The Facts on Foot Pain And Plantar Fasciitis

Running_FeetYou get out of bed and almost fall over, swearing you stepped on a nail that somehow was standing vertically on its head. You hobble around the house as flat footed as possible, careful not to strike your heel, where the pain is most potent. What the heck is wrong with my feet? You wonder.

You’ll hear all kinds of answers from all different kinds of experts. But here’s the bottom line on what’s happening: the ball of your foot and the heel of your foot are moving away from each other at either an unnatural distance or in an unnatural manner, with each step you take. The result is over-stretching and often tearing of the shock-absorbing plantar fascia, which extends from your heel to the ball of your foot. This terrible condition has become known as plantar fasciitis.

There are 2 main causes:

1) Calve muscles that are entirely too tight, pulling on the achilles, causing the heel to rotate back, up, and away from the ball of your foot … pre-loading the fascia before significant work, and thereby overloading the fascia when you use your feet.

2) Arches that are collapsing, causing the heel and ball of the foot to move away from each other … again pre-loading the fascia before significant work, and thereby overloading the fascia when you use your feet.

Furthermore, there are 2 things that contribute to each of these causes

A lack of stretching, flexibility, or range of motion training can contribute to tight calves. A lack of strength from the antagonist (muscle opposite), such as the tibialis anterior, which lays atop the shin, can have the same effect. Often it’s a combination of the two.

Both excessive weight and weak muscles whose tendons support the arch can contribute to collapsing arches. Again, it’s often a combination of the two.

So, to truly fix the problem, we are left with 3 specific prescriptions

1. Achieve healthy body weight to allow better arching of the feet

2. Strengthen the muscles whose tendons support the foot’s arch

3. Increase flexibility of the calve muscles to lesson backward pull of heel bone

Weight loss is about energy balance. Specifically, learning how to make each bite you take and each workout you perform an investment into increasing your resting metabolism (where 80-90% of our energy is burned) It’s something I talk about all the time and beyond the scope of this article, so we’ll focus on prescription #2 and #3. (However, our focus here in no way should take away from the importance of #1 above.)

To strengthen the arch-supporting muscles, we must first know what muscles do that. That would be:

– the peroneus longs, brevis, and tertius

– the tibialis anterior

– the tibialis posterior

Furthermore, we must know what the actions of these muscles are, right? Otherwise, how in the world are we going to work them?

The peroneus group of muscles is primarily responsible for eversion of the ankle joint. This means taking the outside of your foot and lifting it up toward the outside of your lower leg. Do this 50x and you’ll learn to feel this muscle working quite quickly. Note, I did not say lifting your toes toward the front of your lower leg. That’s coming…

The tibialis anterior is primarily responsible for what is called dorsiflexion of the ankle joint. It’s the exact opposite of a calve raise movement. Consider it a “toe raise.” It’s lifting the ball of your foot up toward the front of your shin. Do this 50x and you’ll be able to pinpoint the tibialis anterior with the “burning shins” you’ll feel. If you currently have plantar fasciitis, it probably won’t take much to make this muscle burn, as it is likely weak.

The tibialis posterior is primarily responsible for inversion of the ankle joint. That is, raising the inside edge of your foot up toward the inside of your lower leg. Many people have never thought to, or are afraid to strengthen this movement, having rolled their ankles many times in the past. They think, “why would I want to make my ankle better at doing this?”  That’s unfortunate, because the ankle rolls are caused by a lack of eversion strength, NOT too much inversion strength. Furthermore, this invertor plays a huge roll in maintaining a proper arch and preventing plantar fasciitis. You do yourself no favors to neglect it.

 

To stretch the calve muscles, you must first realize what they do, and the fact that you have 2 (or should I say 4) of them.

The calves plantar flex the ankle. That is, they move the ball of your foot downward, away from your shin. So it stands to reason that to stretch them, we need to somehow pull the ball of the foot toward the shin. But remember that we have 2 different calve muscles. The first is called your gastrocnemius and it’s origin point is actually above your knee joint. To stretch this one, just like if you were trying to work it, you must “pre-tension” it by keeping your knee locked out. The second calve muscle is called your soleus, whose origin is below your knee joint. So, to focus the stretch on the soleous, remove tension from the gastrocnemius by bending at the knee joint during the stretch.

