* Contributed by David Ryan, Dr. Thomas Lee (Orthopedic Surgeon/foot and ankle specialist), Dr. Heather Kite. OhioHealth Orthopedic Foot & Ankle Center
If you are an athlete, it is only a matter of time until you experience some type of foot pain. There are some simple steps that any athlete can take to remove foot pain. I encourage you to stop walking or limping around on the problem, stop taking drugs to just mask the pain, make an attempt to learn about the foot and what you can do to fix it.
What is plantar fasciitis? In general any foot pain that is associated with the bottom of your feet is often referred to as PF. Irritation to any combination of the muscles, tendons, ligaments, but specifically to the area known as the plantar fascia. The connective tissue on the bottom of the foot that extends from the calcaneus to the back of the toes is called the plantar fascia. Long term this condition is properly called plantar faciosis and is more closely associated with the common tendonopathy.
COMMON CAUSES OF PLANTAR FASCIITIS
- Large body mass
- Bad arch support or weak feet
- Direct trauma to the foot
- Hyperflexion, hyperextension, hypersupination, hyperpronation; alone or in combination
- Foot fractures
- Standing too long
- Running, walking, or standing on improper or old shoes
- Tight Hamstrings
- Sleeping with the toes in a pointed position
Let’s take a look at your feet. Learn the basic parts and some basic facts and then you'll have a leg to stand on.
The bones of the foot include the five metatarsal bones, which make up the meat or thickest part of the area, and then there are the phalanges, or the toes. The first toe is the largest and thickest and bears most of the weight and force. When you propel yourself forward, the “Big Toe” bears most of the weight and provides most of the force to allow this movement. Most of the tendons of the muscles attach to the first toe. Now stop and think, while you run or walk, the majority of all of your body weight is on that one toe. Is it any wonder why you might have foot problems? The rest of the bones are mostly for stability. The bones of the foot are well protected, but don't respond well for strong pulling or stretching forces and that is where most of the common injuries occur to the toes.
The heel bone or the calcaneus is the common site for plantar fasciitis. Other more common areas of pain surround that heel bone, but then are more towards the toes. The reason for this local area of pain is associated with the tendon in the foot localized at the heel and spreads out to the various toes.
The most common issues with the bones are stress fractures and they are very difficult to diagnose. Current technology doesn’t permit a clear analyzation and in the younger child and adult it is even more complex. High definition MRI is necessary to clearly see the small changes in the bone’s matrix patterns. Not all MRIs are the same and various powered magnets can range from 0.3-3.0 Tesla. Some higher ranges are used typically in research only.
Holding all of these bones together are the ligaments. The most common reason for chronic pain in the foot is related to the ligaments and tendons. When these structures fail, it often leads to bones moving out of their normal position and wearing abnormally on other bones or soft tissue. Early detection of foot problems is a major factor in preventing more complicated conditions later. Just trying to ignore the pain and hoping it goes away often leads to significant wear that may require a drastic approach.
Tendons and ligaments are mechanically strained/sprained and often this results in a disruption to the local blood supply. Once the blood supply is interrupted it results in further disruption to the formation and repair of the collagen fibers in the ligaments and tendons. This weakens the entire area, and just like a chain reaction, the adjacent fibers begin to take on the additional mechanical stress, and then are also injured. All of this eventually involves micro-tearing and swelling and nerve irritation. Pain is the obvious result of this progression of mechanical breakdown and loss of blood supply. This eventually starts a cycle and further damage to other structures can lead to stress fractures, muscle strain, lymphodema, more pain, etc.
Once this process has gone on for a long enough period of time, various conditions will manifest and likely you will be diagnosed with something that will require surgery. All of this process could have been prevented if only an early diagnosis was correctly made. The motivation here is to seek out a professional at any time you have had condition that last longer than two days.
The muscles in the bottom of the foot are small and thin and easily injured. The most commonly associated is the flexor digitorum brevis muscle. A diagnostic ultrasound can identify some fluid in the FDB, but typically both areas are involved. Other muscles are the abductor and adductor hallicus and the abductor digiti minimi. Any or all of these muscles may be involved with the mechanical breakdown of the plantar surface and hence the distribution of pain on many PF studies.
