Plantar fasciitis easy wins you may be missing

You're listening to the Restoring Human Movement Podcast, where movement experts discuss the latest evidence-based practices to help you and your clients move with mastery. Hey everyone, it's your co-host Sebastian with the Restoring Human Movement Podcast. Thanks for joining the show today. Today I wanted to give a little case presentation of someone that I recently saw with foot pain or pain in the front part of the heel. Some of you may know it as plantar fasciitis, and I'm going to cover some of the intricacies of this case today to give you some insight that, number one, not everybody is exactly the same.

Everybody has different reasons for this problem, but there are underlying mechanics and principles that most people can use. But if you don't fill the holes in the person's life or make sure that they have the proper program in general, then you may be missing some easy wins in regards to prevention as well as pain management. So before we get too far, just know that if you are having problems like this, we do have telehealth sessions available and we're licensed in various states. You can always contact us in the description for the podcast player to see if we can actually help you out as well.

We see tons of people with our telehealth system and we're very good at coaching and watching movement and it tends to work out really well. Give us a shot. Now, plantar fasciitis, for those of you who don't know, we've covered it at length in one of the books that Mandy Riehl wrote, and it's available in the description for the podcast as well. But just know that it is usually pain in the bottom of the foot. It typically presents as single side. I've had various people ask over the years of, is it possible to have bilateral or double foot plantar fasciitis? And the answer is really no. Usually if you have bilateral complaints, it's more of a referred type of symptom from the lumbar spine known as a radiculopathy.

The easiest thing that I can relate it to that's at least relatable to most people is diabetic neuropathy. Like nobody gets diabetic neuropathy in their feet on one side. It gets bilateral because it's typically a bilateral issue. That one's a different one in regards to, it's not really like a spinal issue. It's a systemic one, more of a hormonal one in that nature. But just consider that when you have bilateral presentations on things, like usually it's going to be something a little bit more from a central source or a systemic source. This person came in though, having a good history of being on their feet, walking quite a bit every day, and even doing some hiking and running.

Now this individual had pain over the last month. Usually they have a buildup or some type of habit change, like they've been done more mileage, or they've changed the terrain dramatically. This didn't really happen, which is a little bit atypical for this scenario, but most of the time people will have some type of change of terrain, habit, mileage, et cetera, that creates this problem to become awake again when it was once dormant. This person had it into the underside of the foot, a little bit into the arch. There was no symptoms in the calf, which is really typical as well. They also had some old hip issues up into the same side of the body as well.

This will become significant later when we talk about the mechanics that are associated to it. But she wanted to get back to the point where she can comfortably walk, comfortably run again. Because even right now, hopping was painful. Squatting down all the way to the floor with heels elevated was painful. And so normally what I tell people is the things that are going to reduce the quickest are things that are activities of the daily living base, like the easy things, like being able to squat down, being able to walk. Like these are things that are going to go away fastest, but not to say the symptoms with running or hiking won't.

It's just that there's more load and more demand in those activities. So when we're deciding how to manage this case first, we need to first realize that progress is going to show itself first with activities of daily living, the simple things. And then we can advance that program even more to make sure that the results are expressing themselves in the sport or activity as well. So I decided to look at the squatting pattern with this individual. A lot of people with plantar fasciitis have problems up the leg as well, which I did allude to the hip being an issue. This person had a history of putting more body weight into the right side.

If you've listened to other podcasts, you've heard me talk about this at length, where some people unusually put more body weight into the side of their problem. The reason why this is unusual is because if I stepped on a tack or I had pain on the bottom of my foot, would I put more body weight onto that side or less? Most people with fresh injuries, they do less. Like if I stepped on a tack or stubbed my foot or stubbed my toe, I would probably put less body weight into it, insinuating a fresh new injury cycle and no real compensation that's creating the issue. Now, for people who don't really have a mechanism, it just kind of comes on over time, maybe after a change in their programming or mileage, those people may do a little bit of what this person did, is they put more body weight into the side.

You can see it clear as day in the squat pattern. You get them to squat with their feet in parallel and they squat down and they put more shift onto that side, which insinuates an overload principle, insinuates an overuse, but not main, not really to the point of where we're overused as in mileage. It's more that there's more demand on that tissue structure in the foot because of a poor load sharing principle. There's one that we can point out here where they're putting more body weight into that side. But the second one that we can point out too is that this person had really trouble activating their right glute because of an old hip issue.

So we have the person putting more body weight into the side, the right side, which is where the foot problem was. There wasn't enough load sharing in that leg either because the glute was dormant and so it puts more load into the knee and into the foot. So ways that we can mitigate this problem from returning is to make sure the squatting pattern returns back to normal. There's a series of exercises and stretches that can be done for this, but it's different for every person. And also we can get it so the glute max, which is the most important glute on the right hip starts to do its job. And this can be done with isometric work and it can also be done with making sure the right strength training program is implemented and making sure there's not holes in the program, which I'll talk about in a moment.

Now, if you know anything about plantar fasciitis mechanics, we know that there is more demand put on the plantar fascia if there's a collapse of the knee in single leg patterning. We showed this in the book that I mentioned that you can get for free. And it shows how there's a whole collapse of good mechanics in the entire limb and it usually starts at the core, the hip or the pelvis or all of them. So we know this person has had trouble activating their glute. Now the glute max is the main glute that actually controls inward spiral of the femur, which also controls the IT band, which controls inward dive of the knee.

