!
Notice that this pain is typically on the sole of the foot, near the heel, on the inside. Also characteristic of plantar fasciitis is a feeling like stepping on a nail for the first step out of bed in the morning. Once you get moving and warmed up, it will typically calm down, but then flare up again at the end of the day when you have been on it consistently.
So, what causes this? Well, that is a loaded question. As is the case with every condition in the human body, it depends. In particular, this irritation at the calcaneus can be caused by a foot that is too tight OR too loose. And by too loose, I mean too weak. You see, the foot itself needs to operate as a rigid lever for you to push off of. But it cannot be so stiff that it cannot flex and accept force, and it cannot be so flexible that your muscles are not able to create a stable platform.
How do you know which is the case with your pain? Well, there are a few things we can assess to check. First, we will check your big toe and calf mobility. Here’s how we will do it:
In the first test, compare your big toe extension side to side. You should have roughly equal amounts of mobility and at least 45 degrees of motion.
In the next test, kneel up close to a wall, and keeping your heel on the ground, see how far away you can move while still getting your knee to touch the wall. You must keep the heel down!
And finally, perform a standard calf stretch while keeping your heel down and see if there is any difference side to side. You should be able to get 4 fingers width away from the wall with your front toes.
If you are lacking range of motion in any of these movements, they are a good indicator that something needs to be worked on. For each of these movements, rolling with a lacrosse ball to the sole of the foot or the calf will go a long way to improving your mobility! Some gentle stretches will help as well.
But what about the other case? What about an arch or foot that is too mobile and too weak? We can test for this as well!
In this first test, keep your foot on the ground but lift your big toe and little toes in an alternating fashion. We call this toe yoga. Don’t expect this to be easy!
In the next test, stand barefoot on one foot and see if you can keep your balance or if your arch and foot are wobbling all over the place to stabilize.
If either of these tests were difficult or impossible, you likely have a strength deficit issue. You should also roll with a lacrosse ball to your calf and foot, and you should also include exercises and balancing on one leg.
While this article is just scratching the surface of plantar fasciitis, it hopefully offered you some ideas on how to approach your pain. There are certainly other reasons for heel pain, such as nerve tension, stress fracture, posterior tibialis tendonitis, and more – but those require a more in-depth assessment that can be achieved in the clinic!
Have any questions about what to do for your heel pain? Reach out to us today at 770-842-1418 or ryan@precisionpt.org.
Thanks for reading!
Ryan
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