This condition often causes months and sometimes years of discomfort, and too often leads foot pain sufferers to limit their normal activities. It commonly interferes with their work, sports, and recreational activities. Traditional treatment methods for this type of foot pain are often slow to provide relief and often do not address the true source of the problem, leading to incomplete relief and a high rate of recurrence.
Fortunately, a new treatment technique known as Active Release Techniques® (ART®) is proving to be a very effective method to resolve Plantar Fasciitis and other common foot conditions. But before we talk about how ART® works so effectively, we like to explain how Plantar Fasciitis develops.
Foam Roller for Gastrocnemius Foam Roller for Peroneals Arch Raises
Toe scrunch helps strengthen muscles of the foot and should be repeated 8 times for each foot. Click “Toe Scrunch Step #1” for further video instruction.
Gastrocnemius tension occurs commonly in runners or walkers. The foam roller helps release tension of the achilles tendon. This exercise can be painful at first but you should perform this for at least a minute with rest in between 3 sets.
Peroneals releases tension from the outside lower leg which helps people maintain daily activities. Perform this exercise for at least a minute with rest in between 3 sets.
Arch raises will strengthen the bottom of the foot and prevent further injury. Perform this exercise 10-15 times with each foot and repeat 2 cycles.
Another group of muscles is located on the bottom of the foot. The vast majority of these muscles are attached to the bottom of the heel.
Located just under the skin and over the top of the foot muscles is the plantar fascia, which is very tough and dense connective tissue that runs from the bottom of the heel all the way to the toes. The fascia works to support the arch of the foot and helps to stabilize the joints of the foot when bearing weight.
Beneath the plantar fascia, muscles are arranged in layers, and each muscle in each layer has a different function. For example, some of the muscles attach all the way to the toes and act to flex and stabilize the toes, while other muscles attach to other bones of the mid-foot to control and stabilize the arch of the foot. For the foot and ankle to work properly, and to prevent pain and injury, the foot and calf muscles must have adequate strength and flexibility, the different layers of muscles need to be able to glide freely over another during normal use.
Throughout the day we use our feet a great deal. As we stand, walk, or run, a tremendous amount of pressure is placed on the foot. This creates tension on the plantar fascia, causing the muscles of the foot to contract to support the arch and stabilize the joints of the foot. Over time, the muscles of the fascia can become strained and fatigued and develop small amounts of injury, called micro-trauma. Simply stated, micro-trauma is very small-scale damage that occurs in the muscles, fascia, and ligaments in response to small levels of strain. Initially this micro-trauma is not painful, but may be perceived as a mild ache or tightness in the muscles, or at the heel where these muscles attach. Although small, this damage needs to be repaired. The body responds to soft-tissue injury (including micro-trauma) by laying down small amounts of scar tissue to repair the injured tissue. Over time, this scar tissue builds up and accumulates into adhesions. As these adhesions form, they affect the normal health and function of the muscles. In fact, adhesions often lead to pain, tightness, lack of flexibility, muscle weakness, compromised muscle endurance, restricted joint motion, altered biomechanics, and diminished blood flow.
As the muscles and fascia of the foot become strained and then develop adhesions, they become very tight. As the tightness increases, the tissue begins to pull away from the heel where it attaches, eventually leading to pain and irritation at the bottom of the heel. Sometimes with long-term muscle tightness, this constant tension can lead to the formation of a heel spur. Evidence of a heel spur on an x-ray can lead to misdiagnosing the heel spur as the cause of the pain. The problem is that the heel spur is very rarely the cause of pain, leading to inappropriate treatment.
In addition to causing pain and tightness, adhesions are very sticky, affecting the ability of the muscles to stretch, contract, and slide over one another. Every muscle in the foot has a different function, and contracts at different times, so the muscles need to be able to glide freely on one another. Adhesions cause the individual muscles layers to stick on each other, preventing the normal gliding. When the muscles lose the ability to slide and glide over one another, the entire area binds together. Think of these adhesions like the rust and grime that can build up in an automobile. Normally the parts of the car should be well oiled and move smoothly, but when rust and grime are allowed to build up, the car begins to break down until eventually it does not work properly and repairs are needed. The same thing happens in the body. Stretching or contraction of one muscle causes pull and tension on all the other muscles. This in turn causes more and more strain on the muscles and increased tension at the heel.
Another common development is that the accumulation of scar-tissue adhesions can affect the nerves in the ankle and foot. This occurs because between the layers of muscles are nerves that run from the knee down the lower leg, around the ankle, and into the bottom of the foot. Just as the muscles need to be able to glide on each other, nerves also need to be able to glide freely between the layers of muscles. In many cases the accumulation of scar tissue can cause the nerves to become stuck to the surrounding muscles and fascia. Instead of the nerve gilding easily between the muscles, it becomes stretched and irritated, leading to foot and heel pain. It is quite common for nerve entrapment at the foot or ankle to cause foot and heel pain and lead to an incorrect diagnosis of Plantar Fasciitis. Obviously, an incorrect diagnosis leads to incorrect treatment, which will not be effective in relieving the condition.
How Can Plantar Fasciitis and Other Similar Foot Problems Be Fixed?
The main reason these approaches are often ineffective is that they fail to address the underlying scar-tissue adhesions that develop within the muscles and surrounding soft tissue. These adhesions are binding tissues together, restricting the normal sliding of the tissues, and potentially entrapping the surrounding nerves at the foot and ankle.
Passive approaches including medication, rest, ice, and ultrasound all focus on symptomatic relief and do nothing to address the muscle restrictions and dysfunction. More active approaches such as stretching and exercises are often needed for full rehabilitation of the condition and to restore full strength and function of the muscles. However, these approaches do not treat the underlying adhesions. In fact, without first addressing the scar-tissue adhesions, stretches and exercises are often less effective and much slower to produce relief or recovery.
You can think of ART® treatment as a type of active massage. The practitioner first shortens the muscle, tendon, or ligament, and then applies a very specific pressure with the hands as you actively stretch and lengthen the tissues. As the tissue lengthens, the practitioner is able to assess the texture and tension of the muscle to determine if the muscle is healthy or contains scar tissue that needs further treatment. When scar-tissue adhesions are felt, the amount and direction of tension can be modified to treat the problem area. In this sense, each treatment is also an assessment of the health of the area, as we are able to feel specifically where the problem is occurring.
An additional benefit of ART® is that it allows us to further assess and correct problems not only at the site of pain, but also in other areas of the kinetic chain, which are associated with movement compensations and are often contributing factors to the problem. This ensures that all the soft tissue that has become dysfunctional and is contributing to the specific injury is addressed, even if pain has not developed yet.
One of the best things about ART® is how quickly it provides results. In our experience, foot injuries respond very well to ART® treatment, especially when combined with the appropriate home-stretching exercises. Although each case is unique and several factors determine the length of time required to fully resolve each condition, we usually find that significant improvement can be gained in just four to six treatments. These results are the main reason many elite athletes and professional sports teams have ART® practitioners on staff, and why ART® is an integral part of the Ironman triathlon series.
To book an appointment to see if ART® can help with your foot pain, call our office at 248-477-2100.