Plantar Fasciitis - Exercises
Foot Pain - What is Abnormal and How to Create Normal Foot Mechanics
If you followed my previous blog post about plantar fasciitis (link here), I described the correlation between dysfunctional mechanics and time in relation to the feet. How, inevitably the combination of these variables results in pain in and around the feet.
To recap, plantar fasciitis is an inflammation of the fibrous tissue (plantar fascia) along the bottom of the foot that connects the heel bone to the toes. Many people suffer from pain and problems with their feet in general, so if you have never heard of the diagnosis of plantar fasciitis, these exercises may still benefit you.
What does abnormal look like?
To give you a visual of the types of dysfunction we might be looking for, the following (but not limited to) are a few examples:
Pes Planus (Flat Feet)
Here we see flattening of the arch musculature causing tension on the medial (middle) side of the ankle and foot. This also tends to cause extra upward stress on the outside of the mid foot.
Here we notice how the great toe has a large knob located at the joint. This is called a bunion. Bunions often form as a result of decreased toe abduction (being able to keep the toe
in neutral). It places stress at the joint, forcing the body to increase bone density to the area to withstand the extra stress.
Heel Spur/Bone Spurring
Here, notice the bottom front portion of the heel. This is what “spurring” looks like. Bone spurs often occur because of abnormal stress on the bone, forcing the body to increase bone density to the area to withstand the extra stress. This specific type of spurring (pictured above) is due to constant tugging of the plantar fascia (soft tissue) on the bone as it attaches to the heel creating calcification of the tendon.
Although these snazzy shoes are normal for today’s busy working individual, the feet of this individual are NOT made to be jammed into shoes of this shape. Inevitably over time the toes smash together forcing the foot to take this shape. You can use your imagination to envision what the feet of this individual look like outside of these shoes. Whether you wear shoes that look like this, high heels, or flip flops your feet will eventually begin to take shape of what you put them in.
What characteristics are we looking for to be considered “normal”?
We are looking for feet that:
move and function well
have control of moving and spreading the toes individually
have good space between each of the toes
don’t have abnormal callus formation (like under the second toes, in between toes, etc)
have the great toe positioned in neutral
can hold body weight without arch collapsing
Just to name a few.
This picture (above) depicts what a normal, neutral foot should look like compared with a foot that rolls inward (pronated), and a foot that rolls outward (supinated). We are all striving for a neutral arch as this position is most efficient, and bears load (body weight, gravity, extra load ie. weights) which disperses stress appropriately across the foot reducing stress on the tendons, ligaments, muscles and bones.
How do I create a new normal if my feet look similar to the above pictures?
The following exercises can also be useful for other foot conditions like bunions, bone spurs, achilles tendonitis, osteoarthritis, blisters, old ankle sprains, etc. This is also not limited to foot and ankle pain syndromes. Improper foot mechanics cause a number of injuries leading up the kinetic chain into the knee, hip, back and so on.
Here are some exercises:
1. Become friends with your toes:
Intertwine your fingers with your toes as though you are intertwining hands with another person. This simple, passive stretching on a regular basis will produce more space in the joints and tissues making them more pliable.
2. Toe Yoga:
3. Stretch Toes Upward
Stretching the toes into this position will help to stretch the BOTTOM ligaments of the toe joints, and the plantar fascia.
4. Stretch Toes Downward
Stretching the toes in this position will stretch the top ligament of the toe joints, the muscles and tissues of the TOP of the feet. These tissues are often neglected, and very often used.
Another variation of the above stretches.
c. Stretch Toes Apart
Stretching the toes apart, particularly stretching the great toe and the pinky toe as far away from one another as possible, is effective in keeping the width of the foot functional. More foot surface = better platform to feel, move and control the rest of the body. Start this exercise without a rubber band and focus on just spacing your toes out from one another.
d. Pull Great Toe Upward
While keeping the smaller toes down, pull the great toe up as high as you can. If this is too hard, you can start by pulling the great toe up with your fingers, while pushing your smaller toes downward, and then try to hold this split position. It should get easier with each repetition but may take several sessions to feel really comfortable with this exercise.
e. Pull Smaller Toes Upward
The opposite of the previous exercise is keeping the great toe down while the smaller toes are pulled upward.
The importance of these stabilizing exercises is to make brain connections with the body. Many people are surprised at how hard these exercises can be. Over time, these exercises will become easier, AND very few people experience pain if they practice these often.
3. Self Myofascial Release Techniques
Use a mobility tool to roll the bottom of the foot, calf, and shin. This is called self myofascial release. This technique not only pushes inflammation out of the areas being rolled, but it helps get rid of myofasical adhesions.
4. Toe Spacers
Tools like toe spacers help externally space out the toes. This is a great place to start if you are on your feet the majority of the day and are just starting with the exercises above. It takes time to increase the connection and control between the brain and the body and so an external support will help create space in the mean time.
Keeping in mind that there are hundreds of exercises to help mobilize and stretch the feet, these are a few to start with. Doing these on a daily basis will help to increase stability and most patients who do these regularly recover from their foot pain relatively quickly!As always, it is great to consult a professional before starting with any specific exercises, just to rule out anything more significant. If these do not help your condition, it may be that you need a more comprehensive work up provided by a professional. These are a great start!
Dr. Heather Russell
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