Treating plantar fasciitis (and a bit of my journey)
Plantar fasciitis sucks. Sometimes it burns, aches, tingles, and makes you feel completely hopeless/incapacitated sometimes. Ok, a bit dramatic, but it’s hard when you’ve lived your whole life very actively, it changes a lot. For fear of my feet hurting, I stopped running, playing soccer, I’ve taken buses when I could walk, I’ve stayed home from doing fun stuff, and I get a lot of anxiety about being on my feet.
So it’s been about 1.5 years of dealing with it. I first got it in Fall of 2015 during football season with those damn 3-a-days. Thankfully, I study athletic training and I’m around athletic trainers all the time so I know how to treat it. I learned at least one thing from each of my preceptors. (This whole thing is quite long, I’m sorry).
- Football: At first, 2–3 weeks prior to school starting (pre-season), my feet just hurt. When classes began, I had just understood what plantar fasciitis was, so I just briefly asked my preceptor and he told me I did have the symptoms, and said that I should do 4-way ankle exercises to keep my ankles healthy. I was definitely skeptical because, I mean, it’s a foot problem, why does my ankle matter? Oh, silly Jen…
- Softball: I got orthotics this semester. I was hurting, oh boy. I even cried during clinical once because I was freaking out. I was told to go see Student Health, and I did, and I got my orthotics, and they were nice.
- Summer soccer: I don’t remember exactly what I learned, but I finally ran into an athlete with a similar problem so that was a big deal to me. This was also when I only slightly irritated my IT bands and I thought I was going to never be okay again, and I was so mad I hurt myself AGAIN. Thankfully, no new problems have popped up again.
- Soccer at CMU: My first preceptor taught me foot intrinsic exercises, which I’ll explain later. The other one showed me good ways to massage and do active release for pronation, and the other one told me to get a night brace. This semester was also when I really got into my rehab research and I’ve developed a comprehensive plan for it!! So exciting!
- Wrestling: nothing yet, but we’ll see. At this point I’ve got a pretty good handle on it.
So what have I learned from having plantar fasciitis?
- Don’t talk about it that much. I’m guilty of it, I like being the center of attention. But it’s really a very common problem, and I need to relax, I’m not the only one who has it.
- There will be good days, there will be bad days.
- Myth #1: Orthotics will make me stronger. NO. Orthotics ARE A CRUTCH. THEY WILL WEAKEN YOU!!! They are not the solution!! They are a short-term helper to relieve your pain, but you can’t rely on them forever, and you should really only wear them on bad days. It took me so long to figure that out. Most of the time, I would tell people the problem and they’d say, “Okay, get orthotics!” Which is perfectly understandable, that’s what always happens. So I did. But then, I wasn’t getting better. I saw that everyone online said, hey look, stop using your orthotics so much, they make you weak! I didn’t believe them. But one day I had enough, so I tried it — just stopped using them completely. Absolutely nothing at all. The first few weeks were extremely sucky, my ankles were always tired and weak feeling. Ouch. But recently it’s been so much better, my ankles/feet feel WAY stronger!! It’s amazing.
- Myth #2: Orthotics will make my feet hurt less: yes, but only when you remember to wear them. And what about your fancy shoes that your orthotics don’t fit in? Instead, there needs to be foot development that can allow you to wear all types of SENSIBLE but variable shoes.
- People actually have really weak feet and do not use JUST the feet enough (without shoes): It’s so important to get that barefoot experience from time to time, so you’re truly using all your toes, not your whole foot as one thing. It should be a lot of parts working together as one unit! I walk around barefoot in my house a lot, and I do almost all my workouts without shoes because I want my own body to maintain the correct alignment, not the shoes. If you don’t have stability on your own, then…you better get some. So you know those barefoot shoes? I used to think I could never wear them, but now I’m seeing I definitely could, after working on my arches and such. They may not be for overweight people or severely deficient feet, but for the normal person, they are awesome.
- The arch doesn’t just collapse along the long way of the foot. It can collapse the other way, along the front of the foot too!(Where the toes begin). You must get that arch back. So it hurts, but sometimes I place a small ball under that arch and push my outer toes down around it, stretching my transverse arch.
- The muscles on the bottom of your feet are probably weak, meaning the muscles and the fascia on the top of the feet are being overworked, and tightened because of the collapsing arches. I mean, that’s my theory? So I stretch that, and then I sometimes massage the top of the foot to try and loosen that tissue. Lovely.
