The New Way to Treat Plantar Fasciitis

In this episode, Dr. Lisa explains how her treatment has changed when treating plantar fasciitis so its more efficient and effective for runners.

Here is what you will learn:

• Top mistakes PTs make when treating Plantar Fasciitis 
• Exercises runners need to be going through when dealing with PF
• How to fix the source of the pain 
• Foot and Ankle Program: 12 weeks of strength and mobility exercises to fix the source of the pain
• Toe Spacers: use code DRLISA10 to relieve PF pain and help align toes (Affiliate code)
• Night Splint on amazon (affiliate code)
• Superfeet (affiliate code)

Questions? Email: drlisadpt@gmail.com

Rehab and Strength Programs: www.drlisadpt.com/programs

Check out her Youtube channel HERE for more running tips

Transcript

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SPEAKER_00 0:00

Do you have heel pain first thing in the morning, or maybe after being on your feet all day, or even during a run? Almost like the more you're on your feet, the worse the pain gets. Now, these are symptoms of plantar fasciitis, and it can be a beast. My treatment for plantar fasciitis has changed a lot over the years, and now it's a lot more efficient and faster with better results. And that's what I'm going to be sharing with you today. So let's dive in.

SPEAKER_01 0:31

Welcome to Rehab for Runners, the podcast for runners who are ready to get out of pain and run with more confidence. Dr. Lisa will guide you with the clarity you need to unleash your potential with tools, practical tips, and exercises so you can enjoy your runs and exceed your goals.

