It’s monday morning, the alarms going off and the last thing you want to be doing is getting up and going to work. If you’re like me then you have a love-hate relationship with mornings. As soon as I’m up mornings are the most productive part of my day, but that first step can be a struggle. For some people that first step is not just the difficulty of getting out of a warm bed, but first step pain (known as post static dyskinesia) particularly in the heel, is an incredibly common and painful symptom for many people.
Heel pain is the most common presenting complaint to our Pride Podiatry clinics in both Melbourne CBD and also Pascoe Vale. First step heel pain is a common symptom of a specific subset of heel pain which involves an overload of a structure known as the plantar fascia, or plantar aponeurosis.
Plantar fasciopathy (also known as plantar fasciitis or plantar fasciosis) occurs when there is too much load or stress on the plantar fascia and taking it from it’s stretchy, elastic and happy state towards its thickened, tough and painful cousin. There are many known risk factors for developing plantar fasciopathy, including the shoes we wear, the activities we do, the amount we weigh and also our bodies overall health and wellbeing. While an expert Pride Podiatrist can help identify your individual risk factors, and also how to manage them, today I will explain the underlying causes plantar fasciopathy.
The plantar fascia is a stretchy, elastic like band of fibrous tissue which runs from the centre middle of the heel (medial calcaneal tubercle) via 3 separate bands to the joints at the ball of the feet (the metatarsophalangeal joints). Our bodies fascia is a fascinating structure which has some similarities to tendons and some to muscles. The similarities are that there are some contractile tissues within fascia (the bits of our muscles which create a force to move), although minimal direct blood supply much like a tendon.
Some of us have more prominent plantar fascia than others, but you can feel your own fascia if you sit barefoot, cross one leg onto the other so that you can extend your big toe back. As you do this you can feel you plantar fascia if you run your thumb from the centre of your heel, towards your big toe. In some people you can even see the plantar fascia underneath the skin here.
The best analogy I can give for the plantar fascia in action is to think of it as a spring. Every time we plant our foot and transfer our weight down that leg our feet accommodate that movement and apply a tensile stretch to our plantar fascia. This is like pulling a spring from both ends, and it stores some energy ready for our next move. This taught, stretched spring can then help our feet maintain efficient function (walk, skip or run) by reducing some of the load on our energy hungry muscles.
So life with a good, stretchy and efficient plantar fascia is easy, as we spring from step to step. Life without this plantar fascia is much harder, as muscles must do more to maintain our stride, and if we do not have that muscle strength, or we get too tired, then the extra loading gets transferred to ligaments and joints, and more problems start.
Our plantar fascia has an optimal load capacity, which is much easier to think of in graphical form.
Basically we always want our plantar fascia to be loaded within our own “Happy Place” and spend as little, if any, time in the “Danger Zone” as possible.
How we load our plantar fascia is can involve some complex engineering, however if you’re like me and left aerospace engineering for the much more grounded and interesting career of podiatry then I’ll try to keep this straigth forward.
The two main loads that occur on the plantar fascia are tensile (or stretching) loads and compression. Tensile loads occur when the plantar fascia gets longer during standing when compared to non-weight bearing. Compressive loading is the squishing of the plantar fascia between our bodyweight, gravity and the ground.
How much load our plantar fascia can handle is very individual specific, and can be changed. While some factors cannot change (ie: long term steroid use, disease modifying drugs or diabetes), the ability to train the plantar fascia to take a higher load can be achieved, although time frames and specific training protocols would need adjusting.
As our plantar fascia has similarities with muscles and tendons, lets try on this thought experiment. Imagine you start a gym program, with 5Kg dumbell in your left hand, and a 15Kg dumbell in your right hand. Your expert personal trainer wants you to do 3 sets of 10 reps every day doing bicep curls with these exact weights. What do you think would happen?
Where the difficulty lies is if you’re in pain because your plantar fascia has been working too hard, then any further exercise is going to overload it further, and make things worse, not better. This is where the tight-rope act of balancing strength training to improve load capacity, and reducing current loading must be walked.
Stay tuned for the next post on reducing load capacity to address acute pain, and to allow strength training to occur.
And finally, when that Monday morning alarm goes off, don’t press snooze, put on your running shoes and come visit us at Pride Podiatry for an expert, individualised assessment and treatment program to overcome your heel pain.