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Nothing hampers a person’s ability to move more than foot pain.
You can sometimes work around hip issues or lower back symptoms, but foot pain tends to negatively affect almost every aspect of life.
The human foot is a stubborn part of the body. It can withstand a tremendous amount of stress and abuse. But this stubbornness can also make it a challenging area to treat.
One of the most common foot injuries is plantar fasciitis. The plantar fascia is a thin but extremely strong band of connective tissue that runs along the bottom of the foot.
This fascia attaches at the bottom of the heel, and runs toward the toes, eventually attaching under the ball of the foot. Its main purpose is to provide support to the foot’s arch. If overworked, however, it can become inflamed and irritated like any other part of the body.
Symptoms and etiology
The typical symptoms include pain under the bottom of the heel that often shoots down the arch toward the toes. Waking barefoot can then be extremely painful. Almost always, the patient experiences severe pain with the first few steps out of bed in the morning.
There are many potential reasons why people develop plantar fasciitis. One of the most common and over- looked causes is restricted dorsiflexion in the big toe or the ankle (or both). If you’re not checking the range of motion in these joints, you may be missing the main cause of their plantar fascial pain.
The foot is designed to be stable. If you don’t have the normal amount of big toe and ankle dorsiflexion during the push-off phase of gait, your mid- foot will be forced to move excessively to make up for the toe and ankle restriction. This leads to increased stress on the fascia and other soft tissues in the feet, eventually leading to pain and dysfunction.
Steps toward treatment
So what is the fix? You’ll likely find that this issue responds best to a combination of different treatments and lifestyle modifications.
- You must evaluate, and treat (if limited), the dorsiflexion of the big toe and the Most range-of-motion (ROM) limitations are due to a combination of joint restriction and soft- tissue tightness. You need to look at both of them. As a chiropractor, you should have several options for addressing reduced joint motion at the first toe and the ankle. You could utilize High-Velocity Low-Amplitude (HVLA) manipulation, or something less aggressive such as Mulligan’s “Mobilizations with Movement.” In addition to treating the joint mobility, you should also treat any soft-tissue restrictions in the region. Some might prefer a combination of manual myofascial work and some instrument-assisted soft tissue massage (to the bottom of the foot and the calf).
Figure 1 - After improving their ROM in the toe and ankle, lock-in the improvement with kinesiology The benefits of the tape are wide-ranging, and can help with some of the discomfort, provide some support to the mid-foot, and improve proprioception. Consider the taping technique shown in Figure 1.
- Next, demonstrate how your patient can use a hard ball to perform self-massage to the bottom of their Put the ball on the floor, step on it with the bad foot, and slowly roll your foot up and down the ball. Search for the most painful spots and spend the most time in those areas. Recommend that they use a foam roller to do the same type of massage on their calves. This should be done a few times a day if possible. See Figure 2.
- To address the sharp pain in the morning, your patient needs to purchase something called a “Strassburg ” It’s a sock they wear while sleeping that keeps their toes pulled back toward their shin. This keeps the plantar fascia stretched throughout the night and can greatly reduce the pain in the morning. It can be a bit weird to get used to, but most people notice a reduction in their morning foot pain in five to 10 days.
Figure 2 - Lastly, stress the importance of applying heat to the bottom of the foot as often as possible. Traditionally, the standard recommendation was to use ice. Recent research, however, has called that practice into question. It appears that connective tissue injuries seem to respond best to heat.
Again, plantar fascial pain can be a stubborn condition to treat. Do under- stand that the above list of treatment options is not comprehensive. However, it is a combination of low-tech, inexpensive, and effective treatments that have worked well for me over the past 15 years. Give this combination a try and see if they work for you.
Jonathan Mulholland, DC, CCSP, CSCS, is a sports chiropractor and strength coach who has helped athletes of all levels with injury recovery and performance enhancement. He is a graduate of Northwestern Health Sciences University in 2000. in addition to running his own practices, he has also acted as the chiropractic consultant for the U.S. Olympic Training Center in lake placid, NY. He can be contacted through rocktape.com.
