Q&A - Plantar fascitis

Mike-

My fiance's father is experiencing a bout of plantar fasciitis. It started about 6 weeks ago and migrated from his right foot (he's right handed) into both feet. Initially it started in his heels and now is painful in both arches with no pain in the heels. The doctor had given him a cortisone shot in the heel initially and some stretches to perform. It doesn't seem to get any better - I had suggested a tennis ball for some soft tissue work on both feet, and wondered if somehow keeping the feet dorsiflexed at night would help.

I figured you've probably seen a lot more plantar fasciitis than I ever will, and might have some tricks that work. It seems that there's a lot of theories on the subject, and I was interested in what your practical experience has been.

Keep up the blogs and great interviews - you and Eric are so good at what you do - thanks!

First of all, thanks for the kind words. I hope this post will help!

There are several things I like to look for when someone is dealing with plantar fascitis:

- Soft tissue length in the lower extremity
- Soft tissue quality of the lower extremity
- Issues that may need to be resolved via behavior modification

Generally, the soft-tissue quality in the lower extremity is going to be quite poor. In this case, ART, massage and foam rolling/tennis/lacrosse ball work will all help. I'd start with the plantar fascia itself, and then work your way back up the kinetic chain like this:

Plantar fascia-->Achilles tendon-->Gastroc/soleus

Next, static stretching is really good here to help build up the tolerance to stretch. Place him in a doorway with the opposite leg flat on the ground and the affected leg up on the door frame. The key here is this - make sure that leg is straight! If he's as tight as you describe, this will be very uncomfortable. To increase the stretch further, have him place a towel over his toes to pull himself into a dorsiflexed position while stretching. This will stretch the entire posterior chain and, while uncomfortable, should eventually feel really good.

Finally, I'd look at his behaviors and determine what needs to be addressed. It sounds silly, but if the covers on your bed are too tight and constantly pulling your feet into a plantar flexed position, this isn't a good thing! It's much akin to sitting at a desk all day for your hip flexors. You're essentially telling your body to adaptively shorten those structures, which isn't a good thing. In this case a boot while he sleeps may be a great idea; this will help keep him in neutral, which I'm assumming will be a stretched position for him. Doing this for a few days/weeks should greatly resolve the issue.

I hope this helps and keep me posted on his progress!

Best
MR

Q&A

Mike-

I got to your site a bit circuitously via stronglifts.com. Your “Bulletproof Knees” intrigues me greatly as I own a reconstructed ACL in my left knee and I am a sponge for good info.

I have two questions (if I may):

1) I started the stronglifts 5x5 program about four weeks ago and have been progressing slowly as I am “new” to free weights. I added Bulgarian split squats to my routine as a means of developing the posterior chain. I have no issues going past parallel with either a front of low back squat. I have no pain. I think my technique is solid (feedback from a PT on site where I work out).

My problem/issue is that I have developed a bit of swelling above the knee to the outside of each knee, with the “good” knee carrying a bit more fluid than the left oddly enough. Nothing excessive but noticeable when I fire the quads, you can see a bit of a bulge. Does this sound like an overuse issue due to the additional BSS routine or something I should go see my orthopod about? Empty bar on the BSS and I am currently squatting 140lbs front and back….like I said, just getting started.

2) Plantar Faciitis in left heel…barefoot or shoes? Is there a connection between the aftermath of the ACL issues and the plantar facilities issues? There is a good deal of size difference between the left and right leg, top to bottom. (Many years wearing a brace before the re-construction and poor maintenance during that time…I’m getting religion late in life.).

Oh, I’m 53, 175lbs and an avid squash player who can’t get off the court even when his body tells him to until it breaks down (very stubborn).

Thanks for reading and if the short answer is to “buy the book” or “go see your Doc” that’s cool. Just wanted to get a gauge as to the type of info I can expect with the book.

#1 - It's hard to say exactly why your knee is swelling without watching you perform the exercises at hand. If you haven't been training all that heavy, it could just me an instance of doing too much, too soon. If the knees aren't ready for it, a natural response is swelling until your body acclimates to the loading.

Now, one suggest I would make is that BSS's aren't an optimal choice if you're looking for posterior chain development. I would prefer a PC dominant movement like RDL's, deadlifts, etc. If you want a unilateral PC dominant exercise, single-leg RDL's would be a good option as well.

#2 - With regards to the plantar fascitis, it could be a result of the surrounding tissues "stiffening" to protect the knee joint. I would get some aggressive soft-tissue work done (ART, deep tissue massage, foam rolling) on the gastroc/soleus, Achilles tendon and plantar fascia. You may even be tight up into your hamstrings, so you'll have to explore a little. Some old fashioned static stretching may help as well. If your quads aren't firing as expected, loosening up the posterior knee musculature should help.

And when in doubt, buy the book ;)

Stay strong
MR