|In the previous post (Plantar Fasciitis… and All Its Glory-Part 1) I covered the biomechanics which can be responsible for causing plantar fasciitis. This included certain restrictions within musculature and joints which can cause overloading of the plantar fascia. This, in my opinion, is the actual reason for plantar fasciitis. In this post, I will talk about the strength side of plantar fasciitis which can also be a part of poor foot biomechanics and contribute to the pathology.
In order to get a clear picture of the plantar fascia and its relation to foot mechanics, it is important to know its composition. The plantar fascia is a tendinous sheath. In other words, it is a dense fibrous structure with hardly any flexibility. This means that all though it is strong and durable, it does not have the ability to stretch like a muscle. This inability to stretch is what makes it very good at its job but also puts it at risk for injury if other supporting structures are not doing their job (aka muscles of the foot).
What weakness are we talking about? Foot weakness can be narrowed down to two issues. The first of these is inactivity. We as a population do not move as much as we should. Our bodies are created to move and move a lot. Generally speaking, we as a population spend the majority of our time sitting; not walking, running, jumping and being physically active. This inactivity leads to weakness in our entire body, including our feet. The second issue is our footwear. Modern-day footwear is very supportive. This is a good thing, right? Absolutely not, and I’ll give you an analogy to prove it.
Suppose we lived in a world where we never walked but rode around on little powered vehicles. In fact, we never got off these vehicles except for maybe a couple times a day. In other words, we had them supporting us all day and never had to use our own strength to walk. Well, suppose we did this from an early age. Our entire life, we used these little vehicles to ride on, rarely getting off because we could do everything we needed to while on them. I would assume you understand that our legs would be very weak and incapable of supporting the weight of our bodies. Now, replace “little powered vehicle” with the word shoe and now you understand why our feet are so weak. Highly supportive shoes, which we wear the majority of our day, do not allow our feet to use their own natural strength to support themselves. And since we use shoes from a very early age, our feet fully develop with the inability to support themselves.
Now, this may raise a few questions about why some people develop foot issues and others do not. This is a hard question to answer since every person’s circumstances are different but as a general rule, we can look back at foot mechanics and strength to determine why someone has an issue or not. If your foot and ankle flexibility is good and your foot strength is on par, chances are that you will not have any issues. If one of these factors is lacking, you have a higher probability of developing a problem.
Activity is also a factor in having plantar fasciitis. Let us reference our analogy once again. If we are riding around on our little vehicle all the time, our legs are very weak. The few times we get off per day to do tasks puts stress on our unconditioned legs which is fine if that is all we do. Now say someone has a revelation and decides to go cold turkey and start walking everywhere. His very atrophied legs are not going to be able to take these new stresses and will develop joint and muscles injuries. It is like telling a person who has never run to go run a marathon. Injuries will happen.
The same is true with our current lifestyles. We tend to be fairly sedentary with limited time spent on our feet. We then have a day where we walk 5 miles and then wonder why we develop a foot issue. It is too much stress for the conditioning of our feet on top of poor mechanics probably being present.
So why do active people get plantar fasciitis?
Not to sound like a broken record but, once again, I will reference mobility and strength. Even very active people can have foot weakness and poor foot/ ankle mechanics. In Part 1 we talked about dorsiflexion (the motion of bringing your toes toward your shin) and its importance. I’ve known many long-distance runners who have problems with plantar fasciitis, obviously not because they are inactive, but because of poor ability to dorsiflex their ankle due to chronically tight calf muscles, thus putting too much stress on the plantar fascia.
So, obviously, plantar fasciitis can affect anyone which brings us to our final subject. Shoes. Modern-day shoes are made in such a way that creates the utmost support and comfort. Truly, shoe manufacturers have mastered this. However, this support is a huge culprit when it comes to foot weakness. Once again, if we are walking around for the majority of our lives with ultra-supportive footwear, our feet are not going to be able to support themselves. As time goes on, our feet become weaker and weaker leading to more support being needed (aka arch supports and custom orthotics). It is only a downward cycle which will feed itself.
If you will, partake in a little experiment for me. Go walk around in your most comfortable shoes. I assume this is a pair of running or tennis shoes which have a good amount of arch support and heel padding. Notice HOW you walk. You probably have a decent amount of heal strike followed by rolling on to your forefoot and then onto your toes. Okay, now take your shoes off and walk with bare feet. Notice how different you walk. That heal strike is probably a lot more gentle and your toes should raise up as you put your foot down allowing for more pressure on your forefoot. A bit different than with shoes huh? This is the reason why ultra-supportive shoes are not good for your feet. They actually force your feet to walk or run in an unnatural way. This conditions the feet to have poor mechanics and truly alters the way our body moves.
So what can we do?
I believe that natural is always the better option. In the perfect world, we would all walk around in bare feet. This is obviously not going to happen and should not happen for a couple reasons. First, we need footwear to protect our feet from our environment (concrete is not foot friendly). Second, and more important, our feet are very deconditioned and if we all went cold turkey we would certainly end up injuring our feet and causing more harm.
The answer to this is to start re-conditioning our feet. Start by walking barefoot for a few minutes per day and slowly progress by increasing the amount of time spent barefoot. If walking on hard floors is uncomfortable, start by walking in your backyard, using the soft grass and dirt as padding. Certainly, if you have or have had plantar fasciitis you will know how uncomfortable it is to walk barefoot. If plantar fasciitis is present, this re-conditioning will need to be preceded and paired with proper mobilization and mechanics of the foot, as I previously wrote about, in order to fully help the pain. Once you have the correct function of your feet, walking barefoot should actually feel normal and become part of our everyday norm.
Once strength is gained back in the feet and you are able to walk barefoot with ease (which can take weeks), our footwear can be changed to help maintain proper foot mechanics and utilize our foot’s natural supportive abilities. Footwear should allow for our feet to function in a natural way; not do the opposite and change our feet to the parameters of the shoe. I will premise this by saying that every foot is different and you will need to find what is best for you. However, there are some characteristics that are important to look for in good shoes.