Plantar Fasciitis

Plantar fasciitis is a painful condition that makes your feet hurt, especially with the first few steps after being off of them for a while. What’s happening here? First, we have to understand fascia. It’s a system of connective tissue that holds us together. 

Each muscle fiber has connective tissue, called fascia, surrounding it like a layer of Saran wrap.

Connective tissue (white) and muscle fibers. When fascial adhesions form, it can cause unexplained pain.

Connective tissue (white) and muscle fibers. In plantar fasciitis, those fibers get tight and brittle.

It may help to picture a muscle fiber as a new drinking straw in a paper wrapper. The straw is actually the muscle cell, while the white paper is fascia. At each end, that flap of fascia becomes our tendons. It attaches to bone – or, more precisely, to the fascia surrounding bone. These sheaths of fascia are supposed to slide past each other as muscles move. With long periods of no movement, if the muscles are tight, or if there’s an injury, they can stick together and form a fascial adhesion.

When the plantar fascia (the fascia on the bottom of the foot) doesn’t move, it gets stiff and brittle, causing plantar fasciitis. When you do move, it hurts like crazy! The immediate answer – the one most old-fashioned podiatrists give – is to stop the movement. They prescribe stiff orthotics and walking-boot-type shoes that prevent your feet from flexing. That approach does give short-term relief, but in the long run it just sets you up for more pain.

Instead, advanced podiatrists like Dr. Ray McClanahan recognize that our feet evolved to be mobile. For millennia, they were a wide, stable base for our bodies that responded to uneven ground. Most modern footwear is too stiff and constricting, which restricts both toe movement and foot flexing, and reduces us to balancing on a solid block. The best long-term fix for plantar fasciitis is to get things moving again!

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The entire bottom of the foot can hurt, although pain is usually focused in the heel.

That means:

1) Gradually changing to more minimal, flexible footwear. In some cases, toe spreaders will be useful. 

2) Strengthen the feet with exercises. The muscles that create the arch of your foot are actually in your lower legs (they have long tendons down to the bones in the foot). Myofascial release for your legs will be helpful, too. With a little work, your legs and feet will support you as nature intended.

3) Break up the adhesions in the feet, using any combo of myofascial massage, acupuncture, rolling with small balls, etc. You have to do this a little bit at a time. Some people like to get in and dig the adhesions apart, deep-tissue massage style. That works well in the short term, but it also causes inflammation… which causes scar tissue and fascial adhesions to form… putting you back where you started. Myofascial release uses a more subtle massage approach to slide the layers apart. I love doing this type of work because the result is immediate freedom of movement and no boomerang side-effects.

The bad news: This is the only treatment I do that hurts.

The good news: It stops hurting immediately, and the relief is powerful and swift.

NOTE: This is how to treat the underlying problem – stiff fascia. If you are in a painful flare right now, we need to treat the “hot” injury first. That means (just as with any tendonitis) rest, ice, acupuncture and anti-inflammatory help via the diet or a topical medication.

Come see me and let me treat your plantar fasciitis. Won’t it be nice to go for a walk without pain again? I’ll be happy to help you assess your current shoes (sometimes there are tweaks we can make to give you more space in them) or pics of those you are considering on the internet!

 

 

 

Healthy Boots – that look great!

I got rid of 95% of my old shoes once I made the switch to minimal, wide-toed, unheeled footwear. Wearing my old collection just felt awful after my toes were liberated. Like children, once they are educated, there’s no going back. :) So I was left with my new shoes… and NO healthy boots. With our cold, damp winters, and as much time as I like to spend outside, that was no good at all. So I went on a mission. I visited Shoe Mill (their selection was disappointingly high-heeled and rigid-soled) and Footwise (just didn’t see anything that appealed to me). I would have liked to hit Cobbler Bill’s and the rest of my list, but I’m a busy girl!

