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Dr. Roy Murrell, DC 200 NE 20th Avenue, Suite 140 Portland Oregon 97232 - disclaimer - 971-312-9497

PLANTAR FASCIITIS

Just what is Plantar Fasciitis? In short, it is inflammation of the ligaments on the bottom of your foot. These ligaments attach the calcaneous (heel bone) to the base of your toes and are the main support of your arch. Symptoms can vary due to severity but primarily it is pain in the bottom of the footthm when you step on it. It is worst the first step of the day and gets a little better with movement although excessive walking can make it worse. It can have multiple causes but the most frequent I see in my practice is tight/short calf muscles.

This can be exercise related and it can be genetic. There are many who have genetically short calf muscles. You can usually cope with this when you are young but as you age it puts increasing stress on the foot. The calf muscle is actually made up of three different muscles (the medial and lateral gastrocnemius and the soleus muscles) which all join into the Achilles tendon that inserts into the posterior part of the heel. Tight/short calf muscles affect the Plantar Fascia by restricting the range of motion in the ankle mortise. This changes the bio-mechanics of your gait cycle by making your heel leave the ground very early as you advance through the pronation cycle. This puts tremendous pressure on the foot in general but especially the bottom of the foot. There is a close relationship between the calf and the Plantar Fascia; the shorter the calf, the more tension is put on the fascia. This is very frustrating to patients that have this because it is not really possible to lengthen genetically short calf muscles short of a surgical procedure which is only done in severe cases.

The goal of treatment is to take as much pressure off the fascia as possible. Stretching the calf helps along with soft tissue massage on both the calf and the fascia. ( Do not get too agressive on the fascia as you could inflame it further.) Chronic calf tension also causes tension and dysfunction in the Talus (the primary hinge joint of the ankle) as well as the sub-talar joint, both of which are crucial to the flexibility of the foot. I can adjust these which will increase their flexibility and restore normal range of motion which can be very helpful in taking stress off the fascia. In more severe cases, I put a small lift in the heel of the shoe to put the foot in slight flexion which takes some pressure off the Achilles tendon and the Plantar Fascia. I am not a fan of high heel shoes but for women who get this, wearing a small heel will also help take pressure off the foot. Ice massage with a frozen water bottle is also a good idea.

The best thing to do is to catch this before it gets out of control. It is easier to prevent than to cure once it gets established. If you are starting to feel some degree of pain in the early morning, take heed. You can start by stretching the calf muscle before you go to bed. There are numerous ways to do this -- e.g. foot behind you forcing your heel to the ground, letting the heel drop off a step, etc. Just make sure you hold any stretch for at least one minute at a time. If you are a person that has never been able to squat without falling back onto your butt, you have probably been accumulating tension for a long time. So, be proactive and stretch.

Yours in Health,

Dr Roy

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