We need to talk about our feet, specifically plantar fasciitis and common treatments versus evidence-based treatments. In our physical therapy and athletic training clinic, we see A LOT of plantar fasciitis, a common condition characterized by pain and inflammation in the heel and arch of the foot. We are coming up to the season where people are about to get out onto the golf course, tennis courts and start to run outside again. All those activities tend to trigger plantar fasciitis. We treat this pathology differently than other clinics do. As athletic trainers and physical therapists, we believe our job is to give you as much information as possible for you to make your own decision on care. We are going to talk about orthotics, toe spacers, proper footwear and common treatments for plantar fascia pain. Lastly, we will talk about our approach to this condition.
Over-Reliance on Orthotics
Orthotics, or shoe inserts, have long been prescribed as a treatment for plantar fasciitis, However, recent research has shown that orthotics may not be the best solution for everyone and can do more harm than good in some cases. We will explore why orthotics are not always the best option for treating plantar fasciitis; rather, physical therapy and athletic training corrective care may be the way to get to the root cause of this pathology.
One of the biggest problems with orthotics is that they can become a crutch for people with plantar fasciitis. Instead of working to address the underlying causes of their pain, people rely on the orthotics to relieve their symptoms. This can lead to a cycle of pain and dependence on the inserts.
The muscles in the foot are exactly like all the other skeletal muscles in your body. The more they work, the stronger they get. By putting something underneath them, they do not need to work as hard! That is great, for a short period of time. If your foot is inflamed or the muscles are weak and need support, then yes, this treatment may help. But permanently putting that orthotic under your foot significantly reduces the amount of strength your foot has. There are studies that found, in as little as 4 weeks after using orthotics, the muscle mass of your foot’s intrinsic muscles is reduced by up to 40%. Imagine losing 40% of your biceps....
Inadequate Support
Orthotics can also provide inadequate support for the foot, leading to further injury and pain. Custom orthotics may apply too much pressure to the midfoot, which can exacerbate the problem. Over-the-counter orthotics may not provide enough support for the foot and can be too flimsy to properly address the root cause of the problem.
The problem with the type of support orthotics give is it is in the wrong place in the foot. The foot has a natural ‘arch’ from the big toe to the heel. The proper way to support an arch is to stabilize both ends of the arch, not the middle of it. Orthotics place pressure directly under the structure that mechanically NEEDS to roll when we go through our gait cycle. So, by giving ‘support’ here, they are actually creating MORE pressure on the tissue that is already irritated.
Alternatives to Orthotics
Fortunately, there are alternatives to orthotics for treating plantar fasciitis. Athletic trainers and physical therapists can work with individuals to develop a personalized treatment plan that addresses the underlying causes of their pain. This may include exercises to improve the strength and flexibility of the plantar fascia, as well as tools such as toe spacers, modalities like Instrument Assisted Soft Tissue Mobilization and massage to reduce pain and inflammation.
Additionally, wearing appropriate shoes with a wide toe box to allow the toes to splay can be a more effective and long-lasting solution for plantar fasciitis. This can be especially important for people who are physically active, as they need shoes that provide adequate space for the foot to find its natural position and stability. Check out this video to find out other techniques we commonly use when we see plantar fascia pain:
While orthotics may seem like a convenient and simple solution for plantar fasciitis, they may not be the best option for everyone. Athletic trainers and physical therapists can help individuals develop a personalized treatment plan that addresses the underlying causes of their pain and provides long-lasting relief.
If you have plantar fasciitis, or want to prevent it before our spring season starts, reach out to us at info@variablemovement.com, call us at 207-374-7228 OR head over to our website, www.variablemovement.com, to schedule an appointment today.
References:
Leadbetter, W. B. (2010). Plantar Fasciitis: Current Concepts. American Journal of Sports Medicine, 38(2), 437-446.
Noyes, F. R., Barber, M. D., & Lippitt, S. W. (1999). Avascular necrosis of the plantar fascia. The Journal of Bone and Joint Surgery, 81(7), 969-974.
Thomson, C. C., Joseph, E., & Anne-Marie, C. (2011). Physical therapy for plantar fasciitis. Journal of Foot and Ankle Research, 4(1), 1-12.