Everything you need to know about Plantar Fasciitis
There are a few things in this world I would not wish on my worst enemy. Plantar fasciitis is one of them. If you've ever had it, you know what I mean. When I feel it coming on I get a similar sensation in my gut as Harry Potter might when he knows the Death-eaters are after him … I'll do anything in my power to guard against it becoming a full-blown reality.
This debilitating (not to mention annoyingly persistent) injury can happen to runners and walkers alike. And, it's harder to get rid of than a condo in a recession. I've had my bouts with it and I'd like to offer anything I can to those of you who either wish to recover from PF or avoid it altogether.
My number one suggestion is, the moment you feel it coming on, study your Chi Walking and Chi Running DVD’s to make sure you’re walking and running in a way that will stop this condition from getting any worse. Prevention is truly the best method here. We make suggestions if you’re currently in acute pain, but the key is to avoid and prevent PF at all costs.
Where is the plantar tendon and what does it do?
The plantar tendon runs the length of the bottom of your foot, spanning the area from the base of the toes to the front of your heel. If you think of the arch of your foot as a bow (as in bow and arrow), imagine the plantar tendon as the bowstring. The two ends of the bowstring attach at the base of the toes and at the front of the heel bone by means of fascia, a strong fibrous membrane. The bowstring (plantar tendon) keeps the arch of the foot from flattening completely when the foot is bearing weight, thus providing cushioning and shock absorption when you're walking, running or standing, (see diagram) This tendon also allows you to point your toes.
What is plantar fasciitis and what causes it?
Plantar fasciitis is an inflammation of the plantar fascia, where it connects the plantar tendon to either the heel bone or to the base of the toes.
It can be caused by any motion of your legs that creates a pull on the plantar tendon. That means walking or running up or down hills, climbing stairs, walking or running on your toes (yes, that includes wearing high heels), or dorsiflexing (pointing your toes up as your heel comes down with each stride).
It can also be caused by heel striking, which is usually a result of over-striding. If you're reaching forward with your legs (see page 166 in the Chi Running Book or page 32 in the Chi Walking book) with each stride, you're very likely to land on your heel. Landing in this way can create a force on your heels of up to 6 times your body weight with each footstep. That is a very small area to be absorbing that much weight. The surface area of your heel is about 2 square inches. If you weigh 125 lbs. and you're running with a heel strike, that means the force to your heel is … let's be conservative and say 4 times your body weight. That means that there is 250 lbs./sq. in. of force on your heel with each stride. With that kind of pressure, it's no wonder you end up bruising the spot where the plantar tendon attaches to the heel.
Here's another way you might end up with plantar fasciitis. On the rear side of your heel is the attachment of the Achilles tendon which runs up into your calf muscle. If your calves are tight and/or your achilles tendon is not flexible, you will be pulling and tightening the plantar tendon and weakening the attachment of the fascia to the bone. If for some reason the plantar tendon is pulled beyond what the fascia is capable of holding, the fascia forms micro-tears and begins to pull away from the bone. This will cause the fascia to become inflamed.
Here's a long-term situation to avoid. If the plantar tendon is consistently over-stretched for weeks or months, the body begins to add calcium where the attachment between the tendon and the heel bone takes place. Over time enough calcium is added to actually build more bone mass in that particular spot on the heel … and you end up with a heel spur, which is even more painful than plantar fasciitis. Imagine feeling pain every time you take a step. If the average person takes 5,000 – 8,000 steps each day, that means you'd be feeling pain thousands of times every day. No thanks. I'll do whatever I can to avoid that.
Other causes of plantar fasciitis are:
- Inflexible shoes, worn out shoes, or shoes that bend in the middle instead of the ball of the foot, where they should.
- Low arches … or high arches
- Being overweight
- Spending long hours on your feet
- Tight calf muscles or tight/stiff ankle muscles
- Walking barefoot in soft sand for long distances (sorry, no more romantic walks on the beach unless you're wearing your flip-flops)
What does plantar fasciitis feel like? Of course, this is a very subjective question, so I'll try to give you a range of sensations, progressing from nuance to agony. When plantar fasciitis first appears it can feel like you've got a lump in the heel of your sock. No big deal. No pain…just an uncomfortable "thick" feeling right under your heel.
I find myself taking out the insole to my shoe to see if there's maybe a rock trapped underneath. If, after replacing the insole and straightening my sock out, I still feel a lump under my heal, I take it very seriously. The Death-eaters are on their way if I don't do something!
When you feel it, you know that you’ve slipped into some old habits and that you need to practice the Chi Running and ChiWalking forms some more. Landing with a midfoot strike (Pg. 162 in the Chi Running Book or with a fore-heel strike (pg. 60 in the Chi Walking Book) will insure that you're ankles remain relaxed and your plantar tendon is not overstretched.
