Plantar Fasciitis is one of the more common diagnoses we see in physical therapy. It often presents as a nagging pain in the heels or arches of the foot, and sometimes can be felt in the achilles tendon. It's usually worse in the morning after climbing out of bed, or after prolonged bouts of sitting when you first get up to walk around.
There is a large band of thick ligament-like material called fascia that runs under your skin on the bottom of your feet from the heel up to the base of the toes that makes up your plantar fascia. The plantar fascia is an important structure in maintaining foot stability and supporting the arch of the foot.
When this band of fascia becomes painful it is termed plantar fasciitis. While most pathologies ending in -itis usually include inflammation, plantar fasciitis actually lacks the presence of inflammation. It is more accurately described as a breakdown or degradation of the plantar fascia tissue. A more correct name would probably be plantar foot pain or plantar heel pain.
Like many overuse or sports injuries, plantar fasciitis is often caused by repetitive overstress, or by a sudden change in the physical demands we place on our feet. We see it happen often in people whose employment requires them to be standing for long periods like cashiers or hairdressers. We also often see it happen when someone suddenly begins a new workout routine or a new job responsibility that places a sudden increased demand on the feet without adequate time to build up to the activity.
Plantar fasciitis can be a chronic issue that plagues people for many months or even years because they don’t know what it is or how to deal with it. While some cases can be quite gnarly it really doesn’t have to be this way. By altering the types of stresses we place on our feet in a calculated method the foot can be strengthened and the pain can be alleviated.
How we alter those stresses requires some skill and judgement, and is different for each patient. It depends on what caused the pain, what your current activity level is like, and the status of your current health and strength levels. A recent onset of the pain is approached differently than a chronic case that has been ongoing for a long time.
The plantar fascia and surrounding foot and ankle musculature usually needs to be stressed to engage the healing process through proper exercises and manual techniques. A skilled therapist can evaluate your situation and make appropriate recommendations for the type and appropriate quantity of exercises and ensure the exercises do not exacerbate the pain.
Sometimes some changes in footwear are necessary, and often some targeted strengthening of the hips and knees can actually improve the mechanics and function of the feet.
At Recover Physical Therapy we approach plantar foot pain from several different angles which has shown to be very effective at improving the pain in a relatively short period of time. In addition to the traditional physical therapy interventions mentioned above - which includes a good restructuring of the stresses we place on our feet and some guidance on appropriate stretches and exercises - we also bring some innovative treatment tools and approach the problem not only from an orthopedic but also a neurological standpoint.
The Neubie Machine (Neurological Bioelectric Stimulator)
The Neubie machine optimizes motor patterns between your brain and your muscles. Often when the body is in pain the brain will reroute normal motor nerve patterns or “muscle memory” and downregulate muscle activity. While this is an important survival mechanism built into our bodies, if it goes on too long it can be harmful to normal muscle activation and movement patterns. The Neubie can detect poor muscle activation and very quickly restore full and strong coordinated signals to the muscles and help your brain “remember” how to optimally activate the muscles (assuming there is not permanent nerve damage). Optimizing the motor signals to the feet and ankles produces very fast relief from pain. It can also help to strengthen the ankle musculature much faster than traditional strengthening, and building strong ankles is a proven solution to managing plantar fasciitis pain.
The Alter-G Anti-Gravity Treadmill
The Anti-Gravity Treadmill can unweight up to 80% of your body weight while you walk or run. This unloading takes the pain out of your feet while allowing for a completely normal gait pattern and complete freedom of movement. It has produced some big smiles for several plantar fasciitis victims who hop on and suddenly can walk or run without pain. We use it for conditioning and to restore normal gait patterns while not exacerbating the foot pain. As patients gain strength and pain resolves we gradually increase the body weight until reaching the normal 100% and can transition out of the anti-gravity treadmill pain free.
Manual therapy and instrument-assisted soft tissue mobilization
At Recover Physical Therapy our physical therapist is a certified orthopedic manual therapist (COMT) with advanced training and experience in joint mobilization and manipulation. There are several bones and joints in the foot and ankle that move in various directions, and having a skilled therapist experienced in manually mobilizing the proper joints at the proper amplitude is important in restoring normal foot and ankle mobility as quickly as possible. We also utilize special instruments that help with soft tissue mobilization to improve soft tissue quality and accelerate the healing process.
A recent client, a nurse who spends long shifts on her feet and happened to be in her 3rd trimester of pregnancy when we treated her stated, “I used to come home from work in tears because of the foot pain.” After a few weeks of this multifaceted approach she achieved the ability to complete her long work shifts free of foot pain, even in the last stages of her pregnancy.
Another recent client, a 41 year old who works in retail stated, “I could barely walk after a few hours of work, my feet hurt so bad.” By the time he completed his course of therapy, he said, “I feel better and am able to be more active, both at home and at work. The lack of excruciating pain has changed my life!”
If you have been struggling with plantar fasciitis pain, please give us a call, or drop in to tour the facility and have your questions answered. There really is no reason to endure plantar fasciitis pain when effective treatment options can turn things around in fewer sessions than you might think!