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Plantar Fasciitis 101 Myths/Misconceptions and Common Sense (Very Long Post)

Posted by Mike W on 2/14/00 at 00:00 (015846)

M/M - The traditional definition of plantar fasciitis from Merriam-Webster's Medical Dictionary,1995: Inflammation involving the plantar fascia especially in the area of it's attachment to the calcaneous (heel bone) and causing pain under the heel in walking or running.'

In my opinion this is an incomplete definition of the 'symptoms' of PF
because there are 28 lower leg muscles that have tendons that either attach to or pass through/around the heel or toe bones. Anyone of them could be involved not just the plantar fascia and it's related muscle (the flexor digitorum brevis).

My definition of the underlying physiological cause of plantar fasciitis: PF is a condition caused by repetitive strain on 1 or more short, tight or weak ('inelastic) lower leg muscles that either attach to or pass through/around the heel or toe bones.

1. Repetitive impact strain on inelastic lower leg muscles CAUSES excessive pulling tension on their related tendons.

2. These over stressed tendons then CAUSE micro-tearing at the point of attachment to the heel or toe bones.

3. This repetitive micro-tearing CAUSES progressive scaring, tissue build up and inflammation at the point of attachment.

4. The inflammation ultimately CAUSES the pain and the formation of heel spurs and arthritis.

The Lower Leg Muscles

To better understand the LL muscles it is important to appreciate the basic elements that enable our body parts to move. Muscle cells have the ability to regenerate and are naturally very elastic (strong and flexible). The ends of the muscles are anchored to bones by cord like tendons. Tendon cells regenerate very slowly and are naturally very inelastic. To ensure the body moves smoothly with a minimum of friction the muscles are enveloped in a slippery skin like tissue called fascia. Muscles cannot push, they can only pull and therefore they usually work in pairs (flexors/extensors,abductors/adductors). By pulling on different sides of a bone they enable a joint to open or close.

There are 28 muscles operating in 2 distinct systems in the lower legs
The EXTRINSIC and the INTRINSIC muscle systems. There are 13 extrinsic muscles located between the knee and the ankle that have tendons that attach to or pass through/around the heel or toe bones. There are 15 intrinsic muscles that lie entirely within the foot. Flexor muscles allow the toes and ankles to flex down and generally run along the bottom of the foot and up the back of the leg. Extensor muscles allow the toes and ankles to stretch out straight and run along the instep and up the front or side of the legs. It is not important to know all of there names however, it is important to improve their elasticity.

FUNCTIONS OF THE LOWER LEG MUSCLES

SHOCK ABSORPTION
The extrinsic muscles must expend energy (elongate and shorten) to decelerate the shock of landing impact.

BALANCE
To keep you upright and evenly balanced in a normal stance your bodyweight should be equally distributed between the heel and your forefoot. The big toe alone is responsible for 1/3 of the forefoot weight. Weak toe muscles will not provide the support required to handle your forefoot weight. Most people with PF have inelastic lower leg muscles and therefore will unconsciously shift their bodyweight towards the balls of their feet or their heels. This forces your body to make a series of compensations that can lead to changes in joint position, posture and balance.

CIRCULATION
Lower leg muscles contract and press on arteries and veins which creates a form of auxiliary pumping action that encourages circulation of blood and lymph fluids. The pain associated with the first weight bearing step of the day is the result of poor circulation.

FACTORS THAT PROMOTE INELASTIC LOWER LEG MUSCLES

NEGLECT
'Use them or lose them' may be a cliche but it is true. Muscles that are neglected will over time atrophy. The LL muscles are probably the most neglected muscles in our bodies because we typically do not have the anatomical knowledge, intrest, or physical ability to improve their elasticity.

OVER USE
'Abuse them or lose them'. The LL muscles are among the most frequently used skeletal muscles in your body and must adapt to handle termendous loads. A 200 pound person running will place 720lb/square inch of loading force at impact.

AGE
The natural aging process that causes the gradual loss of muscle mass throughout our body's is called Sarcopenia. It usually starts about age 30 and by age 50 the average person will lose approximately 30% of their muscle mass and flexibility and 10% every decade therafter. Thus it is not surprising that PF is most common among people between the age of 30 and 50. The good news is however, is that you can build up elasticity in any muscle regardless of your age, even after years of neglect and abuse.

Weight
Extra weight translates into exrta stress on your LL muscles, fascia,
tendons, nerves and bones. Elastic muscles can handle extra weight more effectively than inelastic muscles.

TRADITIONAL TREATMENT SUMMARY

The reason traditional treatments fail (some people)and the thing that they have in common is that they focus on relieving symptoms and ignore the underlying cause. The traditional approach usually starts with conservative treatments and if they fail progress to more invasive treatments. This can lead to unnecessary treatments, expense, long recovery times and potential seriuos long term side effects.

There is no magic pill for curing PF, the magic is in your body's natural healing ability.

