If you ever had Plantar Fasciitis, you know how hard it can be to get relief. For most people, walking and standing on their feet is unavoidable, which makes the issue worse.
Here are some strategies to reduce the shearing pain on the bottom of your feet (the dos and the don'ts), and how to get long-term relief.
Plantar Fascia is the connective tissue on the bottom of your foot. See image. It attaches at the heel bone (Calcaneus) and stretches over the sole of the foot to the toes.
It's tough and dense and able to withstand a lot of pressure: your body weight times 3 - that's when you jump or hop on one foot.
However, when hopping (or walking, or running) too much, too long, and on the fascia that has not been stretched or warmed up, the tissue can start to tear off the heel. It happens gradually. Typically, you won't feel those microscopic tears. In fact, the tears are not the real problem.
The real problem is the lack of strength and flexibility of that tissue, ... and also that our tissue heals by collagen fibers.
Collagen is a type of protein that holds everything together in our body. The kind of collagen used for patching up these mini tears is not elastic, i.e. it does not stretch. So when your body heals those mini tears, it lays collagen fibers. Much like a sawing patch over a hole on your sleeve. But it does it every which way forming a bulging nodule, a scar tissue within the fibers.
Next time you put a lot of pressure on the plantar fascia (walking/running), that nodule is more likely to tear. And the whole process repeats itself: TEAR - COLLAGEN PATCH - SCAR TISSUE
But this time the tear is bigger, and so is the scar tissue.
Then, one morning, you get up on your feet, and you step on a sharp piece of glass... or at least that is what it feels like. Right at the heel. Sharp shearing pain.
The first thing people do is try to massage it themselves, ice it, and stretch it.
Is that a good idea?
Let's look at all the things people do to treat their Plantar Fasciitis. And what actually works, and why.
What Works and What Doesn't Work to Treat Plantar Fasciitis
1. Stretching: It depends.
This may be counter-intuitive but stretching is one of the worst things you can do if you already have Plantar Fasciitis pain. Think about it.
You have a tear. Is it helpful to pull at it? To pull it further apart with stretching. Absolutely not. Stretching will create a deeper tear.
Your body heals the tear every night. You wake up and it feels tight (because the collagen patch is in place). So you go and stretch it ... and break the collagen patch... That is the recipe for Chronic Plantar Fasciitis. Yet, many people do it because they think it's helpful to stretch it.
When is stretching good? When it's healed. In fact, it's necessary. Gentle stretching of the healthy plantar fascia is critical to prevent this injury in the first place.
2. Strengthening: Yes.
You can start flexing those fibers right away, especially during the injury.
Flexing means "Plantar Flexing" - pointing toes down, or pressing toes down into the floor. You can do this by rocking back and forth when standing as you press your toes down, or sitting and using your toes to bunch up a towel. Go for 1-2 minutes and repeat 2-3 times.
Why this is helpful? It helps to tighten the tear. Essentially you are helping your body to patch it up. In addition, it helps to organize the collagen fibers so that they are built in the direction of movement, instead of random criss-cross direction.
Doing some flexion in the morning, in bed, before you hit the ground is very helpful to activate and warm up the tissue without re-tearing it.
3. Ice: It depends.
Ice numbs the pain and draws the blood away from the inflammation. But it won't help to heal the tear.
4. Heat: Yes
Heat will bring the blood flow once the sharp pain is reduced (possibly with ice). Blood brings collagen and therefore helps to heal the torn tissue.
Heat also softens the tissue making it less stiff. It's a good idea to use a heat pack on your feet in the morning before you put all the weight on your feet. Keep a heat pack in bed, or ask your partner to get you one before you get up, and put your feet on it for a few minutes.
5. Massage: Yes
Absolutely. One of the few things that actually removes the scar tissue and aligns the fibers is deep (and painful) hands-on cross-fiber friction.
Ask us about it. Not all massage therapists specialize in Plantar Fasciitis or scar tissue removal. We have several therapists at East West who do.