I checked out both Imelda’s and Clogs & More on Hawthorne about a month back – all I found was the rain boots mentioned in the shoe shopping post. They may have some new stock now. After Nordstrom’s and Macy’s at the mall, I went online. Zappos was uncharacteristically empty of options, but the Nordstrom’s website was terrific.

Here’s what my quest brought me. I didn’t buy all of these, but I did “borrow” a few on my credit card, since they all have free shipping & returns, and I can wear them inside for a while to see how they really feel before I pick which one(s) to keep. Much better than a 30-second try in a store, right?

The Finds:

Keen Delancy

The Keen “Delancy” is close, but I couldn’t get it zipped. This is a common problem for me, since I am 4’10” and my calf muscles start lower. If you have longer / slimmer legs, try them out. I have been distressed by Keen’s new line, which is both stiff and narrow. These are a rare, and welcome, throwback.

 

phoenixside

 

Soft Star makes this boot, the “Phoenix,” but it doesn’t meet my aesthetic standards so I haven’t tested it. I’m not fond of the “Ugg” shape and I don’t do brown. If you do, give them a go!

Born Lecia

 

 

Børn “Lecia” – These made me very, very sad. Born is a great company, and I was SO excited about having red lace-up boots! Sadly, the tops were too long for me, and pushed up under my knees. They were fine for standing, but when I moved and bent my legs they were no good. If you are a normal-sized human this will not be an issue. Note – these would be fine for even bigger calves than mine: The tongue has a big overlap. Worse than the height is the heel. It has a pointed bottom, and a soft sole, so the net effect felt like a point poking up into my heel. Immediately very uncomfortable, and it got worse over 20 minutes.

 

Merrel Haven (Nordies)

Merrell “Haven” is no oasis.

My first impression: The Havens are the least comfortable Merrell’s I’ve ever worn. They are far too narrow. By the time I sized up to a decent width, they were crazy long… Like, clown shoe long. Try again, Merrell. Plus, the look isn’t really my style. Note: The Captiva (not shown) is wider and better looking, but I couldn’t zip it. Besides, it has a small heel lift.

 

 

Born Kaila (Macys) healthy boots

THE WINNER! I was Born to wear these healthy boots! :)

 Børn “Kaila,”  at Macy’s 

Love these! They do have about a half inch net heel – the most heel I’ve worn in months – but it’s not bothering me. Initially the top of the calf was snug on me, but it quickly stretched sufficiently that I don’t feel it anymore. Bonus: There is an adjustable buckle at the top. Mine are matte black. This glossy pic is the “mahogany.”

Verdict: YES! There was even room for my Correct Toes inside these gorgeous things!

Romika Fiona

Romika,  please make a quieter, taller version!

 

 

 

Romika “Fiona” at Nordie’s. 

Also in black. These look narrow, but feel huge inside! I swear they are made of Tardis! Unfortunately the zippers jingle when I walk (I’d have to swap the tab out), and the height of the calf is awkward and unflattering. They would be good under pants or jeans, but I pretty much only wear skirts.

 

 

NF JaneyNorth Face “Janey II Luxe” (Ordered from Nordstrom’s website)

I very much liked the short zipper at the inner ankle, which allowed for easy on-off. However, the toebox was narrow and stiffly structured. That’s a no.

 

 

 

Sorel Yaquina

 

Sorel “Yaquina”  (Ordered from Nordstrom’s website)

So close! The toebox is just a little too snug. I could feel it pressing against my big toe. If you have narrow feet, these will work beautifully for you. But not for me.

 

 

Final verdict:

The only pair that really worked for me 100% was the Born Kaila. I’m wearing the black ones right now, and I’m ordering a second pair of “mahogany.” The Keen “Delancy” and Sorel’s “Yaquina” were close… try them if you are, respectively, slim-calved and narrow-footed.

Hopefully this little review has helped you find some healthy boots, and more importantly, reminded you of what to look for when shopping. Please let me know if you find any other good candidates!

