Plantar Fasciitis

This is the first in a series of posts covering common problems that present in a yoga class.  Plantar fasciitis is a nasty pain in bottom of the foot. It causes mainly foot arch pain and/or heel pain.   Pain is quite often at the front of the heel

 Plantar – “relating to the sole of the foot”. Fasciitis – “inflammation of the fascia”.  Fascia is a thick connective tissue and the plantar fascia is a tough fibrous band which supports the arch of the foot. It runs from the calcaneus (heel bone) forward to the heads of the metatarsal bones (the bone between each toe and the bones of the mid-foot).

Plantar fasciitis is a common and often persistent kind of overuse injury. It  affects runners, walkers and hikers, and nearly anyone who stands for a living — cashiers, for instance — especially on hard surfaces. Walking on concrete and running on pavement are probably risk factors.

Most common symptoms:

• Morning foot pain  – even after a night’s rest the feet are tight and contracted and you feel the need to stretch them.
• Pain pattern – As you walk around in the course of a morning the pain reduces but then it recurs.  It may reduce when you sit but then increases again when you get up and put weight on the foot.  Movements that stress the foot such as balancing up on toes, walking upstairs can increase the pain.
• Compare both feet – can you pull the toes up on the unaffected foot – further and without pain compared to the affected foot?  Tight big toe especially that doesn’t extend like it should.  Need to stretch the toes out over time.

Plantar fasciitis is not the same thing as heel spurs and flat feet, but they are related and often confused.  Heel spurs are abnormal bony growths on the bottom of the heel.  They can occur if you have plantar fasciitis but they do not cause plantar fasciitis.  Those with flat feet or high arches may be prone to heel spurs – read the post on Arches – high and low.

Plan of action:

• Rest and ice – rolling the sole of the foot over a frozen bottle of water
• Tennis ball massage of the sole of the foot –  see post.    Trigger massage of the foot ach can help, as can reflexology
• Stretching exercises are targeted towards stretching the calf muscles:  –gastrocnemius –  Put foot on a lower stair (or block) – keep leg straight and hold for 30 secs x 3 times
• soleus –  same as above but keep the front knee slightly bent
• Stretching feet -Sitting down with the affected foot supported on a mat/chair – heel down and toes up.  Pull the big toe down for 10 secs x 5 times.
• Protective heel pads and custom made orthotics are useful
• Cortisone injections
• Wearing shoes in yoga classes if the pain is severe

There are, however, so many contributing factors to plantar fasciitis – flat feet, pronation, high arches, tight calves, running, walking, not running, not walking etc and not everyone with one/some of the above experience such pain.  Yoga classes which tend to foster a whole body holistic approach to movement are helpful, I think.

It’s difficult to stretch the plantar fascia and the first stretch in the morning can be painful.  The foot exercises that we regularly practise in class may be too much if the pain is severe, so make sure that you perform the alternatives from standing.  Our “hovering” manoeuvre into dog pose means that we hold a stretch on the bottom of the foot for longer than normal before we push the pelvis up through the action of the feet.  We tend to go in/out of movements and thus massage the soles of the feet.  Our rocking balance on toes and ball of the foot , spreads the toes, strengthens the arches of the feet and the front of the foot.  The piece de resistance is sprinters and I have written much about this.  In dog pose many people cannot lengthen both legs but we can lengthen alternative legs to stretch the calf muscles.

In the marvellous sprinters, we aim to lengthen one leg only – the back leg and thus stretch the gastrocnemius and soleus muscles.  As we progress and become more balanced, we are also able to lengthen the front leg – which is good for the knee.  We always keep the front foot rooted but we roll through the back foot and thus massage the plantar fascia. I have written many a time and oft about the benefits of Sprinters.   The more we practise, the more we embed the movement into our sensory motor cortex and begin to address the biomechanical issues that may cause plantar fasciitis. Sprinters helps us to balance the relationship between the foot, ankle and knee so that when we walk, run, dance or stand we have a chance of being well-organized.

There are many, many videos on You Tube relating to plantar fasciitis.  If you find anything particularly useful, please share it.  If you have pain in the ball of the foot or a rigid big toe due to a bunion, the foot and toe stretches mentioned above will also be of help.