SPEAKER_00 1:18

I've had planar fasciitis. It was not from running, it was actually from working and being in the wrong pair of shoes. So I had planar fasciitis eight years ago, and this was when I was working as a PT tech. So I was waiting to see if I got into grad school, and I was wearing those famous dance go shoes that everyone recommended, especially if you're on your feet all day. I bought them, they were expensive, and I said, Well, I need a good pair of shoes if I'm gonna be on my feet for 12 hours a day, because those were the shifts that was the shift I worked. And about two weeks into my job, I started getting a ton of heel pain at the end of the shift, and then into the morning, right when I'd wake up, the first couple steps out of bed were awful. They were awful. And you know this if you've had plantar fasciitis, but I just know I've been there and I can't wait to tell you more about how to treat it and how the heck to get rid of it and kick it so you can get back to running without pain. Planar fasciitis is very, very common. And one question that I always get asked is how long until it goes away? And just like with any injury, it depends first, but also it depends a lot on what you're doing to treat this injury. Because if you're just, you know, resting it, laying in bed, or just sitting on the couch and not necessarily exercising, it's not necessarily gonna go away. Now it might decrease, and then the second you start running again or exercising again, it might come back because you haven't actually addressed the source of the pain. You've probably just decreased the inflammation going on. So that's gonna result in less pain, but you still haven't addressed the source of the pain. So it really depends how fast you can get your hands on the right treatment strategy for you that's going to get rid of the pain and not just put a band-aid on the pain, not just kind of mask the pain, and then two days later the pain comes back. And we'll talk about treatment options and ones that work really well for planner fasciitis and ones that are just worth skipping. But let's dive in first to how my treatment plan has changed when treating plantar fasciitis. When I was a new grad, I would see a ton of planar fasciitis and really it's a common, common injury for not only runners, but those who are on their feet all day. And my treatment would start, and maybe you've been to a PTN person and you can relate to some of these, but I would do some scraping with like a grass tin tool, which is that metal tool, and you know, you put some lotion on your heel, and then you start scraping to try to get rid of quote scar tissue or to try to loosen up the plantar fascia. I also had my patients rolling their arch like with a lacrosse ball, and I did recommend night splints back then. Now, back then it was like four years ago, but I did recommend night splints for some of my patients, but I'll talk about night splints later. I would also have them stretch their calves, good old static stretching. I would encourage orthotics, I would stretch the big toe, and for manual therapy, along with scraping, I would massage the arch. Now, this helped patients a little bit, but it wasn't like it took the pain away and they were good to go. It really just decreased the pain just a little bit. Now, I that's all I knew back then. It's what I learned from my mentors. All my mentors would say plantar fasciitis is very difficult to treat, and that just kind of stuck in my head. So I would just go off of the treatment that they did because I didn't know any better. I was a new grad. But now that I'm I know a little bit more and I'm diving more in the research, I my treatment plan has changed significantly, and being able to treat plantar fasciitis is something that I feel more confident in, and I feel like I can treat plantar fasciitis a lot faster now, which is really cool because again, I've been there and I know how painful it can really be. So now my treatment plan works and addresses the big toe, the calves, the arch, the midfoot, rear foot, and forefoot stability, and looking at running form. And these new methods, I guess you could say, work because one, I'm not quote, putting a band-aid on the injury. So like massaging the arch or scraping the arch is not fixing why the pain is coming on. If we think about plantar fasciitis, you usually have pain right where the plantar fascia inserts into the calcaneus, so into the heel bone. It's one of those injuries where you could press your thumb into the heel and you want to jump off the table because it hurts so bad. That's a pretty good sign you have plantar fasciitis. Now, I'm not diagnosing you, I'm just saying it's a pretty good sign you have plantar fasciitis. Now, the reason that there's inflammation where the plantar fascia meets the arch is because there's too much load or force into that area, and over time these compensations from the foot and ankle have just caused more and more load through that area. So I'm trying to reduce the load in that area and massaging the arch and massaging, you know, the calves even, and massaging the plantar fascia is not going to take away the pain. That is not why the pain is coming on. The pain's not coming on because the calves are tight or the plantar fascia is tight. The pain's coming on because there's too much load going through where the plantar fascia inserts on the calcaneus or the heel bone. And that's usually because of the big toe not working correctly, the instability going on in the arch, and the calves being tight. And because of those compensations, there's now too much load. So if I think about my treatment four years ago where I'm stretching the big toe, okay, yeah, that was probably one of the best things that I did. Massaging the arch, you know, it probably felt like a this hurts so good sort of sensation for the patient. But two days later, they're having pretty much the same amount of pain. So that obviously didn't help. Stretching the calves was a rookie mistake because they're probably tight because they were weak. And rolling the arch again, I'm just trying to stretch out the plantar fascia, but that's not necessarily the reason that the pain is coming on. If I'm talking about running form, then in addressing the running form, what's happening when you're running, usually someone with plantar fasciitis is a heel striker, which if you know me, you know there's nothing wrong with being a heel striker, but they're probably over striding a little bit to where all the load is going through that one part of the heel, and they're not able to stabilize the foot once the foot hits the ground. And because of that increase in load, when you're over striding, it's just repetition after repetition, the pain's gonna get worse because now it's more load through that area as you're running more miles, and now there's more of that inflammatory response. So we gotta fix that. So let's talk about why my new method to treating plantar fasciitis works. This is a general, you know, a general treatment plan. Obviously, plantar fasciitis can be very different for everyone. You could also have issues at the knee and at the hip that need to be addressed, but I'm talking about more general plantar fasciitis and why these methods work. So if I'm looking at common movement patterns for plantar fasciitis, there's five that come to me fairly quickly, and these are very, very, very common movement patterns. So this means like if