With the concepts now understood, here’s my recommended practical plan of attack. It’s a daily plan, by the way, since it’s much easier to do something daily consistently than it is to do something every other or every other 2 days consistently. (if you don’t believe me, compare the consistency of brushing your teeth to the consistency of your current exercise program)

Today

Sit on your bed with your foot hanging off and intensely dorsiflex your ankle by pulling your toes up toward the front of your shin. Keep the rest of your leg and body as still as possible. (Try not to externally or internally rotate your foot during this dorsiflexion movement.) Do this until you can’t bear the burn anymore, or you feel like you will cramp. Probably somewhere between 50 and 100 repetitions. If it’s under 50, you need this all the more. Ok, after that failure point, move immediately to the other leg and match the number you got on the first leg. Then go back and do the first leg again. Go back and forth until you have done 3 sets on each leg. The tibialis anterior has been fried.

Now we move to the peroneous longus. With the same body/leg position, evert your foot by lifting the outside of it up toward the outside of your lower leg. Try not to otherwise rotate or dorsiflex it. Just focus on eversion. Intensely evert the foot until you feel that burn, hit failure, or feel like you are about to cramp. Count the reps and then do the same number with your other foot. Go back and forth between legs until you have done 3 sets on each.

Finally, we will work the tibialis posterior. With the same body/leg position, invert your foot by lifting the inside of it up toward the inside of your lower leg. Try not to otherwise rotate or dorsiflex it. Just focus on inversion. Invert the foot over and over again until you feel the burn, hit failure, or feel like you are about to cramp. Count the number of reps you get and then do the same number with your other foot. Got back and forth between legs until you have done 3 sets on each. Congrats, you are done for today!

The Next Day

We’ll focus on stretching the calves the day after our arch-supporting muscle work. Facing a wall, lean up against it with one leg forward toward the wall, and the other leg back away from it. Plant the heel of your back leg on the ground, keep your foot pointed straight forward (not externally rotated!) and keep your knee locked out as you move your hips toward the wall. You should feel more of a stretch in the calve the further forward the hips move. If you don’t feel it, move your back leg further back until you do. It’s important to keep your heel on the ground to minimize stretching the plantar fascia and maximize stretching the calve muscles. After holding the stretch for a full 40 seconds, slightly bend the knee and hold another 40 seconds to stretch the soleous. Then switch your legs and do the same to other one. Go back and forth until you have stretched each calve muscle on each leg 3 times. That’s 480 seconds of total calve stretching. This should take you 8-10 minutes, depending on how fast you transition into the positions.

The Day after That

See “Today” and repeat

The Following Day

See “the next day” and repeat

So on and so forth … 

If you are more of a “free spirit,” and you totally checked out when I started talking about sets and reps, let me summarize the thoughts above and give you a fun way to gain more control over these movements: Healthy feet have both healthy arches and healthy ranges of of motion. You should be able to dorsiflex your ankle (raise your toes toward your shin), invert your ankle (raise the inside toward the inside of your leg), evert your ankle (raise the outside of foot toward the outside of your leg), plantar flex your ankle (point your toes down and away from your shin).

To work all of of these movements, write the alphabet with your toes – either in space, one at a time, or better yet, on a white board with a dry erase marker between your big toe and second toe. The white board is great because you can really see your level of control. Remember, your hips and knees should be still while everything happens from the ankle. See how can do! Be careful where you do this in case you drop the marker. You can always start in the air by hanging your foot off the end of a bed.

While you are performing either these 10 minute workouts or the alphabet drill (every other day) and waiting for the right muscles (arch-supporting ones) to be strong enough, and their antagonists (calve muscles) to be loose enough to fix your condition, you can lessen the severity of your painful symptoms with plantar fascia sleeves. These look like partial socks, and provide compression to control inflammation. More importantly, however, they provide resistance against an arch that wants to collapse under load. They also give support while still allowing the weight to still be distributed where God intended it to be – on the ball of the foot and the heel. If the good Lord wanted the middle of our foot to support our weight, He wouldn’t have built an arched foot in the first place, right? So build your arch-supporting muscles to support the arch of your foot!  Like so many other conditions, optimizing the original and natural design is the only real fix.

Now, most conversations and articles on this matter are primarily filled with talk of insoles. Insoles are not the ultimate answer, so I have saved my mention of them for last. But, they can help provide some temporary partial relief of symptoms, and a reduction in pain. They might also be able to delay or lessen some of the knee, hip, and back pain that may eventually come as a result of unfit feet. Let be known, however, that they will only make your feet weaker if constantly relied upon, as opposed the exercising your feet/ankles. Some of the best feet in the world belong to those who go barefoot the majority of their lives. So keep insoles in proper perspective.