In the next level of PF your heel will feel a little tender when you first get up from a chair or get out of bed in the morning. In the early stages the discomfort will go away once your up and about on your feet. But, as the injury advances into later stages, the tenderness will linger and begin to turn into what feels like little needles sticking you in the bottom of your heel with each step. Sounds fun, huh? Trust me … it's not.
In the very advanced stages of plantar fasciitis, you find yourself surfing Amazon to find books on levitation. It aches all day, not just when you’re walking or running.
How in the world do I get rid of it?
I think I can safely say, there's no instant cure for PF, except for maybe Divine intervention. Believe me, I've wished many times there were. It takes time for the inflammation in the fascia to subside and to heal any tears in either the tendon or the fascia. In fact, right up front, when you feel the first symptoms of PF, I suggest you make an agreement with yourself that you will be more persistent than it. Any injury like this, where you can feel it with every step, is always a great opportunity to practice self-remembering and mindfulness in your movement. Be as consistent as possible with all of your Chi Running and ChiWalking form focuses to stave off PF, as it can take quite a while to heal.
Here are some preventive steps you can take at the first indication of soreness in your heel.
Prevention and early treatment:
Learn to relax your lower legs, especially your ankles and calves, whenever you're walking, running, sitting or standing. Tension held anywhere in your legs or glutes will pull on the plantar tendon when you move. Relax, relax, relax…or suffer the consequences. ALWAYS keep your entire lower legs as limp and relaxed as possible…through every phase of every stride.
If you're a runner, you should always be mindful of landing with a midfoot strike. If you're a walker you should land on the front of your heel and roll forward onto the balls of your feet. Never strike on the back of your heels when walking (see page 32 , Fig. 5b, Chi Walking Book). Confirm that you have a straight posture line and that your pelvis is level and that you are landing with your foot directly under your center of mass (Page 168, Chi Running Book).
Don't reach forward with your legs when walking or running. Let your upper body lead and let your legs follow (see page 32 , Fig. 5a, Chi Walking Book). This will help you maintain more of a midfoot strike and avoid all that pounding to your heel … one of the biggest culprits in plantar fasciitis.
Additional things to do:
- Shorten your stride length when walking or running.
- Walk and run on flat surfaces as much as possible.
- Avoid hills, trails and uneven surfaces.
- Avoid stairs … treat yourself to an elevator.
- Improve the flexibility of the calf muscles and achilles tendon which pull on the plantar tendon. (see stretches below)
- Get a foot massage … the deeper the better.
- Consciously choose to move in a different way (see the Chi Running and Chi Walking books and DVD’s to learn how) so that you’ll never create PF again.
Treatment if you are in acute pain:
- Soak your heel in a big bowl of ice water (5-10 minutes) twice daily until the pain subsides. It's excruciating, but well worth it.
- Scrunch towels with your toes or pick up marbles with your toes.
- If you do drugs, take Ibuprofen for treating inflammation, but PF can last a long time and you should not take Ibuprofen too often.
- Walk barefoot across a coarse gravel surface. This is one of the best cures for PF I've ever used. If the idea makes you wince, do it in your stocking feet. This somewhat painful "therapy" will vastly accelerate the healing process because it helps keep the plantar tendon supple.
- Orthotics can help reduce the pain on the bottom of the heel, but be mindful that they will not fix the reason why you have plantar fasciitis. If you don't want to be tied to orthotics for months or years, you'll need to change the movement habits that are causing the problem.
- Stand facing a wall an arm's length away. Keeping your lower legs and ankles completely relaxed, lean into the wall by putting your hands on the wall directly in front of your shoulders and lowering yourself toward the wall. Hold this stretch for 30 seconds and repeat at least 3 times.
- Stand on a curb facing away from the street with the midfoot of the sore foot resting on the edge of the curb and your heel extending out beyond the curb. Keeping the healthy foot completely on the sidewalk for stability. Then, slowly lower your heel enough to give your achilles tendon and calf muscle a good stretch. Hold this for 20-30 seconds and repeat 3 times.
- If you're sitting for an extended period of time (at your desk or anywhere else), dorsiflex your foot (point your toes toward your knee) as often as you can remember to do so. It'll be much less tender when you get up to walk and it will stretch your calves and achilles tendon.
All of this should set you well on your way to either preventing plantar fasciitis or gradually ridding yourself of this all-too-common-but-avoidable problem. With this particular injury there's an old saying that absolutely pertains. "An ounce of prevention is worth a pound of cure."