Plantar fasciitis is a very common form of foot pain and one that I find really interesting because it manifests in both really active runners and relatively sedentary people. How can a person that is training for their third marathon develop the same pain as someone that doesn't exercise much more than walking from their desk to their car? You can't purely blame it on over or under-use if the desk jockey and the super athlete are getting the same thing. So what is causing the bottom of people's feet to hurt so much and for so long?
The short answer: (a combination of the following factors)
- The shoes you wear all day (not just while running)
- Your posture & movement patterns (how you sit, stand, walk and breathe all day)
- A nerve irritation in your low back
- Weakness in your feet and tightness in your calves
- Fascial restrictions in your visceral system affecting the blood and nerve flow to your feet
The long answer:
It is typically a series of on-going events that leads to you developing that burning, pulling, aching pain on the bottom of your foot. You may have one or all five of the above issues. If your pain has lasted a long time, it is worth exploring all of them. Read on for details…1. The shoes you wear all day…It is hard to talk about foot pain and not mention shoes. I have written a number of articles on this blog already about feet. If you are convinced that your shoes are the culprit please read these articles too:
All too often, plantar fasciitis gets blamed on a 'lack of support' and this bothers me. We are not born with shoes on and our feet should not require external pieces of plastic to push our arches up from below. There is a network of muscles, bones and fascia in your feet and calves that have the capacity to support your feet from within. I think it is naÃ¯ve to think that we can make a foot work better by adding more 'support' under the sole. If you track the problem to its origin, I believe that many years of 'too much shoe' are to blame more than 'not enough support.' Once the foot and biomechanics have weakened from 'too much shoe,' more support may feel better in the short term, but you will be doing yourself a disservice in the long term.
My biggest beef with shoes both causal/dress and running shoes is the elevated heel. It screws up how your feet muscles are supposed to work. It overworks your calves. It encourages overly landing on your heel when you walk and run. It makes it harder to control your ankle during heel strike and affects your entire posture all the way up to your head. Your brain doesn't properly learn how to use your feet and your body awareness, posture and movement all suffer.
When your foot and ankle are used to being on flat ground the weight of your body gets distributed more evenly throughout your entire foot; the muscles in the front of your shin and the bottom of your foot will remain strong at securing the bones in your feet in a strong and supportive position. Conversely, when your foot and ankle are used to having a substantial lift under the heel, your body shifts its centre of gravity back and the heel takes most of the force. As a result the muscles in the front of your shin and the bottom of your feet get quite weak and your forefoot gets floppy and unsupportive and you are a sitting duck to strain your plantar fascia.
Do you have a floppy foot? Try transitioning to flatter, lighter profile shoes with a toe box that is wide enough for your forefoot. e.g. New Balance Minimus Zero or Merrel Glove
Click here to learn how to use your foot again and start building some strength:
Also keep reading to learn about the role of your mid back posture and foot strength.2. Your Posture and Movement Patterns…"You are what you do repeatedly." -Aristotle
Often the development of plantar fasciitis takes years and an event becomes the straw that breaks the camels back and makes you start to feel it. Your feet are being squished at the bottom of a tower of moving parts that you have to learn to control. How you hold the rest of your body will affect how you load weight onto your feet and vice versa. There are a lot of moving parts in your body, but there are a few centres of control. If you can create some awareness of these four centres all the other moving parts will more or less fall into line.
The four centres:
- Diaphragm (mid back)
My article titled: Why Hips Hurt: an illustrated explanation, is a good resource to help you understand this concept, but the following are a few more pictures specific to your feet. Ideally your spine has three natural curves to it and ideally when you start moving forward your body tilts slightly forward from your ankle and you take a short step. If you have good posture and move well, your centre of gravity will be largely over top of your foot as it hits the ground and your ankle will be in a good position to help push you forward.
Unfortunately many people become too 'back grippy' and in attempt to 'stand up straight' they actually end up tipping their torso backward. A back gripping posture tends to shift your centre of gravity backward towards your heels and will make you prone to having a floppy forefoot (see picture below…look familiar?). I liken trying to walk or run forward while your torso is tipped backward to driving with your E-brake on…things will wear down and you are working harder than you have to. When you are tipped back in your upper body you will be prone to having a longer stride in front of you and impacting on your heel with your ankle in a weak position and your centre of gravity behind your foot; this will effectively create a harmful impact force and make you pull yourself along instead of push yourself forward. The cumulative effect of walking or running with poor mechanics will beat up on your heel and your plantar fascia.
