Plantar Fasciitis, The Who, What, Why and How

1.     What exactly is plantar fasciitis?  

Plantar Fasciitis involves pain and inflammation of a thick band of tissue, called the Plantar Fascia, which runs across the bottom of your foot — connecting your heel bone to your toes.  

Plantar Fasciitis causes sharp and/or burning pain that usually occurs with your very first steps in the morning. Once your foot loosens up, the pain of plantar fasciitis normally decreases, but it may return after long periods of standing, getting up from a seated position, or running/walking.      

2.     What are the causes and symptoms 

The causes and symptoms are varied, but below is a list of causes we find to be the main root causes of Plantar Fasciitis.  

  • Tight calf muscles will increase pull and tension on the Plantar Fascia. 

  • Altered foot function: Excessively flat or high arches. 

  • Lack of big toe extension- Upward movement of the big toe. 

  • Tight hip flexors will reduce the ability to use Gluteals in ‘push off.' 
    the phase of the stride, hence increasing the workload on the Plantar 
    Fascia and calves.  

  • Reduced glute and hamstring strength will again increase the demand on the calves and Plantar Fascia, predisposing to an overload of these structures. 

  • Worn-out/Improper shoes 

  • Sudden increase of walking or running frequency, duration or surface

3.      When should you seek medical help and how will a doctor evaluate the problem?

You should seek medical attention if your pain persists over the course of a week or so, if your pain is so severe that it is affecting your daily activities, or if the onset of pain was some sort of trauma. X-rays are not always necessary and would most likely only see a possible heel spur.

4.     What is the normal course of treatment from the most conservative to surgery perhaps? 

The ideal course of care for Plantar Fasciitis is to start conservatively and progress from there. Conservative treatment plan lengths may vary depending on severity, how long it has been going on, previous occurrences of it, and many other factors that would be discussed with you at the time of history and examination. Chiropractic care is a great conservative approach to help. If the below conservative methods don’t work for your, other physicians may be able to offer medication, injections or procedures to relieve your condition. It is recommended to try 4-6 weeks of conservative care before opting for me invasive surgical procedures. Be careful, as invasive approaches including injections and surgery have their own list of potential short and long term side effects.

Stretching for the Gastrocnemius (upper calf), Soleus (lower calf), hip flexors (front of the hip) and the Plantar Fascia. Secondly, you need to be evaluated to determine if you have excessively flat or excessively high arches. If you have flat feet, an orthotic may be beneficial. Manual therapy such as Active Release, Graston Technique to the calves, Achilles, and Plantar Fascia are instrumental in achieving resolution of pain. Lastly, strengthening of the glutes and hamstrings (along with hamstring flexibility) are vital to the proper biomechanics of the lower body.  


5.     How can we avoid this condition mentioning various types of sports, therapy footwear, etc.? 

From a physical standpoint, the best way to prevent Plantar Fasciitis is to obviously correct the causes by performing stretches and exercises to correct any of the above dysfunction. Runners and walkers tend to get this condition the most in my experience, so proper technique, footwear, mileage increases, and surfaces should be addressed and improved as much as possible.  

Do I get headaches or migraines and why do I get them?

Dr. Brian first came to a chiropractor due to getting headaches. This started in high school and continued through college and chiropractic school. Due to this, he grew a passion for helping people with headaches and that has quickly become one of his favorite conditions to treat. This is done by using techniques backed by research which may include muscle release techniques, laser therapy, adjustments, diet changes and supplements.

Differences between a headache and migraine.

Most people describe a migraine as a moderate to severe headache which is not false. However, there is a little more that goes into distinguishing which one you have. Typically, a migraine is a moderate to severe headache with any or all of these following symptoms:

  • Nausea/vomiting

  • Sensitivity to lights, noises or smells

  • Seeing zig-zags or blurred vision

  • Constant, throbbing pain on one or both sides of the head

  • Trouble concentrating

Types of headaches

Cervicogenic or Tension Headache

This is by far the most common type of headache. It is caused by tightness, stiffness and trigger points in the neck musculature. The neck muscles have fascial connections with the dura mater in the spinal cord and the brain. This means that if your neck muscles are tight or have trigger points, it can literally pull along the spinal cord and brain. It is often described as pain in the base of the skull and can also radiate along the head and into the forehead or behind the eye.

