What is Plantar Fasciitis?
What is this painful condition and how can Barks Pedorthics help?
Let’s start with the etymology, what those weird words actually mean:
Plantar refers to something located along the sole or bottom of the foot. Fascia is strong connective tissue that holds structures in the body together. The plantar fascia in particular is a triangular piece of tissue along the bottom of the foot that originates at the base of the heel and extends up towards the base of the toes, pictured here.
The plantar fascia originates at the heel and extends up towards the ball of the foot. It is shaped a bit like a triangle.
The origin of the plantar fascia. This spot at the bottom of the heel where all of the different aspects of the plantar fascia attach to the bone is often a point of extreme irritation.
Finally, the last bit of fasciitis, the -itis, is common suffix used in medicine that means inflammation or irritation.
So, putting it all together plantar fasciitis is an irritation of a triangle stiff tissue along the bottom of your foot.
What are the common mechanisms of plantar fasciitis?
Everyone has an arch along the inside edge of their foot. When we put weight down on our foot, such as during standing or walking, this arch flattens out. This will cause the heel and the ball of the foot the spread out away from each other stretching the plantar fascia. This stretching can cause pain along the arch and especially in the heel where all of the strands of the plantar fascia connect to the bone.
As the arch of the foot is flattened by weight bearing the ball of the foot and the heel will be pushed farther apart. As these two areas are where the plantar fascia is connected it will be stretched as the arch drops down. This stretching can cause painful microtears, especially around the heel.
One particular thing to note is a phenomenon called start up pain. When the plantar fascia stretches it develops microtears, a large source of the pain experienced. While we are at rest or sleeping those tiny, little tears begin to heal and fill in with scar tissue. Then when we wake up and first stand, we flatten our arches right out which opens up all of those little microtears again. And it stings like wild... For about five minutes or so. Reopening all of those little injuries releases a lot of endorphins and happy chemicals so after a few minutes, eh, it starts to feel ok again. Flexing and moving your feet around a bit before getting out of bed can help to mitigate this sensation somewhat.
The main mechanism of plantar fasciitis is the interplay between just how stretchy that plantar fascia is and how the bony structures in the foot are behaving.
In a very flexible foot, where the arch falls or flattens out during weight bearing the plantar fascia may get overstretched regardless of how elastic it is. In a case like this a set of supportive orthoptics that mechanically prevent arch drop (also known as overpronation) can help prevent those microtears from occurring in the plantar fascia.
In another type of foot, the arch may not be dropping all that much, but the plantar fascia itself is very tight and inelastic. In this case a supportive set of orthotics would be used to prevent what arch motion can be prevented, but treatments such as massage for soft tissue release, stretching exercises and a device called a Strassburg sock that helps the plantar fascia rest and heal in a more extended position would also be recommended.
Finally, sometimes it isn’t how far or how much the joints in the foot are moving, it is how they are moving. Ideally these motions will be somewhat fluid and low impact, each joint giving a little bit and each motion kind of rolling into the next spreading out the forces involved over a longer period of time. Similar to how the crumble zone on a car works to dampen the impact of a collision. If the motions of the foot during walking are stiff or abrupt they can suddenly pull or jerk at the plantar fascia in an uncomfortable manner. In a case like this a set of orthotics with shock absorbing pads at the heel and cushioning along the arch would be most appropriate.
