Plantar fasciitis – everybody recognizes it, even if they’ve never had it. You can’t scroll online or walk through a drug store these days without seeing an article or product to treat this dreaded condition. It is a terribly annoying condition and when you’re in pain, who do you listen to?
Who do you believe? It is by far one of the most common conditions we see in our clinic, almost a day doesn’t go by without having to treat someone who has painful heels, but where did it come from? How did it start?
I had a client who came to me with a referral for custom foot orthotics to treat plantar fasciitis. As usual, we go through a detailed history and examination of the feet. We tend to treat conditions of plantar fasciitis like jig-saw puzzles. Each piece we put into place reveals more details of the bigger picture: the how and why of the problem and what to do to treat the condition. This man had seen his doctor after 3-4 weeks of hobbling around with a painful right heel.
By the time he saw his physician, the left heel was starting to bother him too. He was referred to physiotherapy where he received treatment, a stretching program, and some helpful things that he could do at home to try and ease the pain. Fortunately, the physiotherapist recognized that the underlying problem was a mechanical one which was causing the plantar fasciitis, and that custom foot orthotics could probably help. While talking to this man, he had a long tale of all the useful advice he received before he finally saw his doctor. Heat, cold, bed rest, gel heel pads, ready-made “arch supports” and on and on. He had spent dozes of hours and hundreds of dollars searching for relief.
As Pedorthists we labour under an overwhelming weight of opinions, expert and otherwise about the dubious effectiveness of custom-made foot orthoses. Much of this cautionary advice comes from people who don’t wear or have never required them or from those who have had singularly bad experiences associated with orthotics. Many see orthotics as a crutch which should be avoided.
Do we hear this talk about eyeglasses? I don’t think so, yet glasses are orthotics too. In fact, the analogy can be taken further by describing the orthosis as a lens that focuses faulty alignment, muscle imbalances, and creates a better mechanical relationship between the foot and the ground.
So, what is the problem? From my side it’s the assertion that research shows that there is inter and intra provider unreliability in the effectiveness of foot orthotics. What this mean is that many providers don’t interpret the problem properly, don’t design the appliance correctly or don’t counsel the client in the use of the appliance or what their expectation of healing should be. Unfortunately, there will probably never be good research on the effectiveness of orthotics as there are too many different types of providers. The variations of assessment, manufacture and implementation are diverse as well. I can only hope that the reason we are still here is that we are practising above the average.
Now, the problem from your side? Well, it’s you, of course. Go look in the mirror (preferably floor length). Look carefully – head, shoulders, arms, hips, knees, ankles, and feet. Tell me about that sciatica, the medial knee OA, those old ankle sprains, or the appearance of one foot rolling in and the other rolling out. We are conditioned to think of ourselves as symmetrical but between what we are born with and what we add to it in injuries and overuse during our lives, we get less symmetrical as time goes on.
So, if I ask you what your goal is, you are likely to want pain freedom. Symptomatic relief. I might be able to do that with a simple orthotic, but I’ll warn you right now that there’s nothing simple about it. Wouldn’t you rather, while I’m at it, also deal with the sciatica and the knee pain? What is your stake in all this? Most people come to us expecting a pill. Put this thing in my shoe and I don’t have to do anything other than complain about how it doesn’t work or sing your praises if it does. You are a stake holder, and you must manage all the stuff I can’t. I can make you a perfectly designed orthotic, but I can’t make sure that you are going to follow all the advice I gave you about exercise, proper shoe choices, ergonomics, and other avenues of therapy. For Pete’s sake, tie up your shoes and don’t just slop around in them!
The real problem is more fundamental. 60,000 years ago, you might not live long enough to have osteo arthritis, just living to be an adult was painful enough that injury and disease were only a problem if they didn’t kill you. In this age of progress, we need to take better care of ourselves, at least until technology can step in and replace that worn out and abused joint or organ. I don’t want to detract from this important concept. When we get right down to it all these postural aches and pains start out as muscle imbalances. Causes may be congenital or acquired but our bodies are amazingly adaptable. Adaptation is made possible by compensation, and compensation changes the loading of weight bearing structures.
OK, here’s the punch line. Think of your skeleton. By itself without any of the structures that bind us it would just be a pile of bones. But think of those bones wrapped in a web of tissues. Muscles, tendons, ligaments and joints all fascia differentiated by size, shape, structure, and task. All designed to work with each other. Any part that has an issue has adjacent structures to help share the load (compensate). If we don’t deal with those issues when they occur other structures will have to be recruited to share the load and help you heal while you still get the laundry done.
I hope I haven’t put you to sleep but this is the most fascinating stuff and after so many years doing Pedorthic Therapy I’m still figuring out how it all works together. My apologies to all those people I have used as guinea pigs, but this is my conventional wisdom: You cannot apply a force anywhere on or through a structure without repercussions. Why Plantar Fasciitis? The Plantar (aponeurosis) Fascia is symptomatic because it is a weak link in the web that attenuates the forces of walking and standing. Recruiting the strength, flexibility, and support to repair it and keep it from injuring again takes a multidisciplinary approach in which the client, patient, subject, or victim, if you wish, is at the center and clearly understands that their Physician or Nurse Practitioner and the para-medical professionals they rely on will do our utmost to help you get better. My best advice: If it doesn’t clear up within a few days, see your health practitioner, get it dealt with and avoid repercussions.
More questions than answers? You can get more information on orthotics, footwear and pedorthic services at Thera-Ped Foot and Ankle Clinic by calling (506) 632-9397, or book an appointment today with our Canadian Certified Pedorthists.