In the previous post on plantar fasciitis we discussed factors that often made someone more susceptible to plantar fasciitis. Limited ankle flexibility and being overweight were the two most notable factors. Sporadic increases in activity among a “non-athletic” and overweight population were also documented in the literature. The other group that gets a beating is runners! If you have spent a couple of weeks on ankle mobility and/or lost a considerable amount of body fat without success, give these a college try.
Check out an in depth article we wrote on plantar fasciitis at Tony Gentilcore’s website. Tony Gentilcore is a well-sought after strength coach, writer, and presenter. He works out of his own studio in Boston called CORE. He is also one of the co-founders of Cressey Sports Performance.
4. Regular Shoe Rotation
Workers who spend a lot of time on their feet have less reports of pain with regular shoe rotation. This means changing those shoes out every couple of months or rotating shoes on a regular basis. Finding a shoe that is comfortable is also important. Rotating your high heeled shoes everyday defeats the purpose! Reach for the sneakers or the flats if more work appropriate. If you commonly find yourself wearing out certain portions of your shoe, it is time to change them. This fault, whether it is too much pronation or supination, is only exaggerated the more you wear down your shoe.
Orthotics and heel cushions were recommended in the recent 2014 Plantar Fasciitis Guidelines. This could be a source of relief for you. Nothing clearly states that custom made orthotics are better than ones that you buy in the store. You still NEED to be careful here. Having lower arches in your feet does not necessarily mean that your foot “collapses” while you walk. Some degree of motion at the foot is necessary to absorb the force you put through them. Having someone take a look at your foot statically and whole moving is the safest option. Preferably a physical therapist or podiatrist. Don’t show up at your local nail salon looking for orthotic advice. Experimenting with a nice tape job from a skilled provider could let you know if an orthotic will be helpful. Without spending a bunch of money on the front end!
No research firmly supports strengthening to resolve plantar fasciitis. It is considered “expert opinion” in the Plantar Fasciitis Guidelines that working on exercises that promote reduced pronation forces at the foot may be helpful. Excessive pronation at the foot is not purely a foot problem. Often times this excessive pronation is a result of poor muscle capacity somewhere up stream. This could be a skill, endurance or strength issue at the leg, hip or trunk. Having someone watch you run and do a thorough assessment will provide you with more information on how to tailor this training specific to your needs.
Orthotics are only a short term fix at best. If you do display poor strength and endurance with walking or running it would benefit you to work on strengthening of the foot and limbs in various positions.
1. Leg Length Discrepancy
I tend to shy away from discussing leg length discrepancies (LLD). Some LLD are considered “functional.” Meaning it is a result of variations in muscle length and tone. Other times these LLD’s are anatomical. Meaning, you weren’t born with absolute perfected limb lengths! The reason I don’t discuss this with patients much is I don’t want people to obsess over this.
LLD is VERY common. Before you go crazy over LLD I want to see that you are sleeping well, managing your weight, exercising routinely, understand and dealing with your diagnosis appropriately, reducing life stressors, performing regular self care activities (foam rolling, stretching, etc.). Lastly, I will look at mild leg length issues. Don’t get me wrong, having a significant LLD is something that needs to be considered from a biomechanics stand point. We can’t expect the car to ride smooth if one wheel only has 10 lbs. of pressure in it.
In some studies a LLD of as little as 4-6 mm can be considered clinically significant. Just keep in mind that most people will have an asymmetry, not everyone will have pain. If you do have pain, give this some consideration. Your physical therapist would be great at determining its relevance.
Consider the points made in this article and the previous article when trying to manage heel pain. Reducing your weight and improving your ankle mobility is key. If you are a runner, you need to make sure your training program is appropriate. If you are pushing the boundaries regularly on your runs without rest days…. then you deserve that heel pain! Just kidding, I understand the desire to run everyday, but proper pacing and rest breaks are necessary. Consider the points made in this article and the previous article when trying to manage heel pain. Reducing your weight and improving your ankle mobility are critical first steps. Use today’s tips to help speed up the process!
Dr. Michael Infantino, DPT
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