 

Here’s a little insole wisdom for you:

Don’t go too soft. If you are trying to create an arch in your foot that doesn’t exist naturally, then a soft insole isn’t going to make it happen. For example, if your weight rolls to the inside of your foot, then on a soft insole, it will still roll that way, compressing the soft pad. At the same time, the extra padding under the outside of your foot, the lighter side, will now push it up even further. Basically, the soft insole exaggerates what your foot already wants to do, rather than change its behavior.

Don’ get too high of a heel. If your heel is elevated, then the ball of your foot will be asked to hold a higher % of your weight than for which it was designed. Furthermore, you will have to increase the arch in your back in order to keep from falling forward. This is not a terrible thing if you have a “straight back.” But if you are starting with normal curvature of the spine, or like many, with a exaggerated (lordotic) arch, this will certainly give you back pain as it causes you to arch even more. Here’s yet an additional negative of the elevated heel. Many people with foot pain have calves that are too tight. As you put more weight onto the ball of your foot, you work and tighten your calves even more.

Don’t get TOO high of an arch. If your arches have fallen, it’s probably happened over many years. Do you really think that you can throw in an artificial lift that raises your arches right back to where they were years ago and all will be well? If you do think so, you shouldn’t. Consideration number 1: God built the arch into your foot to act as a sort of shock absorber. It works because it’s not in contact with anything underneath it, while the ball and heel of your foot support your weight. When you stick a high-arched insole into your shoe, you are asking a part of your body to bear weight that was designed for such a purpose. Technically, the best insole would be inserted below the bones of your arch and above your plantar fascia, but that’s not practical.

Don’t get too low of an arch: this is an insole that either doesn’t do much, if it’s a harder insole, because it doesn’t change anything; or worsens the problem, if it’s a soft insole, because it exaggerates natural tendencies.

Watch out for slippery surfaces:. You can have an insole that seems just right: not too soft, not too hard, not too high, not too low … while standing still. Then, as you try to walk, you notice that your foot wants to spin within your shoe, changing where the arch support makes contact with your foot, or even bashing your little toes against the outer edge of your shoe. The insole designer focused too much on making getting into/out of the shoe easy, and forgot to add some “stiction” to the surface of the insole to help keep your foot stable upon it and in the right position. I have so far found only 2 solutions for this: either go barefoot (be careful with this option during sporting activities, as you could “catch a nail” on some part of the shoe) or wear yoga or kitchen socks, with the little “traction balls” on the sole. The advantage of the yoga socks over kitchen socks is that they are “fingered,” helping to splay (spread) your toes, which helps keep your feet healthy, while adding another level of traction.

After reading the above, you might be thinking: wow, it seems really difficult to find the perfect insole. You’re are absolutely correct. It’s a bit of a nightmare, which is why I don’t generally even recommend them. It’s better to put your time and efforts into your shoe choice, making sure you have a comfortable and effective fit – preferably without having to match an insole. Once you add an insole to a shoe, it changes the way the shoe fit you originally – which could bring some painful or annoying consequences. If you need a particular insole, be sure to try on your potential new shoe with the particular insole and make sure everything works together well before proceeding to purchase. In the end, the better option is a pair of “plantar sleeves.” These give arch support without asking your arch to bear more weight. At the same time, they can help reduce inflammation via the compression they provide. Supporting your arches with athletic tape is another decent option, but most people won’t take the time to do it properly. Hence my recommendation of a great pair of shoes, plus the sleeves, instead of game-changing insoles. If you really need more cushion, you can always try adding second pair of socks. I’m not against insoles for symptom relief while you are building better feet, but they do require that you do some “self homework” while both choosin and using carefully.

Finally, remember that RICE is your friend, but NOT your healer.

I’m not talking about the food here. It’s the acrostic that every serious athlete knows quite well: Rest, Ice, Compression, Elevation. Essentially, get off your feet, get some ice on them, tie it up tight, and get them above your heart. There are some companies that make a sort of “cold pack slipper” that makes this easier to do. Slip them on before you go to bed and sleep on your back with your feet up on a few pillows. Of course, be sure to place a pillow under the knee as well so you don’t start over-stretching other tendons too. Keep in mind that R.I.C.E. is simply a part of symptom control, not the way to fix your condition.

In summary,

Fit Feet Feel Fantastic, so work those suckers as hard as you work every other muscle in your body. You’ll be so glad you did.