Some Help With Foot Pain and Plantar Fasciitis

You don’t have to be a runner to experience foot pain, but 10 percent of runners this summer will at some point!

We have all heard of plantar fasciitis. It is the most common cause of foot pain in runners, after all. Surprisingly, it is also one of the most misdiagnosed and mistreated.

Pain on the bottom of the foot often gets the diagnosis of plantar fasciitis, but this diagnosis neglects to take into account literally every other structure in the foot as a potential cause of pain.

For those who begin to experience foot pain, beginning to fix the problem can be a bit overwhelming. Far too often rest, ice, stretching, and pain medication do nothing for the pain!

So where do you start? What do you do? Is it just a soft tissue problem or is it a bone and joint problem? In order to answer these questions, you need to start with some assessment.

A simple test used to rule out bone spurs or more serious joint complications is toe walking. Although, not 100 percent accurate, plantar fasciitis or soft tissue problems will be made worse by toe walking. Other assessments include testing dorsiflexion and plantarflexion. Muscles in the posterior and anterior calf insert on the foot. They cannot be ruled out as part of your foot problem.

In order to test dorsiflexion, stand by a wall a few inches away. Place your hands on the wall for support and bring the affected foot forward to the wall. Bring your knee to touch the wall without the heel lifting off the floor. Continue to slide your foot backward until you find the furthest place from the wall your knee can touch the wall while keeping your heel on the ground. Normal, healthy range is five to six inches.

To assess plantar flexion, kneel with both shins flat on the ground. Sit back until your buttocks touches the heels. The shin and anterior foot should be flat on the ground without pain. Any space between your ankle and the floor, or pain with the movement, is a positive test.

These two movements are great places to start. Most problems found with these assessments can be fixed. If you find yourself with any of the above assessments positive, you must return these assessments to normal, healthy movements.

Mobility techniques like basic calf stretching and foam rolling the anterior and posterior are great places to start. Rolling a golf ball on the bottom of your foot for a couple minutes also can be of beneficial. Using your toes to curl up a towel can add some strength to the bottom of your foot.

The above assessments should be used to measure your progress with these techniques. If these do not clear up and you continue to experience pain, the problem may be more severe.

Plantar fasciitis and many cases of foot pain are caused by overuse. The result of overuse injuries are microtraumas and tears that eventually lead to the formation of adhesion. Adhesion acts as glue to prevent further injury to the tissue, but it restricts proper movement and function, and causes weakness and pain for those who continue activity. In order to fix adhesion, the above mobility techniques may help, but treatment from a licensed professional is often necessary.

There are many different causes of foot pain and the solutions are never easy. If you’re struggling to get to the bottom of your foot pain, start with the above mentioned assessments. Work to improve and return these tests to normal. If pain or dysfunction persists, reaching out to your local health care provider is the next best step.

If you are in the Cedar Rapids area, and struggling with foot pain, I invite you to fill out an appointment request on this page or give our office a call at 319-423-0925 and get to the bottom of your problem!  

Chiropractic, PT, or an Educational Booklet: Which Is Better Treatment For Low Back Pain in Cedar Rapids?

Would you believe me if I told you that an educational pamphlet is just as effective as chiropractic care or physical therapy in relieving low back pain?

In 1998, a study published in the New England Journal of Medicine looked to compare the effectiveness of chiropractic, physical therapy, or an educational pamphlet for low back pain.  The conclusion of the study fueled a lively debate.  What the study found was that there was little difference in outcomes between low back pain patients treated with standard chiropractic manipulation, McKenzie exercises, or the educational booklet!  Not surprising, chiropractors and physical therapists alike were outraged from the findings.

While many previous studies done prior have shown chiropractic and physical therapy to be effective for helping with low back pain, why did this study show an educational pamphlet was just as effective?

To start, let’s look at the study design.  The patients were diagnosed with a regional diagnosis, low back pain, after pathology had been ruled out (herniation, cancer, etc.).  This would be no different than saying someone has shoulder pain.  Patients were randomly assigned to either chiropractic, physical therapy, or the educational readings.  This is where things got interesting.

Patients sent to a chiropractor were diagnosed with a sprain/strain 50% of the time, and another 30% of the chiropractic group was diagnosed with facet syndrome, or misalignments of the spine.  The same group of low back pain patients sent to the physical therapist were diagnosed with disc derangement 92% of the time.  This should raise some alarm!  The same group of randomly assigned patients sent to two different providers had significantly different diagnoses!

While it is entirely possible that the provider’s diagnoses were correct, it is highly unlikely that the difference was that dramatic.  It has often been demonstrated that nearly 70 percent of low back pain arises from 3 different sources; disc (39%), facet (15%), and Sacroiliac (SI) joint (13%).  This is where the study inherently failed.

While the study was not specific enough to sub classify low back pain patients into their respective groups, the providers themselves seemed to have classified patients based on what they can fix, not what the patient necessarily had.  McKenzie exercises have been shown to be effective in treatment of pain arising from the disc.  Likewise, chiropractic manipulation would be most effective in treating those struggling with facet and SI joint complications.

While this was not the intent of the study, this ultimately showed where modern day health care has gone wrong!  Too often, providers of any profession try to categorize patient’s problems into what they can fix, and not what the patient actually has.  It comes without saying that patient outcomes would be much higher if patients were given the treatment they need, and not the treatment the provider is certified to practice.   When providers try to fix patients by classifying them into what they can fix and not what the patient actually has, an educational pamphlet has just as much value as chiropractic and physical therapy.

Reference:

Excerpt modified from [Original DC article] by William Brady, DC. Used with permission. www.integrativediagnosis.com