2007 VOL 1, NO 1

So, you have pain on the bottom of your feet, and you were diagnosed with plantar fasciitis. When you try to explain this to someone, all you can remember is that it's called "plantar- something." Well, I can help you with this; the words can be broken down easily to explain the condition. Plantar means bottom of the foot. Fascia is fibrous tissue that supports muscle and skin. The suffix, -itis, means inflammation. Put them all together (after you drop the "a" from fascia) and you have a word that is also a diagnosis, inflammation of the supporting tissue on the bottom of the foot. Easy, right? Easy, perhaps, if you don't suffer from the condition. Plantar fasciitis is very painful and it can take a long time to heal.

If you suffer from painful feet, especially in the morning, and the soles of your feet feel tight and painful in the arch or on the heel, you probably have plantar fasciitis. This is diagnosed without an x-ray, but most health care practitioners like to see an x-ray of the involved foot to rule out bone spur- another cause of pain on the bottom of the foot. Bone spur pain is typically characterized as constant and it does not go away with exercise or stretching. Plantar fasciitis pain usually feels better when you get up and walk around, stretch out the bottom of your foot, and use ice to relieve the inflammation.

Plantar fasciitis is caused by over pronation of your foot. Over pronation happens when you roll your foot to the inside (toward your big toe) when you walk. This occurs in some people, who have a very low foot arch, and others who have increased body weight that weakens the legs and feet over time; their feet compensate by over pronating during walking, running or just standing around. Runners often experience pain in their feet from the repetitive stress of running, and they need to protect their feet from over pronation with quality shoes. People who stand all day and those who have chronically tight calf muscles or tightness in the Achilles tendon are predisposed to plantar fasciitis.

Plantar fasciitis is preventable. Most people know if they have a low foot arch, or flat foot. These individuals can do exercises to strengthen their arch or they can purchase custom orthotics and over- the- counter shoe supports to alleviate the strain on their plantar fascia. Maintaining a healthy weight, using the proper shoes for exercise and recreation and taking frequent breaks from standing are essential in the prevention and management of this condition.

If you suffer from plantar fasciitis, the best self- help for pain relief is the application of ice to the sole of your foot. Ice acts as an anti-inflammatory agent, and mild stretching of the plantar fascia will help to alleviate pain. Be sure to talk to your health care provider before you take anti- inflammatory medication. There are many effective and safe alternative medicines to non- steroidal anti- inflammatory drugs (NSAIDs). I use herbal medicine and homeopathic drugs in my practice and my patients think they are very beneficial. You should also make an appointment with your health care provider to talk about your condition and the possible causes. Be sure to bring your exercise or recreation shoes to the office visit, and take notes: much of your treatment is self- directed at home or the office. If you need custom orthotics, take heart; many insurance plans provide some benefit for this service when your chiropractor or podiatrist provides it.

Here is a sample protocol that I use for patients diagnosed with uncomplicated, acute plantar fasciitis:

• Ice the sole of the foot frequently (up to 25% of your day) for 10 to 15 minutes at a time. Wait 45 to 50 minutes between sessions. This will calm down the inflammation so that exercise and stretching can be tolerated.
  
• Stretch the plantar fascia by rolling the painful foot over a golf ball on the floor; a soup can turned on the side so it can roll works well too. You can wear a sock, but take off your shoe! As you roll the golf ball or can, isolate the most painful spot and hold that position for 30-second intervals over a period of 10 minutes. Do this 2 to 3 times each day to remodel damaged tissue and help it heal.
  
• Exercise is the key to prevent inflammation from returning. An easy exercise; put a small towel down on the floor, and place your bare foot nearby. Grasp the towel with your toes while you keep your heel on the floor, and then scrunch the towel up under your foot. Do this exercise 2 to 3 times each day to strengthen and stabilize the arch of your foot.
  
• Treatment for plantar fasciitis may include the use of electric muscle stimulation, ultrasound, soft tissue mobilization, and foot joint manipulation during the treatment plan. I occasionally prescribe night splint and custom orthotics, and both services can be done in my office. I refer some patients to other providers for cortisone injections or a surgical procedure that releases the involved muscle/ tendon attachment from the foot bone. However, at the end of the day, I typically give my plantar fasciitis patients a sleeve of golf balls and a prescription for a new pair of shoes. Shoes break down more readily than we think, and the arch support in the shoe is critical to keep the foot properly aligned and prevent muscle fatigue. Don't hesitate to bring your shoes in for an evaluation! I can help you make the right shoe choice for work and recreation.

Chiropractic physicians are trained to evaluate foot alignment and to adjust the bones of your ankle, foot and toes. Ask your chiropractor to look at your feet, your shoes, and how you stand, walk, and run. Your feet are very important, and let's face it, nobody wants their feet to ache at the end of the day.

-P Domm, DC, ATC