You have 2 choices regarding your treatment:
Passive choices; Tough it out and do nothing, orthotics, casting, night splints, anti-inflammatory drugs, cortisone shots, extracorpeal shock wave therapy, or surgery.
Active choices; Eliminate morning pain by improving the elasticity of your LL muscles,Improve and maintain the elasticity of your LL muscles, Self massage, Ice, Rest, Proper footwear, Lose excess weight, Improve your diet and Drink 6-8 glasses of water daily.

Health care providers try their best but are limited in their set approach. The nature of PF requires the patient take some of the responsibility for eliminating it no matter which kinds of treatments they undertake.

COMMON CALF MUSCLE STRETCHING MISTAKES

Terminology errors
It is important to improve the elasticity (flexibility and strength)
of all of your LL muscles not just your calf muscles. If you are instructed to stretch your achilles tendon or plantar fascia you are being misled because nobody can safely stretch a tendon. Tendons are composed of inelastic collagen fibers that cannot elongate more than 3% without rupturing. This is old and incorrect terminology. The only natural way you can reduce tension on a tendon is to improve the elasticity of it's related and opposing muscles.

POSITIONING ERRORS
Any calf (or lower leg) stretch that you perform in a weight bearing (standing) position is incorrect because these muscles will be automatically contracted prior to the stretch. If you try to stretch a contracted muscle you will place excessive tension on the related tendons that attach to the heel or toe bones. Muscles should be relaxed prior to a stretch.

A COMMON MISTAKE IS DROPPING YOUR HEELS OFF A STEP. This can lead to chronic damage to your knee, the gastonemius, the flexor digitorum brevis and the flexor halcius brevus muscles as well as inflammation to the achilles tendon and the plantar fascia. Even in healthy people this can caise PF. PF sufferers who perform this exercise will only make their problem worse.

THE CORRECT AND SAFE CALF STRETCHING AND STRENGHTENING POSITION

Any non weight bearing position is safe and effective. This could be in bed before you arise, seated in a chair, sofa, or sitting on the floor with your back supported.

Some therapists recommend using a towel, rubber bands, or ropes which are better than standing.

My Personal Foot Trainers and technique are (in my opinion) more effective because they help you improve the strength and flexibility and isolate all of the lower leg muscles not just the gastronemius muscle.

I hope that this post clearly explains where I am coming from.

MIke W



Re: Plantar Fasciitis 101 Myths/Misconceptions and Common Sense (Very Long Post)

john h on 2/14/00 at 00:00 (015854)

mike: a decent explanation mike. you will of course find some disagreement on stretching (not from me as i am not that knowledgable). i have read a number of articles by PT's and Physicians who recommend the stretch of the calf by standing on steps.

you did not mention a very important Pain Generator in what is frequently called PF. That would be pain generated by the 'baxter nerve' directly under the PF where it attaches to the heel on the inside of the foot. Dr Baxter developed a well recognized surgical procedure 'Baxter Procedure' for treating what he believes is the major pain producer in heel spur syndrome or pr or whatever else one may call it. Many orthorpedic surgeons around the country have been trained by Dr Baxter and many use his procedure. Carl Lewis had Pf surgery performed by Dr Baxter and continued with his running carreer.

i think PF is like low back pain. very difficult to diagnosis and more difficut to treat. i am a great believer in stretching and am constantly changing my stretching based on new research and ideas.


Re: Plantar Fasciitis 101 Myths/Misconceptions and Common Sense (Very Long Post)

VickiJ on 2/14/00 at 00:00 (015856)

Thanks for taking the time to post all the information. I appreciate the added information to what I learned from Scott's book. As I've said before, stretching, for me has been critical in my healing process, and I've learned that some stretches are definitly better than others. I assume that it's because everybody's body is different. 'hanging off a step' never really felt that good to me...tho it was the only stretch I ever used for the calf muscles (because I hyper extend my knees that was the only stretch that did SOMETHING for my calf muscles until I read Scott's book about elevating the toes and leaning into the wall)...But I never felt a really GOOD STRETCH (hanging off the step) the 'meat' of the muscle, but more down in the achilles which was worrisome to me. Anyway, being around the dance professor I learned that my hyper extended knees threw muscles out of balance ...some too tight, others underused, etc. But the exercises she taught me were too 'cerebral' I could never be certain I was getting at the muscles that needed stretching or strengthening. I am fascinated by the concept of being able to stretch so many different muscles in, around and connected to the foot. I suppose I should call and talk with you more about this and order one of your devices so I can see if it's going to benefit me as it has you and your clients. I'll be in touch when the next batch of income arrives.

Re: Plantar Fasciitis 101 Myths/Misconceptions and Common Sense (Very Long Post)

Mike W on 2/15/00 at 00:00 (015895)

Hi, John H

PT's and Physicians have differing views on everything from orthotics to cortisone shots. I just stated my opinion on why I believe that any standing stretch (especially on a step) are poor choices.

