Why Does my foot hurt?
This month we’re talking about the ever-so-annoying and common diagnosis of plantar fasciitis. That’s a fancy name, so let’s first break it down. Plantar describes the aspect of the foot. Plantar refers to bottom, dorsal to the top. You’ve probably heard of fascia in various areas of the body. Really, fascia encompasses everything. Among other roles, it allows our muscles to work closely together by connecting them to each other and connecting our muscles closely to our skin and bones. This specific fascia runs from our heel toward our toes and blends with the muscles that allow us to bend our toes and support the bottom of our feet. This fascia is important in supporting the arch of our foot, and in creating some ‘spring’ when we push off through our toes. That last part of the word ‘-itis’ means inflammation. Inflammation of the fascia on the bottom of your foot – plantar fasciitis.
This condition can be intense, and the pain is often described as tearing along the bottom of the foot, most commonly with those first few steps out of bed in the morning. Despite this intensity of pain, the condition in and of itself is benign, and typically does resolve on its own over time. Even so, there are things that can be done to move that along, and strategies to use moving forward to prevent it from returning!
Because this is an -itis, and inflammation is involved, the first course of action is typically to reduce inflammation and modify activities as needed to prevent large increases in inflammation with exercise. These modifications usually surround activities like running, jumping, walking, and explosive movements. Duration, frequency, terrain, and speed are all modifiable factors for these exercises that can improve symptoms and reduce inflammation. It can also be helpful to assess shoes worn during these activities and adjust as necessary to reduce irritation; or ask yourself if you recently changed shoes as sometimes that can be the culprit for a new case of plantar fasciitis. Over the counter orthotics are often helpful for improving symptoms in the short term, especially for those who spend a lot of time on their feet. Over the counter are typically just as good as the custom-made orthotics for plantar fasciitis, so don’t go running to a podiatrist for custom orthotics just yet!
After symptoms are improving and inflammation is controlled, it’s important to gradually load these tissues so they can build resiliency toward the exercises or activities that may typically aggravate the plantar fascia. These tissues need to be able to withstand both stretch and load, so we need to introduce these in a controlled manner. They become stretched when we go onto our tiptoes, or when we push off toes when walking or running. They also take on load in these positions due to the need to support the bottom of the foot as it stretches. Load is also felt when we move through standing on that foot when walking or running. This is because forces are attempting to flatten the arch of our foot, and this area needs to support that for reduced stress through joints as well as improved efficiency in our push-off in walking or running. We can mimic the activities that create stretch and increase intensity as tissues adapt through things like load and speed. For a good place to start, check these out!
There are also tiny little muscles on the bottom of the foot that help to take up this load and reduce the burden through the plantar fascia and surrounding muscles. These muscles can be addressed through specific exercises that you can find HERE, but they also get stronger by walking barefoot! People with plantar fasciitis are often told to never go barefoot out of fear of worsening symptoms or threatening the integrity of the arch. However, walking barefoot is a great way to strengthen the muscles of the feet and promote adequate mobility through the many joints of the foot! Now, if your foot is very sensitive, there may be benefits of wearing shoes more consistently in the short term, but as this sensitivity decreases, we encourage you to spend more time around the house without shoes!
Through a combination of controlling inflammation and decreasing sensitivity, strengthening throughout the foot and ankle, as well as promoting the natural strength and mobility of the foot when out of a shoe, we can reduce symptoms of plantar fasciitis and return to the activities that matter most!
If it seems daunting to tackle this on your own, or you’re in need of further guidance, we’d love to be the guide on your journey toward healthier feet!
What is the pelvic floor?
The pelvic floor is something that is simply just not talked about in some cultures, and especially not in regards to some of the functions it serves.
Your pelvic floor is comprised of muscles that act as a sling or hammock to support your pelvic organs. These muscles span from your pubic bone to your tailbone. They work to assist with the ‘5 S’s’:
1. Support - to pelvic organs including bladder/prostate, rectum, vagina, uterus etc.
2. Sphincteric – the ability to keep things in when we want them to stay in and to let them out when we want them out!
3. Sexual – achieving orgasm, erection, lubrication, etc.
4. Stability – assists to stabilize hips, low back, and pelvis during everyday function
5. Sump pump – can help with circulation of blood in and out of the pelvic and genital region
The pelvic floor plays a role in a lot, huh?! Its function is so important in so many things. It works closely with the diaphragm, deep abdominal muscles, and muscles of the spine to manage pressure within the abdomen. This is so important when doing things like jumping, lifting, running, coughing, sneezing, laughing. Your pelvic floor provides support during these demanding activities, maintaining sphincteric control, and stabilizing our center.
Since the pelvic floor muscles play such a large role in many things, if there is dysfunction in this area, it can lead to changes in all those things! With decreased support to the pelvic organs, one might develop a pelvic organ prolapse; poor sphincteric control could lead to incontinence with activity, or changes in urge or frequency to void; there may be changes in sexual function including difficulty with orgasm, pain, or erectile dysfunction for males; decreased stability may contribute to low back or hip pain with activity, difficulty with single leg balance or activities like lifting/pulling/pushing; and dysfunction in this region can reduce the effectiveness of contracting and relaxing which can influence blood flow to and from this area. Despite being involved in many functions and contributing to problems that can be very frustrating and debilitating, a lot of these can be helped through appropriate intervention! It’s important to understand that although a lot of these experiences are common, they don’t have to be a normal part of life!
Through pelvic floor physical therapy, a therapist can identify the most likely cause of whatever you may be experiencing. Sometimes this is weakness in the pelvic floor muscles, sometimes it’s tension or over-activity; other times it may have to do with the hips or low back, posture, or breathing. Whatever it may be, it’s important to narrow this down and create an accurate plan of attack!
If you are interested in learning more about the pelvic floor, the specific functions it serves and how these relate to everyday life, sport, exercise, and activities; as well as the role of a pelvic floor physical therapist, drop in to one of our upcoming workshops!
Looking for more specific guidance or one-on-one care? Click the "Talk With A PT" button and I’ll reach out within 24 hours.
Dr. Elle Carlson
Elle Morgan, PT, DPT