Plantar Fasciitis: The Real Cause of Your Foot Pain
Plantar fasciitis is a condition that is defined as inflammation of the connective tissue on the sole of your foot. While this is a very general definition, let’s break down what is actually going on with your foot and why no matter how much you stretch or dig into that tender spot, your pain just won’t go away.
This plantar fascia we are referring to is actually what’s known as an aponeurosis, a white tendonous tissue that connects the bottom of your heel bone, the calcaneus, to the many muscles of the forefoot. Fascia on the other hand is a thin saran wrap like sheet of connective tissue that surrounds and anchors every muscle, organ, bone, blood vessel, and nerve in place. So, while similar, the aponeurosis is actually the source of your problem due to its much larger role in the stability of your foot and its arch.
Plantar fasciitis pain is typically worse in the morning upon waking which lessens throughout the day while still remaining persistent. Pain can be localized to one spot of the aponeurosis, like the inside of the heel, or can be spread out along the length of the connective tissue to the ball of the foot. Often, treatment will consist of resting, stretching, icing, taking anti-inflammatories, or wearing orthotics. While some of these remedies may cause temporary relief, they are only treating the symptom and not the cause of your dysfunction which is why that pain never truly goes away.
The Muscles Involved
The main culprits of your plantar fasciitis pain are two muscles, the tibialis posterior and the soleus. These muscles are important because they connect your tibia and fibula together, aka your shin bones. If the tibia and fibula develop dysfunction due to diminished stability, pain can often pop up further down the chain in the foot. The tibialis posterior also attaches to the interosseous membrane which resides between your tibia and fibula and acts like a web that further anchors them in place. The tibialis posterior then wraps around your medial malleolus – your ankle bone – and has multiple attachments to the bones along the base of your arch. When the tibialis posterior is not functioning properly it will affect the stability of your shin bones, which will affect the stability of the arch of your foot, which can then cause issues with your plantar aponeurosis. Your plantar aponeurosis will receive the brunt of whatever dysfunction is present further up the leg as it is the lowest link in the biomechanical chain. The tibialis posterior has a primary role in pronating and supinating the foot, and a weakness can cause the arch of your foot to collapse as your ankle rolls inwards and flattens your foot.
The second muscle involved is the soleus. The soleus is a deep calf muscle that resides just behind the thicker, more prominent gastrocnemius. The soleus also connects the tibia and fibula together – common theme – and runs down the back of your leg to form the Achilles tendon. The Achilles tenon then attaches to your calcaneus bone, the same bone your plantar aponeurosis is attached to. The soleus is a primary plantar flexor of the foot which allows you to point and stand on your toes.
The True Cause
The final thing that ties your tibialis posterior and soleus to your plantar fasciitis is that they are two of the most common muscles that are affected by stress. Every organ in our body has a muscle relationship and it just so happens that the adrenal glands have a direct connection to your tibialis posterior and soleus. So, while the posterior tibialis and soleus are triggering your plantar fasciitis, your stress is actually what’s causing it. Stress can result from anything including overtraining, being out of shape, eating poorly, not sleeping enough, overstimulating yourself, dealing with emotional stress, or a million other things. Over time, these muscles will begin to fatigue, start to weaken, and then be unable to carry out their function. Treating the tibialis posterior and soleus will greatly speed up the process of healing your plantar fasciitis but reducing your stress will be the key to reversing it and keeping it from coming back.
How To Treat
In order to treat plantar fasciitis, an experienced practitioner will need to focus on what is causing the weakening of these muscles both directly, either through trigger point therapy or clearing injuries somewhere else in the body, and indirectly through the adrenal glands. Strengthening these muscles through clearing injuries and trigger points allow the muscles to function mechanically and finding out what is stressing the adrenals will prevent them from breaking down in the future. A practitioner will need to introduce certain stresses such as aerobic activity, a certain food or allergy, a stimulant, or an emotional conflict in order to figure out how to fix it, often times with a nutritional supplement. Remember, if you have plantar fasciitis, you are under too much stress, and this must be addressed before healing can occur.
There are some treatments you can do at home to help you function throughout the day in less pain. The first is to roll out any trigger points along your calf and sole of your foot, but DO NOT roll out the specific spot on the foot that hurts. As you use a foam roller or lacrosse ball, roll slowly along the muscle until you feel a sore spot, then stop and keep pressure on that spot for about a minute until the pain starts to subside. Secondly, feel along the inside of your shin bone for sore spots, these spots will be deep behind the shin bone where the tibialis posterior resides so it will be difficult to reach and sometimes quite painful. Do not overdo it with these trigger points as too much irritation can exasperate the problem. The last thing you can do is to start naturally strengthening your feet by going barefoot whenever you can, especially inside the house, and wearing barefoot/minimalist shoes while outside. Take it slow when transitioning to these types of shoes as they have a zero-drop sole that provides no arch support. Your foot muscles may be unaccustomed to having to actually work in order to walk, especially over long periods of time. These shoes are incredibly helpful as they have a large toe box allowing the toes to splay and take its natural position, allowing the plantar aponeurosis to do the same. Poor fitting shoes, especially ones that are too small will cause the foot and the aponeurosis to shorten resulting in pain. Ideally you would like to have a thumbs width of room between your big toe and the tip of your shoe. While they can be expensive, Xeroshoes.com and Vivobarefoot.com shoes give you the most barefoot feel by having the least amount of room between your feet and the ground while having a large toe box. Vivobarefoot have very nice casual shoes, which to be honest is very hard to find, while Xero shoes are great for athletic activities.
The Do NOT's
Things that you should not do for your plantar fasciitis are stretch or ice the area as we need to treat the cause of the pain and not the pain itself. And while it may seem like a good idea to stretch your calf, you are only lengthening the injured muscle and not helping it. Do not roll out the bottom of your foot exactly where you are having pain as this will only add more irritation to the injured area. Lastly, do not wear orthotics. Orthotics provide incredible stability to your arch and in turn your plantar aponeurosis, but it comes at a great cost. Over time you will become more dependent on them as your foot muscles weaken and are replaced by the arch support causing your gait mechanics to alter. This may lead to more injuries in other parts of the body over time and screw you up even worse. Cushioned shoes can be helpful if the pain is too much but raising the heel, especially more than 2-4 mm will cause issues.
Plantar fasciitis is a painful and common condition that requires a thorough investigation beyond the pain itself. Treating the muscles involved, looking further up the chain, and addressing the adrenal glands are the first steps to truly healing, and this requires a knowledgeable practitioner. Make an appointment with a professional in your area to get started.
Disclaimer: Dr. Bill Schuler is a licensed Chiropractic Physician and Applied Kinesiologist in the state of North Carolina. Information on this website is provided for general educational purposes only and is not intended to constitute (i) medical advice or counseling, (ii) the practice of medicine including psychiatry, psychology, psychotherapy or the provision of health care diagnosis or treatment, (iii) the creation of a physician patient or clinical relationship, or (iv) an endorsement, recommendation or sponsorship of any third party product or service by the Sponsor or any of the Sponsor's affiliates, agents, employees, consultants or service providers. These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any diseases. If you have or suspect that you have a medical problem, contact your health care provider promptly.