Foot Pain, Foot Function, & Shoes

My personal health issues, combined with frustration with lack of results using the current common answers, continually take me to new and interesting places. In the past year most of what I know about metabolism, nutrition, and now feet (and foot pain) has shifted drastically. It all comes back to evolution.

I’ve had intermittent stabbing pain for about 7 years, focused at the 1st MP joint (where the big toe joins the foot). I walk a lot, and the more I walked, the more it hurt. It had been diagnosed as a stress fracture years ago, and and for years I would wear Danskos* (hard soles, so my feet didn’t flex) when the pain got bad. Basically the Danskos acted as a walking boot. I am heavy (180lbs, due to muscle and bone from my bodybuilding days, plus all the extra padding I’m currently carrying) and have small feet and a stompy gait… It just refused to heal.

The foot pain had been interfering with my workouts, but it was getting worse and now messing with my weekend fun, too … that’s no good! So I started investigating and it turns out the solution was simple. I didn’t have a stress fracture at all.

diabetes_foot_problems_s13_hammertoesWearing tight shoes, especially heels, can cause bunions (angled big toe), neuromas, and hammertoes (bent toes), too. Fortunately my problem was easier to fix than the poor feet in this stock photo!

I had to change my shoes.

That wasn’t all of it, of course – I also needed some fascial adhesions stripped out. Acupuncture reduced the pain and swelling, and the minimal shoes I transitioned into have had the cool side-effect of forcing me to soften my gait. I wear CorrectToes spacers when I remember. Still, changing the shoes was key . Shopping guide here.

Rolfer Karin Edwards-Wagner does a lot of work with feet, and she pointed me towards the brilliant Dr. Ray McClanahan. He’s got a bunch of videos and articles on his site, so rather than reinventing the wheel I’ll just let you look at his stuff.

Here’s the deal: See those bones on the top of your foot? Your toes should extend in a straight line from them. For centuries we have crammed our feet into shoes that gathered the toes together, creating a sleeker pointed look instead of the spread “duck-foot” that nature intended.

Available here in the office, Correct Toes spacers help separate and flatten your toes into a natural spread for better stability. Use them along with changing your shoes, and getting some acupuncture and medical massage to break up fascial adhesions and relax the muscles of your feet. Your knees, hips, and even lower back will be happier once your gait is correct!

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Under your big toes are tiny floating bones called sesamoid bones, which provide leverage and assist in tracking as a tendon moves over bone. The knee cap is a sesamoid, too – in fact you can imagine a miniature knee cap under that joint in your foot. The bones have grooves that the sesamoids are supposed to follow. If the toe angles inwards, the bone is pulled off track. Ouch!

The funny thing here is that my feet look pretty “normal.” I don’t have bunions or any obvious deformation… just a few degrees was enough to cause that foot pain for me. I haven’t worn heels for years. Even so, I had a huge pile of shoes and boots (some of them practically new) that I had to sell, donate, or toss. The trick is finding shoes that:

1)   Have flexible soles across the ball of the foot and also longitudinally, for twisting.

2)   Have the heel at the same level as the toe. Now that I’m used to “zero-drop” shoes, even a half-inch heel feels weird.

3)   Fit well in the heel and instep, but have lots of room in the toebox. This is why regular “wide” shoes don’t work for me – the rest of my foot isn’t wide. See the pic below.

4)   Don’t have a lot of  “toe spring” – that’s when the toe of the shoe comes up off the ground. It pushes you into an unnatural position all the time.

When buying shoes, remember to check for fit with the shoe liner test. Take out the inserts and stand on them (with all of your weight). If your toes drip off the edge, they are too small. Standing  on the bottoms of the soles of shoes is another good way to assess how much room you’ll have. If your favorite shoes are just a smidge too tight in the toe box, you can remove the inserts, which gives you a few more millimeters of room to stretch out.  If they are lace-up shoes, skipping the first set of holes can also let the toe box open up.

