Managing Plantar Fasciitis

Plantar fasciitis is a condition that affects an assortment of individuals. It plagues those who are highly involved in sports as well as those who are sedentary and often a bit overweight. Despite the variety of people it targets, one and all feel the same: frustrated! Fortunately, it can be a simple condition to manage.

For those of you who have evaded an attack of the dreaded plantar fasciitis and are not quite sure what it is, here is an explanation for you. The plantar fascia is a taught band of connective tissue that runs along the bottom of the foot from the heel bone (calcaneous) to the toes (proximal phalanges). Fascia refers to a web-like sheet or broad band of fibrous connective tissue deep to the skin, around muscles, muscle fibers, and other organs of the body. The function of the plantar fascia is to support the longitudinal arch of the foot as well as aid in the biomechanics of the propulsion phase of gait.

Plantar fasciitis is most commonly caused by either hyperpronation (flat feet), hypersupination (high arches), or excess body weight increasing the load on the plantar fascia. Hyperpronation of the foot is when the inside of the ankle rolls towards the ground, the front foot toes-out, the leg rotates inwards in relation to the foot, and the foot points up towards the sky. Hypersupination of the foot is when the outside of the ankle rolls towards the ground, the front foot toes-in, and the foot points down towards the ground.

Since the front foot turns out in hyperpronation, there is a stretching effect that is placed on the plantar fascia which leads to repetitive tension overload. Supinated feet are quite rigid and are therefore poor shock absorbers. The forces that are usually absorbed through the movement of the foot and ankle are instead transmitted through the plantar fascia and lower leg, again leading to repetitive overload. Both of these forms of overload are what cause the characteristic sharp heel pain that travels along the bottom of the inside of the foot. Individuals experience this pain most severely upon standing subsequent to long durations off of their feet as the fascia tightens while not in use.

Much of the pain experienced with plantar fasciitis is due to scar tissue. Scar tissue is a type of connective tissue that results from the normal healing process. However, it is not as elastic or as strong as normal, uninjured tissue. Due to this inelasticity, the range of motion in the area is restricted and causes a sense of tightness and pain. The plantar fascia is continuous with the fascia that runs up the back of the leg, thigh, and buttock of the same side of the body. This fascial connection is also continuous with the lower, mid, and upper back as well as the arm of the opposite side of the body. Due to these fascial links, other areas of the body can be affected by a tight plantar fascia.

From a chiropractor's perspective, the most effective in-clinic treatment options include Active Release Technique ®, Graston Technique ®, adjustments of joint restrictions in the foot and ankle, and taping and orthotics for severe cases. Instructions for home rehabilitation exercises such as rolling a tennis or golf ball under the arch of your foot, rehabilitation of weak muscles, and gentle stretching of the involved musculature are also essential elements of a thorough plan of management. Shock wave therapy is another technique that is now showing some evidence in the literature for its success. Another effective treatment option for this pesky condition is yoga.

Due to the previous explanation of the plantar fascia's connections with other areas of the body, yoga can function as an effective adjunct to in-clinic treatment or recommendations. Since the plantar fascia connects so intimately with the fascia of the back of leg, downward facing dog pose couldn't be more perfect for addressing the tight fascia of the calf as well as the musculature which can tighten in concurrence with the fascia. Dolphin pose and chair pose (utkatasana) will similarly target the posterior calf with the intention of lengthening the fascia through that area, thereby releasing some of the fascial tension into the bottom of the foot. Downward dog and dolphin pose will target the upper calf (gastrocnemius) while chair pose will focus more intensely on the lower calf (soleus). Garland pose (malasana) is another posture that will aid in releasing the soleus and Achilles tendon.

In working up the chain, the hamstrings also should be lengthened via poses such as standing forward bend (uttanasana), standing half forward bend (ardha uttanasana), and big toe pose (padangusthasana). The hamstrings connect both with the calf on the lower end and the pelvic ligaments and musculature on the upper end. Therefore to address the upper link of the hamstrings, one-legged king pigeon pose (eka pada rajakapotasana) will create an opening through the sacrotuberous and dorsal sacral ligaments as well as the buttock muscles on the front leg.

As the connections continue into the lower, mid, and upper back as well as the arm of the opposite side of the body, spinal twisting poses as well as eagle pose (garudasana) will aid in releasing the fascia through the upper components of the chain.

Numerous fascial paths exist in the body. Entire yoga classes could be organized to specifically target certain fascial connections. Therefore, the above mentioned poses will provide a loosening of the line of fascia that begins at the bottom of the foot and works its way up through the posterior aspect of the body. If you are one who suffers from Achilles tendon troubles, tight calves or hamstrings, these poses are excellent.

Addressing the muscular weaknesses in the body is also essential for developing an ideal plan not only to address the tight areas of the body, but strengthen those which are weak. Most often, weak links cause tightness; therefore, without targeting the origin of the tightness, no amount of stretching will correct the problem. The root of the problem must be discovered for an optimal plan to be derived for an individual.

Remember, a healthy body comes from a balance between the length of our muscles, the strength of our muscles as well as the order in which they contract. Neglecting one area will lead to problems in another. Enjoy the process of learning the balance of your body.

 

Learn More about Dr. Carla Cupido.

My name is Carla Cupido and I am a chiropractor in Vancouver (Kitsilano), Canada, who believes strongly in the bond between yoga and chiropractic. I will be writing a series of articles on neuromusculoskeletal conditions and their connectedness to yoga from a chiropractor's perspective. I encourage you to learn as much as you can about the human body, as the more you understand, the better able you will be to protect yourselves from injury. I wish you all the best in your practices and in your lives! Namaste.

You can contact Dr. Carla Cupido by email at carla@drcarlacupido.com or
via her website: www.drcarlacupido.com.
Her practice is located at 3623 West 4th Avenue, Vancouver, V6R 1J2.
The phone number at the clinic is 604-222-4131.

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