someone presents to me a plantar fasciitis, majority of the time, now not always, but majority of the time, they are at least showing three of these five signs. So the first sign is lack of big toe mobility and stability. Now, I did a podcast episode on this. So if you're like, why is the big toe important? Make sure you go back to that podcast episode because it is very important. But the big toe has to stabilize when the foot hits the ground. But as you push off, it also has to go through that mobility for push-off with gait, with running. So if the big toe is not able to stabilize and the big toe, once it stabilizes, once the foot hits the ground, the big toe is pushing into the ground, that triggers the arch to now stabilize and the posterior tip to now activate. So it's definitely a cause and effect or ricochet effect. So if the big toe is not able to stabilize and tell the arch to stabilize and control and then the posterior tip to work, those other things, the arch control and the posterior tip not working is it's out the window because the big toe is not stabilizing. So being able to stretch out that big toe into specifically big toe extension where you bring your toe up or closed chain big toe extension where you're pushing off the ground and being able to stabilize it. 9.9 times out of 10, someone with plantar fasciitis does not have enough big toe mobility and they are not able to stabilize the big toe, specifically in a single leg position. Number two is lack of arch control. So again, because the big toe triggers arch stability, you're not gonna have that arch stability. The arch, specifically the midfoot to the rear foot, and then the midfoot to the forefoot is very unstable. And again, that's why all of that force is going through that one part of your heel, your arch. So if you you need to have that arch stability, you need to work on these foot intrinsic muscles that sit under the planar fascia, which there's like five layers of them. It's insane because they're very small, but they're very, very important with foot stability and arch stability. So being able to work on those muscles, being able to activate them, stabilize the foot so it's not all going through the heel. Next is the weak calves that appear tight. Now, again, the rookie mistake with stretching the calves, I didn't really know better. But if you are static stretching your calves, you're not addressing why they are actually tight. Even if you hold it for two minutes straight, you're still gonna have that tightness two days later. I guarantee it. So we have to work on the strength of our calves specifically into a single leg position. So working on your calf strength with your knee straight and your knee bent is a great place to start. And then also double whammy because if you're working on single leg heel raise, your big toe has to push into the ground when your heel is up in that single leg heel raise position. So that's why I love single leg heel raises. Now for running, I already stated that you're over striding. Very, very common. You might also, if you're having a ton of pain, you might also have an antalgic gait, which just means it looks like you're running with pain. Basically, you might be taking shorter steps, trying to change your foot strike. You might be just basically trying to avoid any load or force through your heel because that's where the pain is, that's where the inflammation is. Your body's like, how can I continue to run without putting all this force and load through this one spot that is killing me? So you might even land, try to land more on the outside of your foot or just any compensation. So you're not putting so much load and force through that one area. The last movement pattern that I see all the time is a very stiff ankle. Now, this goes, if you think about it, this really goes hand in hand with having all that load go through the planner fashion insertion because if your foot is hitting the ground without any give or you're not able to disperse the shock, you're probably landing very loud, but also your foot is just hitting and your heel is just hitting where the planner fashion inserts. And instead of it being like a smooth rocker foot, you're just loading all that force onto where the planner fashion inserts. And again, usually we see more stiffness into dorsiflexion compared to planner flexion. So being able to go through that dorsiflexion range of motion and absorb the shock is very important. Now let's talk about rehab options because this is one of those injuries that has like 10 rehab options that I've seen and heard of. And let's go through if they are even worth trying because some of them can be very expensive, and I don't want you to waste your time or your money. So the first rehab option is a massage. You know, you might get a foot full body massage, and you might want it to really emphasize like foot and ankle tightness. And the masseuse might say you have very tight calves and very tight planner fascia. Now, again, we already talked about this about why it's tight, but it might feel good. It might feel you might feel better after the massage. And if you want to keep doing it, go ahead and keep doing it, but it's not addressing why the pain is coming on. And again, it's not addressing how your foot is absorbing shock. It's not addressing the big toe mobility and the stability of it. So that's why you don't have to get a massage for pretty much any injury, but if it helps reduce your pain in that moment, you know, and you want to do it, then that's up to you. I'm just giving you my recommendation. The next rehab option is dry needling. Now, I really like dry needling. And if you have planner fascia, then you might want a dry needle or get, don't do it yourself, but you might want to get your calves and your planner fascia dry needled. I will say if you get your planner fascia dry needled, just bite your tongue because it's it's gonna be a little intense. But your calves, you know, they're gonna be tight, so they might feel a little bit better when they get dry needled. But again, you're just releasing the muscle. You're just releasing the it's basically when you insert a needle into your body, a dry needle, specifically, you're eliciting a muscle twitch so the muscle can relax. So you're not strengthening the muscle like we want to, you're just helping it relax. So if this helps with pain management, go for it. But follow it up with exercises. Do not just dry needle. Your pain is gonna come back. If your PT just has you dry needling, you have to follow it up. Say, what are some exercises that I can do? Because that's just not enough. It's not enough. Talk about a waste of money. We have number three, okay. If your PT does this or your Cairo does this, run. You're wasting all your money. And that is laser treatment or ultrasound. Now, if you do see benefit to this, chances are it's placebo. A lot of clinics don't even use laser anymore because insurance doesn't even reimburse it because it's just that much of a waste of time and money. Um, same with ultrasound. When I was treating four years ago at an ortho clinic, they did not, insurance did not even reimburse for ultrasound because it's not it's not doing anything. So if you do feel any difference, it's probably placebo, which is fine, but again, follow it up with exercises. If you have a choice whether you want to do it or not, just skip it. Spend your time on things that will address the source of