- Night braces are great! At least, I personally liked it. Don’t get me wrong, it looks like a walking boot and it can be really hard to sleep with it on, especially when you’re sweating and uncomfortable. Do NOT get the sock ones, those just end up stretching your toes and don’t do much for your actual calves, which is what the key is. When you sleep, your feet naturally point, which really shortens all the tissues on the bottom of your foot, which is why they hurt so much in the morning. So this just keeps your feet in that stretching position.
- Feet are very particular. You have to really sit there and look at the history to figure out how it happened, whether it was from compensation, or if it was what caused compensation in other body parts. But you need to know that to understand how to treat. You can’t just treat the feet, you do the ankle muscles, calf muscles, gluteus muscles (which are way important!). So that was really important to learn. Yes, treat the area that hurts, but also figure out the causes of the pain, which usually isn’t the location of pain. Fix those too or you’re just treating the symptoms
- Work on your gluteus medius muscles: I’m absolutely serious. Those clamshells, monster walks are NOT just for knee and hip injuries. That little guy is so important, even for your plantar fascia/pronation. I mean, really, your plantar fasciitis probably happens BECAUSE you’re weak somewhere else!! Not necessarily the glut med, but pretty often, it’s that guy.
Okay, now onto my treatment plan:
- Ultrasound: I actually liked using this to warm up my feet before doing exercises, also since I have some turf toe going on it’s quite nice. But it’s not necessary, it’s really just a luxury.
- Graston: OUCH. I would often use a butter knife (with lotion or coconut oil) to scrape at the bottom of my foot, focusing on the medial area and the heel. But you gotta do it sometimes!
- Massage: I use my knuckles a lot, and I do it in fully lengthened (foot flexed fully, toes extended) and shortened positions (ankle plantarflexed, toes curled)
- Myofascial release: with ball. I do the transverse arch, work on toe extension, the longitudinal arch (medial AND lateral). I use a small spiky ball as opposed to a lacrosse ball, since your feet are too small for a lacrosse ball usually. Also it’s important to release the calves if they are tight (which they probably are), even going up to the hamstring (all that posterior chain stuff). Here’s my favorite release method: https://www.instagram.com/p/BPiNRONhCsy/
- Wall drill: stand in front of a wall, feet forward, a few inches away. One knee at a time, try to touch the wall with your knee. If it’s easy, back up. Back up to the point where you have to push hard to touch the wall with your knee. This is a dynamic drill! I usually do 3 sets of 10 per side.
- Dynamic squat: People always say NOT to let your knees cross your ankles, but it’s okay if you load it correctly, and slowly. So I get down into a squat that is maximally stretching my calves, and then I come up. It’s also dynamic.
- Loaded squat: I’ve seen people hold the above squat position, and then they may also hold a weight, using the weight to dig down and get more mobility. In any stretches that involve your foot flat on the ground, remember not to let your foot collapse, because that in turn will bother your knees, and also, it’s just not good mechanics.
- Big toe extension: why?? Well, I haven’t figured out exactly, but it definitely has to do with the path of fascia, I’ll figure it out…but my foot that has less big toe extension is definitely the more painful one. I usually put a lacrosse ball under my big toe to stretch it, and then press down on the ball to train that new ROM. Or just sit there and stretch your big toe.
- Ankle mobilizations: I’m linking 2 videos because honestly, I can’t explain it. https://www.instagram.com/p/BNnUyURB_1_/ and https://www.instagram.com/p/BNmrO-ohs0b/ I hope they work, if not, they’re under the account “@Footcollective” which you MUST follow! These things are great, but they’re not necessarily a stretch, they’re more helpful in regards to the capsule and other tissues.
- Gastroc stretch: This is the standard stretch, ankle flexed as much as possible, knees straight. I do this against the wall so my toes get a stretch too.
- Dynamic calf stretch: I do this in a plank position with my knees straight AND with knees bent, pushing down on my heel with my other foot to stretch. I just like it in a plank because you might as well get 2 things out of one.
- Soleus stretch: Same as the gastroc stretch, but bend your knee here to stretch it!
- Kneeling toes stretch: Kneel with your ankles and toes curled all the way under you, so you’re really feeling a calf/big toe stretch at the same time.