Try this, stand up and then lean down and grab your calf muscles on say your left leg, now slowly lift that leg. You should feel your calf muscle relax. Next slowly lower your leg and you should feel your calf muscles contract. My point is that contracted muscles will not stretch as efficiently as relaxed muscles and the related tendon will be forced into excessive traction, which could do more harm than good.

One important aspect about stretching/strenghtening that I neglected yesterday is when to S/S the lower leg muscles. My #1 self care solution is to eliminate the cumulative damage caused by loading cold inelastic muscles with the first step out of bed (or after long periods of activity). If you do not warm them up you may be re-injuring yourself daily. With PFT's you can stretch and strenghten all of the lower leg muscles, get your circulation going and prevent the micro tearing in the comfort of your bed.


I am not familiar with Baxter's nerve procedure and if it works for people that's great. I developed PFT's with the idea to help prevent the need for invasive treatments.

I hope that you get results from your stretching and find a solution to your PF.

Take care,

Mike W


Re: Plantar Fasciitis 101 Myths/Misconceptions and Common Sense (Very Long Post)

Helen A. on 2/16/00 at 00:00 (015949)

I would be very interested in the exercise equipment/system you are proposing. Can you post more details?

Helen A.
(email removed)


Re: Plantar Fasciitis 101 Myths/Misconceptions and Common Sense (Very Long Post)

john h on 2/14/00 at 00:00 (015854)

mike: a decent explanation mike. you will of course find some disagreement on stretching (not from me as i am not that knowledgable). i have read a number of articles by PT's and Physicians who recommend the stretch of the calf by standing on steps.

you did not mention a very important Pain Generator in what is frequently called PF. That would be pain generated by the 'baxter nerve' directly under the PF where it attaches to the heel on the inside of the foot. Dr Baxter developed a well recognized surgical procedure 'Baxter Procedure' for treating what he believes is the major pain producer in heel spur syndrome or pr or whatever else one may call it. Many orthorpedic surgeons around the country have been trained by Dr Baxter and many use his procedure. Carl Lewis had Pf surgery performed by Dr Baxter and continued with his running carreer.

i think PF is like low back pain. very difficult to diagnosis and more difficut to treat. i am a great believer in stretching and am constantly changing my stretching based on new research and ideas.


Re: Plantar Fasciitis 101 Myths/Misconceptions and Common Sense (Very Long Post)

VickiJ on 2/14/00 at 00:00 (015856)

Thanks for taking the time to post all the information. I appreciate the added information to what I learned from Scott's book. As I've said before, stretching, for me has been critical in my healing process, and I've learned that some stretches are definitly better than others. I assume that it's because everybody's body is different. 'hanging off a step' never really felt that good to me...tho it was the only stretch I ever used for the calf muscles (because I hyper extend my knees that was the only stretch that did SOMETHING for my calf muscles until I read Scott's book about elevating the toes and leaning into the wall)...But I never felt a really GOOD STRETCH (hanging off the step) the 'meat' of the muscle, but more down in the achilles which was worrisome to me. Anyway, being around the dance professor I learned that my hyper extended knees threw muscles out of balance ...some too tight, others underused, etc. But the exercises she taught me were too 'cerebral' I could never be certain I was getting at the muscles that needed stretching or strengthening. I am fascinated by the concept of being able to stretch so many different muscles in, around and connected to the foot. I suppose I should call and talk with you more about this and order one of your devices so I can see if it's going to benefit me as it has you and your clients. I'll be in touch when the next batch of income arrives.

Re: Plantar Fasciitis 101 Myths/Misconceptions and Common Sense (Very Long Post)

Mike W on 2/15/00 at 00:00 (015895)

Hi, John H

PT's and Physicians have differing views on everything from orthotics to cortisone shots. I just stated my opinion on why I believe that any standing stretch (especially on a step) are poor choices.

Try this, stand up and then lean down and grab your calf muscles on say your left leg, now slowly lift that leg. You should feel your calf muscle relax. Next slowly lower your leg and you should feel your calf muscles contract. My point is that contracted muscles will not stretch as efficiently as relaxed muscles and the related tendon will be forced into excessive traction, which could do more harm than good.

One important aspect about stretching/strenghtening that I neglected yesterday is when to S/S the lower leg muscles. My #1 self care solution is to eliminate the cumulative damage caused by loading cold inelastic muscles with the first step out of bed (or after long periods of activity). If you do not warm them up you may be re-injuring yourself daily. With PFT's you can stretch and strenghten all of the lower leg muscles, get your circulation going and prevent the micro tearing in the comfort of your bed.


I am not familiar with Baxter's nerve procedure and if it works for people that's great. I developed PFT's with the idea to help prevent the need for invasive treatments.

I hope that you get results from your stretching and find a solution to your PF.

Take care,

Mike W


Re: Plantar Fasciitis 101 Myths/Misconceptions and Common Sense (Very Long Post)

Helen A. on 2/16/00 at 00:00 (015949)

I would be very interested in the exercise equipment/system you are proposing. Can you post more details?

Helen A.
(email removed)