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