It is amazing how many people I encounter on a weekly basis, whether at my clinic or out and about, that complain about foot pain. And all of them tell me they have “plantar fasciitis”. I would tend to disagree.
In today’s world of Dr. Google and social media, most of us are quick to assume we know what is wrong based on the opinions of the internet (and let’s face it, nowadays, it is easier to doubt what we read there than take it at face value). Or better yet, my friend’s cousin’s, sister’s husband had that! But I bet most of these people don’t actually ask the right questions to determine how the problem started, what makes it worse, and better yet does anything make it better?
Plantar Fasciitis or Not?
As a physical therapist with a biomechanics background, I have an innate sense to look at someone from the moment they walk in the door. And over time, there are many similarities I have discovered in those patients that complain about the dreaded diagnosis of plantar fasciitis. I know, I know, but your doctor told you that is what you have. That pain in your foot when you take a step, walk without shoes or try to exercise just has to be plantar fasciitis. Well, what if it’s not??
Did you know that the body is made out of levers? Better yet, let’s say they are made out of teeter-totters. Think of it this way: the bones in our body are like a teeter-totter with the muscles being what makes them move. When you have a heavier person on one side of the teeter-totter, and a lighter person on the other, there is an imbalance present. Without extra effort from the smaller person, the other end never changes its position.
How the Foot Works
The foot works in much the same way (at least for this common issue). Our feet, like the teeter-totter, are mostly in a position that drives our toes and ankle upward the majority of the day. Do you sit with your feet tucked underneath the chair at the office? Do you wear shoes? Walk/exercise or stand? All of these normal activities cause our feet to work mostly in one direction. When you sit with your feet under your chair, you are putting continued stress on your toes to be in a position not much unlike a woman wearing high-heeled shoes. Bet you never thought about that?!
But it is true, and when you do this for multiple hours a day, your poor foot continues to try to get a break. So those muscles under your foot along the arch, from your heel to your toes, those muscles start to fight back. But much like the teeter-totter above, the muscles that are working all the time have the advantage of making it a tug-o-war the muscles on the bottom of your feet can’t win. And so, the battle ensues. Now simple things like standing or putting on any shoe that doesn’t have a ton of cushion become dreaded tasks. And exercise,? Who we kidding?!? Those first few steps of the morning to make it to the bathroom are killer!
What About Painful Steps?
Every step you take when this issue is present is painful and you head straight to the internet, your doctor, or friend that has expertise in body aches because they have had it all. But what those resources often tell you is that you have to stretch those muscles, you should get orthotics for arch support, and yes even so far as to put people in a boot or night splint to assist that area to “heal”.
I am here to tell you that those recommendations are wrong. Does plantar fasciitis exist? Of course, it does, but it is quite uncommon and, in my opinion, requires surgical intervention when it truly is the underlying cause. What if I told you that all of those things actually make things worse? What if I told you that those things prolong the issue and limit improvement in function and what all of you seek… elimination of pain!
The foot is made up of a system, not unlike a bag of marbles, contained but able to move freely. When we walk in a stiff shoe, a hard orthotic, or on concrete that has no give, it is like walking around wearing flippers or a pair of clown shoes. We slap our feet on the ground with very little movement in our feet. Our balance is impaired, our walk looks funny, and our first line of cushions is almost eliminated, and we feel each and every step we take. Now, when the toes, foot, and ankle are free to move in a balanced way not only can we walk on surfaces like sand or pebbles, we no longer have pain or feel like we are going to fall with every step.
Focusing on Your Feet
So, what do you do about these symptoms if the conventional way to treat them is wrong? Well, for starters you need to work to balance the system back out. Focus on your foot position when you are sitting. When you catch yourself tucking those feet, set them flat on the floor. While this doesn’t quite do the trick of leveling the body, it certainly helps decrease the irritation caused by being up on your toes.
You also can start wearing shoes that have a nice snug back to them. Flip-flops, slides, slippers, and even dressier shoes often have a fairly loose fit around the heel. And that means your poor toes have to work hard to hold that shoe on with every step you take. And women…get out of the heels!! I love a great high heel when I’m dressed to go out on the town, but let me be honest: unless I can put them on, get in my car…DRIVE to where I need to go and then walk in to sit looking cute at the bar or theater…I am just not a fan anymore.
Maybe it’s just me getting older, but I am not willing to sacrifice comfort for style if it means I have to be miserable. And one of the best words of advice I can give you is STOP STRETCHING!!! Your arch and calf are working to try and curl your toes and point your foot. Every time you stretch them as a way to alleviate the pain, you simply take away all the effort they have put forth trying to help you! It is like adding bricks to the heavier end of the teeter-tooter; that poor lighter side has to practically jump up and down to even attempt to make his side move!!
Foot Protection & Exercises
Now because this is a blog and I don’t believe patients can be given recommendations without first being assessed by a healthcare provider, I won’t provide specifics of what types of exercises I would give to a patient. I believe while many people share symptoms, most of us have a very individual combination of dysfunction and that treatment plans should reflect that.
What I will say is that if you are in the NW suburbs of Chicago, come in and I can assess you and share my findings. If you aren’t, I will tell you that whomever you find to help with your journey, make sure not to fall victim to the token line about needing to do months and months of treatment that never changes and continue with “maintenance” for life.
Something I tell all my patients is: Say you start beating your head against a wall and get a headache as a result. Then you ask me for an aspirin, but you fail to stop beating your head against the wall, you probably aren’t surprised when the aspirin didn’t help the headache, right?
The same thing is true for treatment. If it isn’t working it either isn’t the right treatment, or you haven’t stopped the activity that caused the issue in the first place. Search for providers that look for the cause, treat you as an individual and educate you on how to prevent it from happening again in the future. Until next week…remember…you are not “crazy”, it is not “just in your head”, and you are not “just getting old”.