In a person with good posture and mechanics the foot acts as a rocker for weight transfer to help propel you forward when walking or running. In a person with poor posture and weak feet the foot endures a big impact force on the heel, then to forefoot slaps down and little propulsion is created. Your feet are very tough structures, but over time this repetitive trauma builds up and your body starts to yell at you. If you want to feel what it feel like to get support and propulsion from your feet watch the YouTube video below of my toe spreader tape job.
Even though your mid back is a long way from your foot pain, addressing the posture and mobility of your torso can go a long way to improving your stride and take a lot of forces off of your poor feet.
See the videos related to the four centres of control to help you address your posture and mechanics.
3. A nerve irritation in your low back…
Your nerves are the electrical wiring of your body and your L5 and S1 nerve roots from the small of your back supply a lot of the electrical wiring to your feet; if you irritate these nerves, you are just as likely to experience foot pain as you are to experience back pain. Foot pain can come almost exclusively from your back even if your back doesn't really bother you; it is called referred pain and it is a common ingredient to persistent plantar fasciitis.
The faulty postures, movement mechanics and impact forces touched on above can all create compressive forces on your low back. If your upper body is leaning backward it is more than likely you will create a compressive extension hinge in your low back as you stand, walk and run. Overtime the compression in your low back will irritate the L5/S1 nerve roots which are major feeders to your sciatic nerve which branches and extends right down to your heel. When nerves are irritated they will create bands of tension and muscle knots in the muscles that they innervate, in this case your foot and calf. When muscles are full of bands of tension they get quite stiff and act functionally weak. Stiffness in the calf and lack of muscular support in the foot leaves the plantar fascia very vulnerable to strain and injury; it will really lower the threshold of what it takes to create pain.
If nerve root irritation is a major part of your plantar fasciitis (as it usually is), it typically responds quite well to treatment with intramuscular stimulation (IMS). Treating the hips, lower spine, calves and the muscle in the bottom of your feet, although uncomfortable, can create almost immediate relief. The challenge then becomes to correct your posture and movement mechanics so you stop irritating your low back, otherwise the problem will slowly start to arise again. There is a good sequence of exercises to follow listed at the bottom of this article on IT band and Patellofemoral syndrome. If your feet are quite painful, the YouTube video above demonstrating the toe spreader tape job is a great way to offload your foot and give your strained plantar fascia a rest.
4. Weakness in your feet and tightness in your calves…
I will keep this one short and summarize what you have already read:
- Traditional shoes do the work for your feet and inevitably create weakness
- The compensations that occur due to poor posture, shoes and weak feet cause the calves to get over worked and tight
- Irritation in the nerves in your back cause your calves to tighten further
- There is a direct relationship between calf tightness and forefoot weakness/floppiness
- Calve tightness + foot weakness = eventual foot pain
5. Fascial restriction in your visceral system affecting the nerve and blood flow to your feet…
Fascia is a thin connective tissue that can be found throughout your body that helps support and hold everything together. Your visceral system is referring to all of your organs in your pelvis and abdominal cavity. Organs like your intestines, your stomach, liver and kidneys all attach to the back wall of your abdominal cavity. They are loosely held in place by fascia, ligaments and pressure, but they need to be able to freely slide over each other as you move to allow normal human movement. Things like stress, trauma, pregnancy and abdominal surgeries can affect the mobility of specific areas of your visceral system. These mobility restrictions can cause alignment issues and irritate or impede blood and nerve flow.
The major nerves and blood vessels to your lower body pass through your pelvis en route to your feet and as such, fascial restrictions in the lower abdomen can be responsible for foot and ankle symptoms. Personally I have found having visceral manipulation on either end of my large intestine (cecum and sigmoid colon) to have a huge impact on the blood flow and mobility in my feet. Clinically I have found that almost all of my clients that have improved, but plateaued with IMS and postural work have had the missing link to their foot/leg issues be visceral in origin. Click here to read my post for more detail on Visceral Manipulation.
It seems hard to believe that your guts not moving well is the reason why your feet have hurt for three months, but believe me that when you understand the anatomy of it, it makes sense. Resistant plantar fasciitis is usually multifaceted in origin, but as I am discovering as I get better and better at visceral work, it is definitely one of the culprits.
Congratulations you made it to the end! I hope this answers some questions for you. Please use the links throughout this article to find a good pair of shoes, work on your posture and find someone to help you with IMS. Posture and movement awareness is a process that can take a while to develop and improve.
Please feel free to leave questions or comment in the area below and I will try my best to reply to them.