No more foot pain! See how the medial (inside) edge has a square-ish corner, instead of being rounded? Wide at the ball of the foot isn't enough - that big toe needs to be able to move and spread outwards. These are my new favorites, Clark's "Faraway Field," available in other colors if you aren't into blue suede shoes. :)

No more foot pain! See how the medial (inside) edge has a square-ish corner, instead of being rounded? Wide at the ball of the foot isn’t enough – that big toe needs to be able to move and spread outwards. These are my new favorites, Clark’s “Faraway Field,” available in other colors if you aren’t into blue suede shoes. :)

The sad truth is that most of the anatomically correct footwear out there is hideous, but I have found some cute options! Shopping info here. My winter boot review is here.

In addition to going shoe shopping, I also got some socks! The regular “mitten” sock can encourage toes to gather together, especially if they get pulled tight as you slip into your shoe.  When I wear those, I stretch out the toe seam to give myself some room. Sock Dreams is a fun local company that carries a variety of toe socks, and they ship for free.

Can’t give up the heels due to work or your fashionista status? Check out this article on ways to mitigate the effects of high heels. 

So… the real question is, did it work? My emphatic answer is YES! A week after switching, for the first time I finished a LARPing weekend without being in agony. My foot and knee may have grumbled a few times (I run for miles during these weekends) but that searing pain was gone. At the end, instead of waiting miserably for Robert to be done cleaning, I was out doing extra trash sweeps, because I felt that good!  Plus, at my next workout, I had to ask Brandie to throw extra weights on for the leg extensions and squat press, because the weight we were doing before suddenly felt ridiculously easy. Correcting my foot function helped my knee normalize, too, which is a bonus I hadn’t expected. It makes sense, though. If the toes can spread out and do their job creating stability, it takes a lot of pressure off the knees.

The next adventure is the perfect intersection of SCA / LARP / craftiness, and healthcare: I’m going to try making my own shoes!

 

*Setting aside the issue of the heel height for the moment, it’s true that Danskos and other hard clogs make it easier on your feet. The trouble is, they make it too easy. It was obvious once I thought about it…

When a patient comes in with a brace (on the wrist, knee, back, whatever), we always have this discussion: “Immediately after an injury, a little support is very helpful. As you heal, though, you need to wean off the brace. It’s good to wear it for sports, or challenging events, but not all the time. If you baby the muscles, they won’t work and get stronger, which is what you really need to heal. Eventually you should be brace-free.”

I’d been over-bracing my feet. *headdesk*

Wearing softer, more flexible shoes that allow / force my feet to get to work makes them stronger. Here’s a cool exercise you can do to strengthen your feet. I still prefer some shock absorption when walking on man-made surfaces like concrete, but for dirt and carpet I like to go more minimal. 

What about arch support? Modern shoes actually give us TOO much support, so our foot and leg muscles don’t work, and get weak. Remember we evolved without shoes. Our feet are designed to support us, given the chance. By doing foot exercises and gradually transitioning to more minimal shoes, your arch will support itself. This is awesome because it means your feet take a lot of the load back from the ankles, knees, and hips in terms of balancing. The whole body works better when strong and supple.

Now that I have spent some time opening my feet up, I love the thin toe-separated shoes like Vibram 5 fingers. Just ease into them… minimal footwear takes some transition if your feet have been over-supported in regular shoes. I have a pair of Filas that are similar (just have shorter toes, so they fit me better) and I adore them! They are phenomenal for running around in the woods.

EDIT 7/1/13: Here’s an awesome article on another reason to wear good shoes – neurological challenge! Also – I get asked about foot pain due to Morton’s neuromas and plantar fasciitis (inflamed fascia) a lot. YES, I can treat them! The good news is that the treatment is immediately and highly effective. The bad news is that it’s the only treatment I do that hurts… Sorry. But only briefly, and it’s worth it, speaking personally!