Plantar fasciitis 

Plantar Faciitis is a common problem that manifests as burning, searing or stinging pain in the soles of the feet.

Back to Front

The bottoms of our feet bear an enormous load. The plantar fascia carries much of it. It arises on the front of our heel bone, the calcaneus, and inserts into the end of the long bones of our feet, then crosses over into the first bones of our toes.

Support

The plantar fascia helps to support the arch of your foot. It absorbs much of the strain of standing and the shock of walking as your weight rolls forward, then helps to propel you forward as your weight is transferred to the ball of your foot and the heel lifts off the ground. 

The plantar fascia pulls your heel bone forward. Counteracting this the achillies tendon attaches to the back of the heel bone and pulls it up.

Plantar Fascia v Calf Muscles

Strong as the plantar fascia is, it is overpowered by the immense pull of the calf muscles through the achillies tendon. When you take the weight off your feet they tend to droop down somewhat because of the pull of the calves.

Tight Calves

The most common cause of plantar fasciitis is tight calf muscles.

If your calves get excessively tight the extra pressure on the plantar fascia can cause inflammation and pain. This invariably gets worse when you stand up because of the extra stretch and load that standing and walking put on the muscles, tendons and fascia of the lower leg and foot.

First Thing

Plantar fasciitis pain is usually really bad first thing in the morning when you get out of bed, which is a rather nasty way to start your day.  It's worse because overnight your calves tighten up due to the position of your feet as you sleep. They drop into plantar flexion with your toes pointing away from the rest of you.

This happens when you lie on your side but it's worse when you lie on your back because of the weight on the blanket or doona pressing the ends of your feet down.

Yow!

This is why many people with tight calves get cramps in the middle of the night. These cramps can be so bad they can wake a person up with a yelp.

When you get up in the morning those first few steps or minutes until your calves loosen up can be very painful indeed. This is where calf stretches before you go to sleep and before you get up really come into their own.

More Tension equals More Pain

The tighter your calves the more they hurt and the longer they take to warm up. The tighter they are, the more you need to stretch them - at least a few times a day and up to every hour or so when they're really tight.

If that seems excessive, think about how many hours you stand and walk around every day. That is what you are counteracting here. If you are on your feet for 8, 10 or 12 hours, and take 5 to 10 thousand steps a day, (and have been for 30 or 50 or 80 years), and you stretch your calves for a couple of minutes a day, it may not be enough to have a useful effect. You have to do enough stretching to have the desired effect.

Cortisone

The usual medical way of dealing with plantar fasciitis is injecting cortisone into the soles of the feet, usually near the front of the heel bone. This often gives relief but does nothing for the underlying cause - tight calves and stiff ankle and foot joints.

The tension and stiffness that caused the problem in the first place are still there so what do you suppose are the chances the pain will come back again after the cortisone wears off?

2nd Last Resort

I'm not against using cortisone, just don't do it until you've had a really good go at stretching your calves, mobilizing your feet and trying arch supports. If that doesn't work see an osteopath or other suitably qualified professional. If that doesn't help, then try the cortisone.

Arch Supports

Arch supports are another excellent way of dealing with plantar fasciitis. You can have these custom made by a podiatrist which is expensive, or get pair off the shelf which is cheap. I find these ready made ones excellent. They are made of high density foam so are comfortable to wear. If you have foot leg or low back pain, or if you work on concrete floors, consider a pair of arch supports. 

Arch supports work by supporting your arches. The flatter your foot the more stretching force you put through your plantar fascia. Keeping that curve in the arch can make a big difference to how much slapping force goes through your feet. The flatter your feet the more they slap.

Roll don't Slap

When you walk the outside part of the bottom of your heel should make first contact. As you transfer your weight onto the foot, it should roll up the outside of your foot, then across the ball of your foot to your big toe.

Rolling is good, slapping is bad.   

The last medical option is surgically cutting the fascia. A desperate option indeed. See heel spurs for more on this subject.

The Best Things To Do

When you first wake up, before you get up, give your calves a stretch. You can start by pulling your toes back toward your knees and doing a few circles with your feet.

However you'll get a much stronger stretch if you sit up, drop one leg off the bed, then lean your whole torso toward the foot that's still up on the bed. Lean from the hips not the waist. You do that by pushing your chest towards the opposite wall and keeping your head up.

Towel it

If you can't grab your toes comfortably, keep a towel handy. Fold or twist it lengthways and lob it over the top half of your foot. Walk your hands down either side of the towel towards your foot. When it starts to pull in your calf take a deep breath and as you breathe out, keep your head up, push your chest forward and pull on the towel. 

Keep a small bend in your knee so you don't stress the nerves at the back of your knee.

You are not trying to pull your chest towards your knee, you are trying to pull it over the top of your toes. By keeping your head and chest up like this you will be bending at the hips, not the waist.

Slow Deep Breaths

Take 3 or 4 slow, deep breaths. Each time you breathe out, pull your chest just a little further forward to increase the stretch on your calf. Ease off slowly and swap legs.

Do 2 to 6 sets on each leg and hey presto! stand up with less, little or no pain.

Every am Every pm

This is a great stretch to do every night before you go to sleep and every morning before you get up. Once your low back pain, calf cramps or foot pain settles down, keep doing the stretches so they don't come back.

Don't Forget

The normal thing here is to forget to stretch once the pain disappears. If you do and it does come back, don't think 'Rats, it didn't work', think 'Oh yeah, I need to keep stretching', and get back into it. If you stretch your calves every day for the rest of your life you will be much better off than if you don't.

There are plenty of ways to stretch your calves. See the Calf Step Stretch for a detailed description of my favourite. There are 4 calf stretches on the DVD.

Roll

Another thing you can do is sit on the edge of the bed (or any chair), with your feet flat on the floor. Keeping the outside part of your feet on the floor, lift the inside arches of your feet as far as they'll go off the floor.

Persevere, chip away. You might find rolling your foot over a small ball, like a tennis, cricket or baseball, makes it much easier to get good movement. You can do this whenever you're sitting down.

Bottom Line

1 Do lots of calf stretches. High frequency, low to moderate intensity. In other words, do lots of them, not too hard. And roll your feet up onto their outside edges when you sit.

2 Try some out of the packet arch supports.

3 Gets professional help. Start with an osteopath, if you can find one. If not, try a masseur, podiatrist, or other type of physical therapist.