At last, the nice warm weather is here. As the temperature heats up we tend to be more and more active; walking, jogging, biking, playing sports, and, hopefully soon, swimming. This extra activity is great for our moods, our hearts, and our bodies, so long as we don’t get injured or over-train. I read an interesting article about a fairly common injury that occurs primarily to joggers, but can potentially affect anyone due to improper footwear. In fact, this extremely painful disorder of the foot will affect 10% of the population at some point in their lives. It is commonly called plantar fasciitis, but according to this article, should be called plantar fasciosis.
Inflammation was always thought to be the cause of heel pain, thus the use of the suffix –itis, which means inflammation, such as in the words tendonitis, appendicitis, bronchitis, etc. However, a study was done with biopsies of the plantar fascial ligament in patients with severe plantar fasciitis. Instead of inflamed tissue, they found necrotic tissue, meaning this area of the body was not receiving proper blood flow.
One possible cause of necrosis and pain in this area is anatomical in nature. It has to do with our shoes. When the large toe is pushed upwards and towards the other toes and then held there, blood flow and blood supply can be decreased to the sole of the foot. Without proper blood supply, the tissue begins to degenerate, with the fastest degeneration occurring in the tissue sustaining the most trauma.
Athletes and people who stand for long periods of time on hard surfaces are most prone to this problem.
Fortunately, this problem can be corrected by looking at our footwear. Most modern footwear is responsible for this unnatural position: heels, toe spring and tapered toe box. A heeled shoe is not good for feet or posture, yet almost every modern shoe has at least a 2:1 heel-to-forefoot ratio. This causes the toes to be held in an extended position. Toe spring exacerbates the extended position. You can see this when you place a shoe on a flat surface and notice that the sole of the shoe curves up at the front. The tapered toe box pushes the first and fifth toes towards each other. When a person runs or walks in this position, they constantly traumatize these structures.
When humans are born, the toes are the widest part of the foot. The feet of people wearing shoes are widest at the ball of the foot due to the shape of their footwear. Therefore, the most important treatment for plantar fasciosis is getting the patient into a shoe that allows their foot to be in its natural position.
Although inflammation is not the most important reason for pain in this condition as was commonly thought, I believe acupuncture helps this type of pain because of its ability to increase blood flow into problem areas.
So check out your shoes and stay active! Ingram, G and McClanahan, R. Treatment of Plantar Fasciosis, Naturopathic Doctor and News & Review, 8-9, March 2007.