The IT band is the main structure that stops the knee from diving inward. And 70% of the glute max fibers attach into the IT band. It's not that TFL muscle because it's so tiny and small. It doesn't do a lot. The glute max is the main player in this. And so if there's inward spiral spiraling or the knee dives inward, it's going to collapse the arch. You can look at this clear as day on yourself. You put your foot on the ground and push your knee into where the other knee is. You'll see the arch collapse. You cannot have these mechanics that aren't connected to each other. These mechanics couple.

So if we need to spare the plantar fascia from taking so much of a hit, we need to, number one, again, get the squat mechanics to normalize, which I'm not going to cover how we're going to do this today in this podcast. But the glute max one, though, on the same side would be a really easy one to address. The person actually had really good questions about, should I rest this foot? Should I not challenge the leg at all? Should I rest more, et cetera? Ice, heat, and so on. A lot of passive care, which are really common questions. And so I said, no, we should challenge this foot. We should make this foot stronger and we should make the peroneal muscles stronger, which are a big player with plantar fasciitis as well, if you look into the research.

And we should make the glute max active. We'll cover the squat thing at the end of the day. The way we did this is to, number one, get the tibialis anterior muscles working, which when we did it, the person had no symptoms whatsoever. And so when they asked that question about, should we load the foot, my statement still stands. We're, yes, we should load the foot, but should we load the plantar fascia? Probably not. Like, at least not in isolation. The next thing we did was we tanked the tibialis anterior. And the tibialis anterior was so sore on this person that they said, oh, this is going to be sore tomorrow.

And I said, yeah, it's going to be sore. But the good news is, is we don't have any symptoms with this exercise, right? And she said, no. And I said, great, that's all we want. Next thing we did was we loaded the big toe, especially in flexion. The best way to do this is in toe dorsiflexion or big toe dorsiflexion. So we use a specific exercise where you slide their big toe pad into the doorway. We wedge it in there and we have them push the doorway. This is an isometric exercise that we ramp up into. She was able to do this, three sets. Do you have any pain? No, I don't. I said, look at that.

We're loading the foot, but we're not loading the specific pain generator of the foot, which is a plantar fascia. So again, another good win. We can load and support the foot, make it stronger without really irritating the tissue which is involved. The last thing that I had her do was a glute max isometric one, which is a single leg hinge. We call it a crossover wedge. It's a wall version of an isometric exercise for the glute max. And it kind of looks like you're bowling. We've shown this on our free giveaway. So please take advantage of that. There's a full length video in there as well. And so those are the starting points and all these are very hard.

None of them created symptoms in her problem. And so I said, these are all easy wins. So that's, we need to load the foot. We need to load the glute. We can load the squat on another day, but something we can do to take some pressure off of the symptomatic structure. So we're not just working around the area, is to mobilize the tarsals, the small bones of the foot. And so I gave her toe threading, again, that's completely free in the podcast, in the description of the podcast that we have, that recovery program we have. Toe threading is one of the most useful things you can do for plantar fasciitis.

I remember there was one person that had years ago, he dropped into town. He was just in town for a day or a couple of days before his race. And so I saw him one day and he had plantar fasciitis. And so I saw him on about a Thursday, I think, and he has a race on Sunday. And so I gave him toe threading to do, and that's all we really did. And so he actually reached out to me and he said, I was able to run the entire marathon and I didn't have really any significant heel pain that stopped me. And when he had come into town, he said, I am worried I'm not going to be able to actually finish the race.

He thought he was going to DNF. That one tarsal mobilization was really, really helpful to him, but there's other things that need to come into play as I, as I mentioned here. Now, the last thing that I talked to her about was filling a hole in her program. And this comes down to a strength training program, which we do suggest that people do. Your race times will probably get better. You'll be more injury resistant and you'll overall feel stronger and faster in your runs. Your running economy will get better. And so there's lots of literature to support this, having a well-rounded strength conditioning program that's more specific for your actual activity.

She was doing a lot of squatting, a lot of pushing and pulling and pushups and so on, which are all great. And I said, where's your deadlift pattern? And she said, I don't have one. And the main reason why was because just home equipment, a lack of home equipment is probably one of the number one reasons why people have lopsidedness to the strength training program. The squat that she did was fantastic. I liked the choices she made. I liked the pushing and pulling. Those were fantastic choices. But when it came to a deadlift, like generally your deadlift should be higher than your squat. And she was very strong in her squat.

But the fact that she had not really been doing a deadlift because of lack of equipment and weight is something that's very avoidable. I like using bags of sand or gravel or river rocks from Home Depot. The reason is because the height is a great height or it doesn't bother people's backs. And it's heavy enough that it's heavier. It's about usually 80 pounds. And it's heavy enough to where the person can already get into a lift that is heavy enough to complement their squatting pattern. And again, the reason for this is because you need to build strength in your glute max and your hips, which we know from the literature is a big factor associated with plantar fasciitis.

Whether you believe it or not, plantar fasciitis responds really well to hip exercises. So don't miss out on easy wins. If you guys are wanting some help with your plantar fasciitis, remember we do have telehealth options. We have in-persons, but we're licensed in various different states. And we have a running expert on. We have an ultramarathoner on staff who is excellent at not stopping people from doing their mileage, which is needed for their mental health, but also their physical well-being while they're settling these problems down. So if you want to keep running and keep active with your plantar fasciitis, reach out to us.

We'd love to help you out. See you guys next time in the podcast. Take advantage of those free offerings we have in the description. Take care.