Cluster Headache

These are the most severe type of headache which presents as a burning pain along the side of the head or eye and can also be accompanied by a runny nose, red, swollen eyes and other symptoms.

Icepick Headache

These headaches come on very suddenly and last only usually less than a minute. They are described as a sharp, stabbing, intense pain that is often located in the forehead, temples or side of the head.

Common Triggers

Diagnosing the type of headache or migraine is not as important as finding what is causing or triggering it. Most commonly, headaches are not life threatening and are caused by the following:

  • Neck pain/tightness

  • Stress/Anxiety

  • Certain foods

  • Post concussive disorder

  • Hormonal changes

  • Weather changes

  • Certain foods

  • Alcohol consumption

There are some instances where headaches are more serious and can be caused by:

  • Tumor

  • Stroke

  • Hypertension

  • Drug withdrawl

Treatment options

Treatment is highly dependable on the cause of the headache. There is almost always something more that can be done besides medications. Some other treatment options include:

  • Diet changes

  • Supplements

  • Chiropractic care

  • Physical therapy

  • Acupuncture

  • Relaxing, stress reducing techniques

If you are experiencing headaches, be sure to seek a healthcare provider. This is important to find out what is causing the headaches and what to do to treat it. Often times, there is more that can be done besides taking prescriptions for the rest of your life. Call or email our office and see if we can help you solve your headache/migraine problems.

Am I using the right pillow?

Choosing the right pillow can be a tough decision due to the many options. People often put focus on their mattress but they forget to update their pillow. Choosing the right pillow is a personal decision and it should definitely be comfortable but there are some guidelines to help choose the right pillow for you.

When should I get a new pillow?

New pillows should be purchased every 1-2 years on average. Any one of these reasons is grounds for a new pillow: frequent neck pain, loss of shape, stains or odors. If you are waking up with neck pain or headaches in the mornings, then it is time to look at your pillow and consider getting a new one.

How do I know what kind of pillow to get?

Height and firmness are the two main factors in deciding which pillow to purchase. Firmness is highly dependent on personal preference, whichever material feels good to you is the right start. More importantly, the height of your pillow is very important as is determined based off of your sleep style. A good rule of thumb is that you want your neck to be in neutral, whichever position you sleep in.

Back sleeper:

First off, the back sleeper has to decide if they have sleep apnea or snoring problems. If so, a low pillow will be tough to use due to exacerbating these conditions. A medium height pillow is best for back sleepers so that the neck is not stuck in excessive flexion or extension for 8 hours a night. You do not want your chin to jut up towards the ceiling yet you do not want your chin touching your chest either. You want something that falls in the middle. Back sleeping is the best position for those with neck pain.

Side sleeper:

Often times, the side sleeper chooses a pillow that is not high enough, causing their head to point down towards the mattress which causes constant, unwanted stress on the neck. Choose a pillow tall enough that your neck is neutral left to right on your shoulders. For example, if you sleep on your right side, you do not want your right ear to be closer to your right shoulder than your left ear compared to your left shoulder.

Stomach sleeper:

This is arguably the worst sleeping position for those with neck pain and or headaches. Being a stomach sleeper requires your neck to be in near full rotation for hours at a time. It would be best to try to flip over and sleep on your stomach however that is not very easy for some people. If you cannot sleep on your back or side and must sleep on your stomach, use a thin or short pillow. This will allow the least amount of twisting on the neck as possible.

Ok, now what?

Choosing a pillow will ultimately come down to preference, style and comfort. Start with recognizing your sleeping position and choose a height based off of that. Most companies will give a money back guaranteed if you do not like the pillow. Be sure to capitalize on that if your pillow is not comfortable or you are waking up with even more pain and headaches than previously.