Tulsa Spine and Rehab

You put your foot down and it ouch, it hurts. Could it be plantar fasciitis? Let’s find out what it is first of all, what you can do about it by talking with Dr. Sean Riley who is with of course Tulsa Spine and Rehab. It’s a team of specialists under one roof with one mission to help you get moving or in this case to get you standing up without pain. Dr. Riley, let’s start. First of all, what is plantar fasciitis?

Yeah, it’s a mouthful, isn’t it, Charlie? Yeah, very common condition. Plantar fasciitis it’s a condition that affects your foot. Typically it’s going to be the bottom of your foot. This is a more of a cumulative or repetitive type injury, meaning it’s typically not secondary to one event or like trauma for instance, like an accident, like a sprained ankle. Many times it’s just over and over can be related to a handful of different things.

Fascia is a thin layer of tissue that resides on the bottom of your foot. Fascia is also something that is a thin layer of tissue that sits over muscle, but it’s located on the bottom of your foot and if you could imagine your Achilles tendon back there on your heel, if it was like a rope and you fall that rope underneath your heel onto the bottom of your foot, that is the fascia or tissue that’s affected. And fasciitis essentially means inflammation of fascia.

When you say that this is something that happens over time, how much time are we talking? Like if you go, let’s say you go hiking, is the kind of thing that over a week’s hiking, it can become exacerbated and that much time or does it take more time than that?

Typically it’s going to be a longer time horizon. I mean it’s going to take, I don’t want to say weeks or months specifically, but I rarely see someone traveling on vacation for instance, or a specific hiking trip and then come back and will complain of plantar fasciitis. Plantar fasciitis is actually more of kind of a chronic condition. Now granted, when you go hiking, you might’ve irritated the tissue on the bottom of your feet and you might have a little acute plantar fasciitis, but typically with a little bit of rest, maybe some ice and some [inseds 00:02:18], it’s going to resolve itself. For this conversation I’m talking more about the chronic type. I’m on my feet a lot. I’ve developed this condition that’s lasting three to four weeks at a time.

It is a stabbing kind of pain though as it grows, right? I mean it’s very local?

Very, very uncomfortable on the bottom of your foot and obviously it’s affected with standing, walking, obviously running is very challenging. Many times I’ll see athletes that are unable to run secondary to the pain and discomfort. There’s a host of things that contribute to it and footwear is going to be really, really important, really big and that many times we’re not the correct shoes. I’m a big fan of related to running shoes that you’d take the time, you spend the money on being properly fit. You might be a little bit of a pronator, meaning you kind of move on the inside of your foot or supinate or to the outside, but we all have different makeups, the arch.

I might have a larger higher arch than you Charlie, so it’s important that we’re in the correct footwear, so footwear’s one of those things or old footwear, that the shoe is just broken down. I see a lot of women that wear high heels repetitively and that’s the first thing that I want to take a look at with plantar fasciitis. What type of footwear and then also kind of what the mechanics of the foot and ankle are like and do they have proper mobility through their ankle? Have they lost motion? Are they compensating throughout that tissue? Have they developed a lot of tightness restriction in the calf muscles, so obviously the calf muscles and the backside of the lower leg broken down in two areas. The gastrocnemius, which is the upper portion of the calf closer to your knee, and then the soleus, which is the lower portion. That soleus is actually the one muscle that transitions into your Achilles. The tendon and that tendon wraps around and kind of transitions into your plantar fasciitis or your plantar fascia.

So imagine like if I was constantly yanking on the tendon, like a rope, if I was really tight in the soleus and the gastro, that calf. Soft tissue is very tight, it’s going to chronically pull on the tendon and then ultimately that can create inflammation to that area on the bottom of the foot. I do recommend that footwear, like I mentioned, so when we are symptomatic, it’s not a good idea to be walking barefoot on a tile and hardwood floors. That’s one of those things related to treatment options.

Let’s just kind of move into options. What can you do for plantar fasciitis? Tulsa Spine and Rehab, most people think as a chiropractor that I’m just going to treat the spine and that’s so far from the truth. I want to take a look at all types of regional complaints, or orthopedic injuries within my scope and we are a conservative integrated facility providing multiple conservative options for patients. And many times rehab or conservative options are first line of defense for plantar fasciitis, so I’ve spoken about patient education with their footwear, things that they need to be doing, not doing like staying away from hard surfaces, barefoot on tile and those types of things, and then a stretching regimen.

Ice versus heat. Ice is always the option. Remember when we’re inflamed or swollen, we want to use ice to bring the blood flow down and we can freeze water bottles. Just simple water bottles, keep a few in the freezer and at night you can roll around on those water bottles bottom of your foot and that’ll help manage some of that inflammation. Just one of the simple things that you can do on your own. Physical therapy to promote proper ankle mobility and so forth. If we determine there’s tightness and flection or extension or whatever the case may be, we want to maybe recommend exercises to overcome those mobility limitations.

