Chiropractors treat the whole body
Now unfortunately it is true that occasionally people do come to us with foot issues because they have confused us as Chiropractors with Chiropodists and we have to gently explain that the two are not the same. When they realise their mistake they commonly gasp and say something like, "Oh, no! You're the back people, not the feet people!" and again we must gently explain that although Chiropractors are commonly associated with back pain and neck pain, that kind of a big part of Chiropractic is that we help the ENTIRE body by improving and maintaining the structure and function of... the ENTIRE body. So even though we are not "the foot people" we do commonly help and advise people with issues with their little tootsies.
Don't get me wrong, we're unlikely to buff your corns or take a bolt-cropper to those talons that look as though you've been using them to climb trees or catch prey, but some of the structural and functional problems that can cause foot pain we can help with and today we are going to discuss one such problem; Plantar fasciitis.
What is Plantar Fasciitis?
If you've never heard of plantar fasciitis, then you are likely to be one of the lucky people that have never had it (or you just know it as "Policeman's heel"). If you have had it, then you'll know all too well just how debilitating it can be.
Plantar fasciitis presents most commonly as pain, usually severe pain, in the middle of the underside of the heel, but it can cause pain all the way up the arch of the foot and into the ball of the foot. It's pretty common. It tends to be worst first thing in the morning and it can make it unbearable to even stand, let alone walk.
I've seen it more in girls and most frequently mid-summer to mid-autumn, which may sound strange, but I have a few theories as to why and a few suggestions on things you can try to help it and how to prevent it.
The structure of your feet:
The way your feet are designed is incredibly clever, because they have to do two very different jobs; they have to be solid enough to ‘push off from’ when walking, running and jumping but they have to be soft enough to absorb all the impact every time your foot makes contact with the ground from walking or jumping.
To illustrate this, get a bouncy ball and bounce it off a hard surface, like the floor. It will bounce a lot more than if you try and bounce it off a big cushion. If you fall, however, the impact would be less damaging if you landed on the cushion rather than the hard floor.
So we need our feet to be able to be solid and soft at different times. And they can.
Collectively your two feet have a total of 52 different bones forming 66 separate joints! All bound together by a lot of ligaments and tendons. When the ‘soft-tissue holding elements’ throughout the foot (like the tendons, ligament and the plantar fascia) are relaxed, it allows all of these little joints throughout the foot to move and give and spring a little, and consequently, to absorb and dissipate impact forces rather than transferring them up to your knees, hips and spine. When the ‘soft-tissue holding elements’ tighten up it makes all of these little joints stiff and solid and gives you a stable structure for you to ‘push off from’, like when running and jumping.
Part of what creates this affect is the arch in the foot. It acts like a mini suspension spring and part of what creates the springiness is the plantar fascia. It creates tension between your heel at the back of your foot and the ball of your foot at the front. It also helps to keep your foot in a neutral position, with your arch up, your ankle externally rotated and your toes all pointing forward.
What causes plantar fasciitis?
With some people the holding elements (ligaments and plantar fascia) are very tight and they don't spring much and the arch is stiff, but stable. Some people have much more give in these little foot joints and the arch falls in (pronation), their foot flattens, their ankle rolls in, the big toe gets pushed towards the other toes (halux valgus) and their big toe 'knuckle' gets jammed into the floor and sticks out. And that is how baby bunions are born (or at least are a lot more likely in people with less joint stability)(Bunions aren't hereditary. Joint stability is).
In people with more give through these little joints in the feet, the plantar fascia has to work a lot harder as a spring to keep tight and keep the arch up. If, for example, every time you take a step your arch falls in, then that will pull against your plantar fascia, which then has to pull the arch back up again. If this happens with every step you take, this can result in one VERY upset plantar fascia. It gets inflamed and that is plantar fasciitis. So, in essence, plantar fasciitis is a repetitive strain injury of the plantar fascia.
How footwear can cause foot pain:
In my experience girls tend to suffer with plantar fasciitis more than guys and in my opinion there are a couple of reasons for this. Firstly, girls tend to have better joint mobility than guys, but because of that they tend to have a bit less joint stability, which can mean more demand on the plantar fascia. Secondly, girls shoes tend to be the kind of shoe that looks amazing, but might not provide sufficient support for their foot or ankle. But for all of us, during the warmer weather we tend to wear lighter, less supportive shoes and tend to be out and about more in them, which is why by the end of the summer a lot more people tend to be hobbling in, in flip-flops, complaining of foot pain.
What can you do to help plantar fasciitis?
So, what plantar fascia treatments can I get? Well, like any repetitive strain injury, if you keep repeating the strain, then it will never get better. Treat it a similar way to a sprained ankle:
- Rest it. It is difficult to rest your feet as we all need to stand and walk, but keeping off them will help. Just be prepared though that when the plantar fascia gets inflamed, just like muscles, it will want to tighten up when it's rested, which means that when you go to use it after resting, like getting up first thing in the morning, it can hurt. A LOT!
- Ice it (check out my advice on how to use heat and ice properly).
- Support it. Wear something that will hold and support your foot and ankle. Don't wear anything too soft and 'comfy'.
You would be forgiven for reaching for the softest and most comfortable footwear you have at this point.
Unfortunately, it can make the issue worse and a lot of times 'comfortable' is a major contributing factor to this issue. 'Comfortable' usually means soft and there is an enormous difference between soft and supportive. We've all sat on a really soft and comfy sofa only to be in pain when we try to get up from it.
Some off-the-shelf insoles to stick in your shoes tend to help a lot! I have been wearing the same £20 pair everyday for the past five years and they're excellent. There are a lot of different ones out there, however, and some could make the problem worse! I would, therefore, recommend getting some professional advice on which ones are most appropriate for you, either from your Chiropractor or from a reputable running shoe shop (they tend to stock all kinds of insoles and orthotics, not just ones for running).
So, hopefully you now understand the structure and function of the foot in more detail and how to best support it to prevent plantar fasciitis but also how to treat plantar fasciitis if you do have it. Should you have any questions about anything I've gone through, please don't hesitate to get in contact with the clinic and we will do all we can to help.