Instep Dance Magazine Articles
Reprints of monthly column as first appearing in Instep Dance Magazine.
Soles On Fire - Plantar Fasciitis
By Rick Allen, DC
Last month we screamed, "Argh," those aching muscles! This month the soles of your feet are on fire. No, you didn't choose to walk over burning coals with Anthony Robbins, turning "Fear Into Power." You are in good company, though, with a number of runners, triathletes and at least one dancer I have treated recently for plantar fasciitis.
Proper Identification of the Problem
By its name ending in "-itis", you would think that this would be an inflammation of the soles of your feet, technically called the "plantar fascia". And as such, the answer would be anti-inflammatory medications, such as Ibuprofen, Advil or Aleve, and cortisone injections. Wrong on both counts.
The constant stretching and overuse common to running sports and, sometimes, dancing causes degeneration and ultimately loss of blood supply to the plantar fascia, a flat tendon which attaches to the heel on the bottom of the foot. On occasion, a bone spur forms as well from the heel or calcaneus. This malady is still commonly treated with rest and anti-inflammatory medication, including cortisone injections. Sometimes the entire plantar fascia is released surgically. This, too, is wrong.
According to the summer 1996 newsletter of the American Running and Fitness Association (ARFA), plantar fasciitis is not an inflammatory problem, but a painful degenerative condition. A better name for it would be "plantar faciosis" or "plantar tendinosis". I am not splitting hairs about the naming of the condition. As I have mentioned several times over the past year, anti-inflammatory medications, both steroidal and non-steroidal, while having short term beneficial effects which may be necessary for serious acute crisis, actually slow healing and have serious side effects. They should be used judiciously, not given out like candy, as they often are for conditions such as this.
Like Dr. Robert Nirschl, an orthopedic surgeon and Founding Director of the Virginia Sports Medicine Institute and a fellow ARFA member, I have found that plantar tendinosis is commonly accompanied by major weakness and loss of flexibility in the entire leg. Quality rehabilitation to restore strength, endurance and flexibility must, therefore, include all areas of the leg. The biological goals of treatment include restoration of blood vessel supply for nutrition and tissue production of protein collagen, the "healing glue" of the tendon.
Proper Conservative Treatment
Treatment of plantar tendinosis may seem frustratingly slow, requiring treatment several times a week for a few months. It is hard to provide the relief from repetitive re-injury, especially when the condition is painfully acute. Often times, the condition waxes and wanes because you don't allow it to heal fully before resuming the activities that precipitated the injury.
I believe a good natural strategy of treatment and rehabilitation includes the following elements:
Consult a therapist or doctor who is familiar with hands-on techniques to progressively loosen the area. Get a massage of the legs and feet to help restore better flexibility and blood flow. Start gently and work more deeply as the area can tolerate deeper pressure. A doctor of chiropractic will also check for incorrectly aligned bones and improperly functioning joints.
I often use ultrasound as well to stimulate better blood flow and healing of the plantar fascia. An herbal ultrasound gel seems to work better than plain ultrasound lotion for relief of pain.
Stretch your back, hips, legs and calves, and feet daily.
If the plantar fascia is tender, rolling a frozen golf ball under the soles of your feet may help to loosen the fascia while minimizing painful inflammation.
Take an Epsom salt bath or use the pool and hot tub for 15 minutes of relaxation.
A night stretching splint or foot box appears to be help the restoration of flexibility. A chiropractor, osteopath, podiatrist or other sports doctor familiar with the treatment of foot problems ought to be able to help you.
Make sure your shoes are in good shape, with reasonable mid-foot flexibility. You may find it helpful to change your shoes during the dance.
Protection of the foot during the rehabilitative phase with taping or soft orthotics is generally helpful. (Dr. Nirschl notes that heal cups are generally ineffective.)
Drink lots of water - 6 to 8 glasses each day.
Eat a good, natural diet, supplemented with a good, natural multi-vitamin and mineral supplement, which includes 1000 mg of vitamin C. (This is a topic worthy of an entire column itself!)
Do some alternative exercise, such as swimming or bicycling. This will keep you in shape and avoid irritating the plantar fascia.
When you restart weight bearing exercise, start slowly, again avoiding irritation of the plantar fascia.
If, after several months, conservative measures fail, you may require surgical help. According to Dr. Nirschl, many surgeons are not aware of the recent research and changes in surgical procedures. Standard surgical techniques are based on the erroneous premise of total tension release which was presumed to cause the inflammation. These techniques, unfortunately, release the entire plantar fascia (tendon) and, on occasion, the heel spur, if present. This surgical concept increases post-operative pain, and, more importantly, may unnecessarily weaken the foot support mechanism. These weakening increases the prospects of injury to the other foot and leg areas. To avoid this problem, the advanced surgical technique is to remove only the painful tendinosis tissue. This tissue is usually located in the medial one-third plantar fascia attachment to the heel.
Remember, though, that, for the vast majority of cases, conservative treatment and rehabilitative measures will be all that is necessary to get you back out on the dance floor.
Dr. Rick Allen is a chiropractor, massage therapist and dance student who splits his time between Portland, Oregon and Trout Lake Washington. Dr. Rick welcomes your questions and suggestions for future articles. However, he cannot make specific diagnoses or treatment recommendations unless you visit him in person. He can be reached by phone at 503-257-1324 in Portland, 509-395-0024 in Trout Lake, or toll free at 1-888-247-3248, email or on the World Wide Web: www.CascadeWellnessClinic.com
DISCLAIMER: The information included in this website is meant to encourage thinking concerning choices of care for and insight pertaining to possible causes of various problems. It is not a prescription for or diagnosis of any disease or condition. Suggestions are based on the assumption by the writer that a thorough examination was done previously and the reader is under care by a healthcare professional. This information is not a substitute for a live doctor.
© Dr. Rick Allen
Cascade Wellness Clinic