pain. Number four is night splints. And I talked about this before. I think now night splints are in the research, and a lot of the things in the research are more like a combination of things like night splints, new shoes or orthotics, and then exercises. Um, so night splints, I recommend if you are having moderate to severe pain, not necessarily low level pain. Now, remember, you're wearing this at night, and if it's affecting your sleep, your muscles aren't able and your tissues aren't able to recover and repair themselves like they should. So make sure it's not affecting your sleep because it's not worth it. That is not worth it. I'll link a night splint below. Again, only if you're having like severe pain and we just gotta work on pain management. This can help with decreasing the amount of pain that you have first thing in the morning when you're taking those first couple steps. But again, do not just use night splints and nothing else. You're not gonna see results. Number five, planar fasciitis socks. Now, basically a planner fasciitis sock is a sock with arch compression. Now, pretty much all running socks should have arch compression, in my opinion. So if you're running with planner fasciitis and you're able to tolerate it and it doesn't necessarily get worse to where you have to walk and you're still able to continue running, then it's a good idea to get socks with a planner fascia compression. Basically, like I said, arch compression. But other than that, you know, if you're on your feet all day working, it might be a good idea as well, but it's definitely not a necessity. Number six is rolling your arch with a water bottle. This is super, super common. And the whole idea is basically you take a plastic water bottle, fill it up with water, stick it in the freezer, and then after your long day running or at work, you roll your arch with this frozen water bottle. I think that this is a good idea if you're having a ton of pain and you need to focus on pain management. Because the whole idea is it reduces your inflammation because of the ice and also you're rolling out your arch. So again, if you're having a ton of pain and you really, really have to get that inflammation down, it's not a bad idea to do it. But again, that's not gonna fix it. It's not gonna fix why you have the plantar fasciitis. Number six is a corticosteroid injection. This is pretty common, I'm finding for those with pretty moderate to severe plantar fasciitis. And I think it's a good idea because if you're having a ton of pain, like I would say seven out of ten to ten out of ten pain on a day-to-day basis, we have to get that pain level down, or else you're not gonna be able to tolerate exercises that actually work to address this inflammation. And so I think it's a good idea if you are having that moderate to severe pain, so you'd get the corticosteroid injection. Again, it's not gonna feel great, but you get it, and then you follow it up with exercises. So now your pain level is a lot lower and you're able to tolerate more exercises. Now, don't just get the corticostero injection and say, Well, I feel great because that thing's gonna wear off and then you're gonna have pain again. So make sure you combine it with exercises, and that's really what the research concludes for plantar fasciitis is combine whatever you're doing with exercises that address the source of the pain. Shoes or orthotics. Now, when I had that plantar fasciitis episode when I was working as a tech, it was because of my shoes. My shoes were like bricks, and I have very flat feet, and they felt awful at the end of the day. The second I wore different shoes, my pain went away. So, this is one of those injuries where I will say your shoes can be for blame. A lot of the shoe options that can cause plantar fasciitis or a flare-up of plantar fasciitis are ones with a very narrow toe box because again, you can't use your toes like you should, including that big toe, or ones with a very narrow heel cut. So take that into consideration. You want to pick a shoe that works for you. Again, I used the best-selling shoe for those on their feet all day, and it did not work for me. For orthotics, I don't recommend jumping into custom orthotics, but they can be like 300, 400 bucks, and you might not even be getting any pain relief. So start with an over-the-counter orthotic that is still good quality. I'm not talking about Dr. Scholes, those are flimsy, those are cheap. I'm talking about something like Superfeet, where the focus is on the arch support and the focus is on the heel cup. And that is something that I would just start with. Now, if you're finding that, you know, this is definitely not a necessity, but if you're like looking for different treatment options, then I would definitely try something like Superfeet. It can be sold at REI or online at Superfeet before you jump into custom orthotics because PTs can make custom orthotics and I've made them before. I've made them before when I was a student. And one small, small, small change, like one degree, one millimeter change where it's not perfect, is basically not going to be helpful. So consider that even if it's a custom mold of your foot, they're just so, so, so expensive too for them to sometimes not even be helpful. So I would try over-the-counter first. Now, the last thing that I would try, and this has been the best treatment option that I've heard, and I'm not being biased because I hear this every single day now, is a combination of using toe spacers and going through the foot and ankle program. And the whole idea is this combination. Now, I have not tried toe spacers when I had planar fasciitis, so I've just heard this through the grapevine, or actually directly to me. But this combination using toe spacers, you're spreading your toes out because usually they're crammed inside a toe box. So you're spreading your toes out, and then you're backing that up by addressing the source of the pain with the foot and ankle program. So I'll link both below, but basically the toe spacers, if you haven't heard of them by now, then you need to get them. They are amazing. They're amazing if you even if you don't have plantar fasciitis, they're basically like rubber toe separators that pretend like you know you get a pedicure and those foam blocks in between your toes. It's basically that, but it's rubber, so you can move around in it. And they help a ton because you spread your toes out. Your toes are now into abduction and you're able to align your toes. You're able to use your big toe like you should. So going through and using those toe spacers, once you get them, I recommend that you use them, I would say 10 to 20 minutes just sitting, not necessarily and standing yet. And then as you progress, you'll be able to use them more and more. So consider the toe spacers and consider the foot and ankle program. Again, the foot and ankle program is addressing exactly why you have the pain. So all of those things that I talked about, how my treatment plan has changed, all of those things, the big toe mobility and stability, the arch control, the tight calves, the over striding, the ankle stiffness, that all is being addressed in the foot and ankle program. So make sure you go through both, get both, and then your your plantar fasciitis pain will decrease. If you enjoyed this episode of Rehab for Runners, please rate and review it. And as always, enjoy your runs and run strong. I'll talk to you later. Bye.