Working with Plantar Fasciitis

The last newsletter looked at plantar fasciitis from different perspectives.  Click here to read if you missed it.  

Today’s newsletter is about treatment considerations and suggestions.  You’ve got a diagnosis from the doctor or physical therapist, and hopefully also had a good alignment analysis to see if there are any biomechanics issues at play.  Follow your practitioner’s treatment protocols, and perhaps you’ll find a few other suggestions from the list below that may help!  

Rest: Stopping the overuse syndrome of plantar fasciitis is tricky.  It’s hard to not be on your feet! Rest may mean a couple of days or even up to a week or more away from the activities that irritate the plantar fascia.  Dancing or teaching and then icing and doing ‘good’ things for your feet isn’t the same as really truly taking time away from weight bearing activities.  At times doctors will recommend a walking boot that helps keep stress off of the plantar fascia.  Wearing the boot doesn’t give permission to still be on your feet for 10 hours a day without concern.  My point is REST is IMPORTANT.  This is the one area that if properly utilized can really make a difference.  Not sure whether that means a few days or a few weeks – that is dependent on each case, but you can cross train in ways that don’t irritate your foot.  Swimming, Pilates, etc. are all good alternative activities to keep in shape.  When you are coming off the rest cycle – you have to ease back into your activity.  You can’t just jump back into class and undo all your good rest efforts!

First thing AM: Warm up your ankle and foot if possible before taking those first few steps in the morning.  Put your feet into shoes or slippers with an arch support instead of walking barefoot to the bathroom.

Icing: Can be very helpful in the beginning of plantar fasciitis and for decreasing pain. (Temporarily numbing the pain.)

Contrasting cold and hot water: There isn’t a lot of research showing contrasting water baths is spot on for plantar fasciitis, but on the other hand doing contrast baths is a very gentle way to give your tissues a workout.   It can help improve circulation around the injuries tissue and is a cheap and easy process to try.  Do 3-6 alternations between heat and cooling.  Two minutes of heat, and then 1 minute of cool, repeat 2 more times (ending with the cool/cold)

Ibuprofen and other NSAIDs: They don’t have a lot of evidence of being a successful treatment, even though they are commonly prescribed for plantar fasciitis.  There is some evidence that using NSAIDs compromise or retard long-term tissue healing. (1)  Instead, ask your doctor about using Voltaren Gel instead of ibuprofen.  This is an NSAID in a tube, and you rub it on the affected spot and it is absorbed through the skin.  It is commonly used for arthritis pain (first heard about it when my dad was prescribed it for a bad shoulder). It seems promising for arthritic pain (helped my dad for sure) and best case scenario it could provide some pain relief with lower risks of side effects compared to other anti-inflammatory medication.  You do need a prescription for it.

Massage: While massage will not change the plantar fascia directly, it can go a long way in helping to ease tension and stress in the calf muscles.  Sometimes there are even areas above the knee that seemingly help release the pull from plantar fasciitis (hip area, hamstrings, etc.) Feels good – and as we know – the muscles are connected facially to each other and makes sense that releasing tension in one area may help one stand more efficiently on your feet.  

Stretching: You’ll want to stretch both the gastrocnemius and the soleus muscles of the calf. That means you’ll do both straight and bent kneed calf stretches.  If you can flex (dorsiflex) your toes at the same time you’ll get a pull into the arch as well.  I didn’t know about the yoga stretch called broken toe pose before doing my research, but some people felt it got into the arch and plantar fascia area better.  Try it and see if the 2 feet feel different.  Mine did… and while I don’t have plantar fasciitis I’m going to keep playing with this stretch to see if I can even out the flexibility of my toes.

Strengthening: There is some promising research that strengthening the calf may decrease pain of fasciitis even faster than stretching (2) The heel rises that were used were NOT rélevés.  Place your forefoot on a thick book and put a towel under the toes (that are on the book) This places a small pull on the plantar fascia.  Start on 2 feet and don’t go up to the toes, bringing the heel above the toe height should be enough and don’t overdo.  

Hopefully, there are a few ideas that you can try.  Let me know your results and what has helped you if you have successfully rehabbed from plantar fasciitis.  I’ll share your stories with other teachers that may be struggling currently with this issue. 

To your success,

Deborah

(1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1320354/

(2) Rathleff MS, Mølgaard CM, Fredberg U, et al. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scand J Med Sci Sports. 2015 Jun;25(3):e292–300. 

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