Deep tissue massage, fantastic option, not to the foot itself always but likely to that area that we discussed that the calf, the gastro and the soleus, reducing tightness to those muscles hopefully will relieve some of the tension on that tendon and then will ultimately allow that tissue on the bottom of your foot to heal. Laser, man, I added the laser last year and I’ve had some fantastic response with the high intensity laser, our cure wave laser. It’s once again kind of at a cellular level, changing the chemistry down there in promoting healing, reducing inflammation. A great option for plantar fasciitis.

Chiropractic care, I’ll do a little with ankle mobilization, but typically my treatment options, it’s very integrated and that I will do five to six things to get them on the road to recovery and then like discussed in the past, very important that they’re going to be doing some things on their own. These can be tough injuries because obviously we don’t understand the value of weightbearing standing on our feet and walking and they’re easily exacerbated. Sadly, many times I always talk about keep moving. This is one of those circumstances where we might need to power the patient down if necessary to allow that tissue to heal, because they can hang on and they can really interfere with a lot of daily activity whether it’s we enjoy running or walking, whatever the case may be. But it can be challenging at the time.

But once, like I said, there’s a conservative option, that’s a good option. Once we run out of conservative options, you start talking about surgeries and those types of things. I would like to mention that injection therapy steroid is a possibility in some cases and then in some extreme circumstances surgery is an option. Obviously foot surgery is very difficult because I like mentioned before, we’re weightbearing all the time and the recovery, it can be very challenging.

I’ve had the opportunity, I’m really lucky, I’ve got a good referral network here in Tulsa and I work with a handful of podiatrists down the street and so sometimes if the patient is responding is as quickly as I would hope they would. I will get them with one of the podiatrist down the street and maybe if they have some additional recommendations, but a lot of the podiatrists are really big on obviously conservative care because we’re wanting to provide or prevent surgery, so remember it’s inflammation on the bottom of your foot. Let’s pay attention to footwear, not going barefooted.

Remember, stretching the calf muscle is a good option for treatment, managing the pain with ice and maybe some type of over the counter insead, another great option. Working on physical therapy to increase mobility throughout the ankle and then in some cases if you’re not responding quick enough, we can always make the appropriate referral to a podiatrist, which is a foot doctor and then we can work hand in hand with their office moving forward.

What about shoe inserts? Are those something that can help stave off some of this pain or will that help you on the healing path?

It’s a great question. Yes. We’re talking about orthotics, an orthotic is an insert that you’re putting the bottom of your shoe. There’s all kinds of different orthotics. Orthotics can be very expensive and custom fit orthotics typically it’s a mold that’s made to the bottom of your foot. It’s very specific. Those are great options for patients to help manage the plantar fasciitis as well as preventing it. Like I said, it can be expensive. There are a couple running stores that have a product called Superfeet. It’s actually like a gel insert that is relatively inexpensive, 35 bucks and I typically will recommend that right off the bat just to say, “Hey listen, this is something we can try to give you a little more margin for error and reduce some of that stress and pressure on the foot.”

But podiatrists, that’s what they do and so that’s like I had mentioned, if things aren’t moving along quickly enough or we’re starting to exhaust our options here in the clinic, we’ll make that recommendation and with further testing, possibly an examination, the podiatrist may feel like a custom fit orthotic is a good option for that patient and so many times the patient will come back and Dr. such and such fit me for orthotics, recommend that I continue with my rehab here at the clinic and so now we kind of like I mentioned work on that tag team approach, but orthotics are a very good option for the management and the treatment of plantar fasciitis.

Sean, you’ve covered a lot here, the physiology of it, how it happens, what some of the things you can do to heal from this, but the one thing I didn’t hear you say was how long are these episodes? What duration can I expect?

Well, it’s tough. I mean like I had mentioned, I’ve seen some really nasty cases and not nasty in that they’re surgical but just nasty and that they hang on. I’ve seen patients that have had plantar fasciitis from four to six to eight months and keep in mind those longer cases, they didn’t do anything. Like most of us were like, Oh, it’ll go away. It’ll go away. And many times they can continue on with their activity of choice. They can continue to run and walk. What typically brings them into this office? I’m sure you can guess Charlie is when there’s interference, they’re not able to do what they want to do. Then kind of the check engine light is on and they’re like, okay, now I can’t run.

I need to figure out what’s going on and at that point how long have you been dealing with this? Four or five months and I just figured it’d go away and just like with any type of condition it can progress and it can develop a little bit more of a serious condition so it’s more challenging to manage. But the beginning of our conversation, you’re asking about those cases that might happen if you were to walk or hike and just over one week and develop a little bit of foot pain on the bottom of your foot, when to seek treatment? I think two to three weeks, it hangs on. I think it’s reasonable to have someone take a look at it.

Many times it could just be managed with home exercise like here are the stretches you need to be doing, you need to be on a strict ice regimen. We need to modify some of your activity and then it’s easily managed. Obviously a three week case is going to be much easily managed than an eight month case. I think a golden rule, foot pain, three to four weeks if it hasn’t resolved, I think it’s a good idea to get it checked out.

Don’t let it get worse, take action quickly. That’s great advice. So there you have it. If you’ve got an idea that you might be suffering with plantar fasciitis, the time to act is now and reach out to Dr. Riley and the experts at Tulsa Spine and Rehab. Dr. Riley, thanks a lot for your time today.

Hey, thanks Charlie.

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