Obviously there are many causes of plantar fasciitis, but the most common treatment is associated with the use of an orthotic device in the shoe. The function of this device is to reduce the physical strain placed on the plantar surface of the foot. While these orthotics can help stop the pain cycle associated with the PF; a concern is that these devices do not result in an increase of blood supply to allow healing. Other mechanical factors that usually lead to the manifestation of PF are not addressed by simply using orthotics. A multi approach to actually correcting PF is often necessary.
SELF-TREATMENT OF PLANTAR FASCIITIS
The treatment of PF begins with the correct diagnosis. Depending on the intensity and duration of the condition, a single or multiple treatment approach will likely result in success. To have a truly successful treatment you must have the appropriate diagnosis. Many times the failure of PF treatments is directly related to the inappropriate treatment directed at something other than the true root cause of the problem. Read through the list of treatments below. Understand that each deals with a specific segment or factor of a foot problem. Your condition should show some improvement within a few weeks, if not, discuss this with your physician.
Orthotics These come in a wide variety of forms. Some are prepackaged and may be successful since they are geared at correcting the common problems. Other more specific problems are directed at the more specialized orthotics. These may have to be molded or cast, the cost is usually much higher for them.
Strassburg sock This is a commercial product that is basically a long soccer type sock with a long piece of fabric sewn onto the toe. A ringlet is on the top and front of the sock to allow for the fabric to pull the toes upward, thus stretching the bottom of the toes and the bottom of the foot up. There is an orthotic boot that is also used, but it often doesn’t provide enough flexion at the toes and heel, thus no stretch is noted. The device is worn while you sleep and often takes several days to allow for progressive shortening of the fabric band. It is patented, but this idea was originally used by soccer players who used to sew the toes of their socks end-to-end and then slip on the one sock and tie the free sock end around the knee.
ABC exercises General exercise helps strengthen the foot. Most of us don’t exercise the bottom muscles in our feet and just run on them and pound them with countless hours of cardio. Simply sit down and prop up your lower leg on a foot stool. Using your big toe as the lead, begin by making the letter “A” in the air as large as you can without moving the rest of your leg. Continue on until you have made all the letters in the alphabet. Time yourself and eventually challenge yourself by completing the alphabet three times in less time, but with the same extreme amount of foot movement.
Foot grip strength Begin by having a towel on a smooth flat surface, like a hard wood floor. Place your heel on the towel and make sure your toes are free to move. Use your toes to grip the towel and pull it towards your heel. Once you have bound up the towel, reverse the direction and push the towel away from your heel. In some cases of a carpeted floor, you can work the foot by picking up a towel or some tissue paper, then drop it and begin again. These exercises are all designed to work the muscles in the bottom of your foot and to promote improved blood supply and muscle tone.
Running/Walking grip This is a simple idea of learning to gently grip the ground with your foot as you run or walk. The proper amount of tension is equal to that of a steady hand shake; variations will help keep your foot from cramping. This helps promote plantar muscle tone and is a must for anyone with flat feet.
Hamstring stretches Very commonly the rear of the legs is stretched by bending forward and touching the toes. If you are over 65 or get dizzy, then elevate the foot to about knee height with the leg straight and then bend forward and hold for 10, 15, then 30 seconds. Several studies have shown that tight hamstrings result in back pain and also PF. Other factors that have been proven to work with PF include; chiropractic manipulation to the joints of the foot to provide mobility, massage and/or rolling sticks to the muscles to provide skeletal muscle flexibility, cortisone injections to help break the pain/spasm cycle and reduce persistent inflammation. In any case it is very important to stay in touch with your health professionals. It is also important to get different opinions from professionals if you don’t seem to improve after a few weeks of any given treatment. Remember the proper diagnosis is critical in obtaining the correct treatment. Doctors like Tom Lee are board certified in orthopedic surgery of the foot and ankle and are at the top of the pecking order when it comes to foot injuries. Always seek out a professional with his qualifications in conditions that seem to require surgical intervention. That’s why we have professionals, just like him, to make the right call at the Arnold Sports Festival.