Plantar Fasciitis - Ask Dr. Eric Dickerson
Dr. Eric Dickerson, DC FRCms is a sports physician and owner of Radius Physical + Sports Rehab who integrates functional rehabilitation, physical therapy modalities, and advanced soft tissue techniques to craft a comprehensive treatment approach for his patients.
Dr. Dickerson earned a Bachelor of Science in Kinesiology from Arizona State University and earned the prestigious Academic Excellence award during his doctorate program at Palmer College in Iowa. While a member of the Sports Council at Palmer, he minimized injuries in athletes through pre- and post-event treatment. As Vice President of the Palmer Package Club, he excelled in training others in chiropractic techniques, orthopedic and neurological examinations, and rehabilitation/exercise protocols. He graduated from Palmer Magna Cum Laude with a Doctor of Chiropractic degree.
Dr. Dickerson is a healthy living enthusiast who promotes maintaining an active lifestyle. He is often found running, hiking, mountain biking, golfing, playing sports, or doing yoga or CrossFit. Find Radius Physical + Sports Rehab at www.radiusclinic.com.
Plantar fasciitis is one of the most commonly diagnosed causes of heel pain by doctors. Most people with plantar fasciitis experience stabbing pain that runs through the heel and rest of the foot, especially in the first few steps in the morning and on hard surfaces. Pain is usually worse after long periods of standing and sitting, and after, but usually not during, exercise or activity. We consulted the experts at Radius Physical + Sports Rehab in Grass Valley, California to learn what can be done if you suffer from this often debilitating issue.
1. What does Plantar Fasciitis mean?
a. Plantar fasciitis literally translates to “inflammation of the fascia located on the bottom of the foot”. Fascia is the connective tissue surrounding our muscles, blood vessels, and nerves. The plantar fascia is the connective tissue that connects our heel bone to our toes and helps to support the arch of the foot.
2. It’s so common these days, what causes it?
a. Let me first start out by saying that plantar fasciitis is a commonly diagnosed condition these days. It’s been one of the most misdiagnosed conditions patients experiencing heel pain have been told they have, in my experience. One in ten people will suffer from pain in their heel at some point, and many will be told or assume they have plantar fasciitis. There are a host of neurologic, skeletal, and soft-tissue causes of heel pain that should be ruled-in or -out before physicians pin the blame on plantar fasciitis.
b. If you truly do have plantar fasciitis, however, a variety of different factors can cause it. These causes can be broken down into 3 categories: anatomical, biomechanical, or environmental. They will all have the same general effect on the plantar fascia - increasing the stress and tension on the fascial tissue in the region. If this stress and tension is sustained over a prolonged period of time, like standing on a hard surface everyday at work, or if the tissue is repetitively stressed past the tolerance of what it can comfortably sustain, like long-distance running, you may develop this condition.
3. How can we prevent it from developing?
a. Biomechanical Risk Factors
Proper stretches and exercises can help to prevent some of the biomechanical causes of plantar fasciitis. Typical biomechanically dysfunctional causes of plantar fasciitis are overpronation (middle of the foot rolls in, flattening the arch), limited ankle dorsiflexion (decrease in amount one can bring the top of their foot and shin closer together), and weak muscles in the foot. Therefore, the best exercises and stretches depend on what dysfunctions you might have. Standing ankle mobility exercises and foam rolling your calves can help improve limited ankle dorsiflexion. Foot towel grabs and smooth criminals barefoot (Google Michael Jackson’s Smooth Criminal Lean dance move for this one!) can strengthen weak foot muscles. Progressively loading the achilles tendon and plantar fascia with a toe elevated isometric or eccentric calf raises can actually prevent plantar fasciitis by increasing the amount of load capacity the tissue can withstand before becoming a problem.
b. Anatomic Risk Factors
Anatomic risk factors include obesity, flat feet, high-arched feet, and a shortened achilles tendon. Many of the same stretches and exercises that help prevent biomechanical risk factors can be used for anatomic factors. Over-the-counter orthotics, weight loss, and activity modification may also help in prevention.
c. Environmental Risk Factors
Common environmental risk factors include deconditioning, poor footwear or walking barefoot, prolonged weight bearing, and inadequate stretching. Gradual training progression, proper stretching, and proper footwear can help prevent these risk factors. Proper footwear will differ depending on if you have true flat feet, high-arched feet, or foot weaknesses.
4. What can we do at home?
a. I’ll refer back to the last question on this one. An important point that hasn’t been stated yet is heel pain can be debilitating, but you should not let it control your life. Do not avoid all activity and become sedentary simply out of fear of the pain. Confront the pain head-on with some of these strategies and seek out guidance from an expert in your area if needed; that is the only path to recovery. Ignoring symptoms can lead to further damage to those tissues and/or have damaging effects up the chain to your knees, hips, and low back.
The views expressed in this article intend to induce conversation. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.