- Tibialis anterior/peroneals: these are important to release! Especially if you are pronating or feeling more pain on the inside of the foot/lower leg
- If you pronate: The outside/back half of the foot needs to be released. I usually just hold it down on the edge of a table, or you can have someone do it for you, it’s a weird sort of place.
- It honestly doesn’t matter how you stretch, but get it done. Well, first release, then stretch. Mobility/flexibility take a long time to train but it’s so important if you want to fix this and get healthy feet.
- 3-way ankle: I generally avoid doing plantarflexion because honestly, your posterior calf is already so tight, and you use it walking allllll the time, so I just do the other 3 directions. Also, you’ll be doing calf raises later.
- Foot intrinsics: Working on your intrinsic foot/toe muscles. I’ve attached a video from my personal instagram account: https://www.instagram.com/p/BPIYAr2hNHx/ THESE ARE A LIFESAVER. I got these from my preceptor in the fall, and honestly this is what got me into looking up other treatments. LOVE these. I usually do 30 reps of each thing right in a row, to really tire it out. You’ll be working toe extensors/flexors/abductors/adductors, and also getting that neuromuscular control practice in.
- Calf raises: Okay, so there’s something called the windlass effect (no idea where this came from). But you know how the plantar fascia and the lower leg fascia are linked? Ok, well here’s what you do. You put a towel roll under your toes so that they are extended, and then you perform calf raises. You can do it on a raised surface, but I would suggest not starting with those, you WILL cramp. I still do it on the floor. But what you’re focusing on is the eccentric movement, so I suggest 3 seconds up, 2 second hold, 3 second down. These are apparently amazing as well, I love them a lot. What you’re doing is putting a little stretch on the calf muscle/fascia and then working it, so you’re gaining strength in a more lengthened ROM.
- Balance: neuromuscular control is SOOOO important here! That’s what I was missing all the time. So, one thing I do is stand on one foot, and just do around 30 reps of a short foot stance — think of 3 points of contact, the heel, the pinky toe metatarsal head, and the ball of the foot. So you’re not doing a towel curl necessarily, you’re doing a baby towel curl. Look back to my video of foot intrinsics to see what I mean. I also just do regular balance, so maybe 30 second bouts of standing on different surfaces, eyes open vs. closed. I do another thing where I stand on one foot, and reach my other leg in 8 directions (around a circle like a pie) as far as possible, similar to the SEBT. I’m testing my balance/when my center of gravity changes, and getting some single leg work in. Any sort of balance is good, but you need to be focusing on GETTING. THAT. ARCH. Do not do your balance exercises without forming that arch first.
- When I am doing balance, I remind myself (and my athletes) to GRIP THE FLOOR using my toes!! Really important to do this barefoot. Sounds weird, but it needs to become unconscious.
- Pickup blocks: Whether it’s marbles or pieces of foam, work on using your toes to pick up these blocks and maybe put them in a cup, or somewhere specific. Work on your toe dexterity!
- Work on your gait: You do have to work on this. It’s hard to tell your athletes like “hey, don’t use your orthotics ever and just watch how you walk!!” Because often times they’re not interested enough, I was, because I’m a nerd about this kind of stuff. But when I walk around campus I’m always very wary of how I’m walking, making sure I’m not pronating too much, because that was my root cause.
For me, this needs to become my daily exercise, at least at the start, and I can say that I have not done that. BUT I am trying. The thing I have learned is that a lot of athletes don’t really care to do this much, so that’s when you run into trouble. You have to really figure out what type of athlete you have. If they like fitness and want to really get better, they’ll do it. But if they don’t care enough, then they don’t, and you just have to try your best to get them to do the important things. Not all of what I have is necessary everyday, of course.
I’ve found that so many problems stem from the feet. Knee, hip, back problems, check the feet/ankles. Because why? Your gluteus medius gets weak, your feet hurt, your back hurts because you walk weird and your gluteus medius makes your back hurt. Or something like that. Also, in ankle injuries, the foot strength is important too.
And welcome to the scrambled mess that is my really excited brain! This kinda stuff has made me absolutely love injury prevention and rehab. I’m sure it’s hard to instill injury prevention programs, I’ve obviously never done it, but I would love that in the future. I’ll probably do a thoracic mobility post soon :))