Foot dis-ease: tricks to ease their aches

Helpful hints for plantar fasciitis sufferers

“Oh my aching feet! “ says the majority of adults. And plantar fasciitis is high up there as a causative factor. So what are we doing to bring it on … and how do we make it go away?

Plantar fasciitis, aggravation of the plantar fascia, causes pain in the underside of the foot, typically near the heel, in ~ two million people in the United States each year. It is an injury caused by excessive and repetitive loading of the foot’s longitudinal arch and could be related to weak foot muscles that are not strong enough to provide foot stability; this increases strain in the plantar fascia, which wraps around the MTP joints, affecting their stability.

Running shoes slope up at the front so that the toes are lifted. This can permanently dorsiflex the joint between the toes and the rest of the foot. This could potentially aggravate the plantar fascia by causing it to strain more. In addition, weakened foot muscles may be a consequence of features in these modern shoes that support the longitudinal arch and passively stiffen the foot.

DJ Davis et al.

Blame the shoe?

The upward curvature of the sole at the front of the shoe elevates the toe box dorsally above the ground and thereby holds the toes in a constantly dorsiflexed position. Toe springs facilitate the forefoot’s ability to roll forward at the end of stance. However, they alter the joint moments and work at the toes such that greater degrees of toe spring curvature results in lower work requirements during walking. Hence, toe springs may contribute to weakening of the foot muscles and to increased susceptibility to plantar fasciitis.

The ability to dorsiflex the toes relative to the rest of the foot at the metatarsophalangeal (MTP) joints during the propulsive phase is one of the key evolved features that enable humans to walk and run bipedally effectively and efficiently. (A) Dorsiflexion at the MTP joints helps stiffen the foot through a windlass mechanism. During this action, dorsiflexion of the toes creates tension in the plantar aponeurosis that tends to pull the calcaneus towards the metatarsal heads. This motion creates an upward force in the longitudinal arch. (B) During propulsive phase, the metatarsal heads and the distal phalanges are the only points of contact with the ground on the trailing leg and hence become load-bearing. As a result, the ground reaction force (vGRF) acts on the distal phalanges at a distance R from the MTP joint center to generate a moment that causes the MTP joints to dorsiflex. (C) The intrinsic flexor muscles are active (Fflex) at the end of stance phase, balancing the dorsiflexion moments at the MTP joints (with r as the lever arm of the acting flexor muscles).. —F Sichting et al.

However, barefoot activities improve balance and posture and prevent plantar fasciitis. They strengthen the small muscles in the feet that are crucial for movement and stability, similar to that of the core muscles in the abdomen.

The simplest way to reintroduce the feedback provided by the small muscles of the foot is to shed footwear when possible. McKeon says activities like Pilates, yoga, martial arts, some types of dance, etc. are especially beneficial.
"Anything that has to deal with changing postures and using the forces that derive from the interaction with the body and the ground [is great for
developing foot core strength]," he said.
McKeon also described the short-foot exercise, which targets the small muscles by squeezing the ball of the foot back toward the heel. It's a subtle
motion, and the toes shouldn't curl when performing it. https://medicalxpress.com/news/2015-11-strong-foot-core-plantar-fasciitis.html

UltraSound Treatments

When it is too late to prevent the injury, and pain is established, one treatment modality is use of ultrasound. A recent study reports results from a trial utilizing ultrasound imaging and specific ultrasonic energy to penetrate, emulsify and remove diseased fasciitis tissue.

In the study, 100 patients were treated, beginning in August 2013. The patients presented with chronic, refractory plantar fasciopathy, and all patients had previously failed to respond to medications, activity modification and arch supports. Before treatment, patients reported how their foot pain affected their ability to manage everyday life through the Foot and Ankle Disability Index (FADI). FADI scores were collected from the patients at two weeks, six weeks and six months post treatment.

Two weeks after treatment, greater than 90 percent of patients reported improvement in symptoms, and these improvements were maintained at six months. Patients also reported being highly satisfied with the treatment and had no treatment-related complications. - https://medicalxpress.com/news/2015-03-interventional-radiology- treatment-relieves-chronic.html

Permanently removing damaged, pain-generating tissue allowed room for healthy tissue to regrow in its place, restoring normal function.

Fat Injections Treatments

Another approach puts fat tissue to good re-use. Perforating fat injections can decrease plantar fascia thickness, reduce pain, and improve quality of life.

Adults with plantar fascia greater than 4 mm for whom standard treatment had failed were included in a prospective, randomized, crossover pilot study. Group 1 (intervention) was followed for 12 months. Group 2 was observed for 6 months, injected, and then followed for 6 months. Validated patient reported outcome measures, ultrasound, and complications were assessed. Group 1 had nine female patients and group 2 had five patients. A total of 2.6 ± 1.6 ml of fat was injected per foot at one to two sites. In group 1, plantar fascia thickness decreased from screening at 6 and 12 months (p < 0.05). Group 2 had decreased plantar fascia thickness from screening to 6 months after injection (p < 0.05). Group 1 had pain improvements at 6 and 12 months compared with screening (p < 0.01). Group 2 reported no pain difference after injections (p > 0.05). Group 1 had improved activities of daily living and sports activity at 6 and 12 months compared with screening (p < 0.003). Group 2 noted increased sports activity 6 months after injection compared with screening (p < 0.03). In conclusion, perforating fat injections for chronic plantar fasciitis demonstrate significant improvement in pain, function, and plantar fascia thickness. - B Gusenoff et al.

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My personal go to preventive measure trick? Relevé! Rising onto or standing on the toes or balls of one or both feet.

So weak feet … get thee to the barre!

https://www.energetiksblog.com.au/blog/2017/6/7/dance-advice-the-art-of-pirouettes

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REFERENCES

DJ Davis et al. Foot arch rigidity in walking: In vivo evidence for the contribution of metatarsophalangeal joint dorsiflexion, PLOS ONE (2022). DOI: 10.1371/journal.pone.0274141

F Sichting et al. Effect of the upward curvature of toe springs on walking biomechanics in humans, Scientific Reports (2020). DOI: 10.1038/s41598-020-71247-9 , www.nature.com/articles/s41598-020-71247-9

S Shoemaker. Strong 'foot core' could prevent plantar fasciitis, shin splints, and other common injuries. https://medicalxpress.com/news/2015-11-strong-foot-core-plantar-fasciitis.html

Interventional radiology treatment relieves chronic plantar fasciitis (2015, March 1) https://medicalxpress.com/news/2015-03-interventional-radiology- treatment-relieves-chronic.html

B Gusenoff et al. Perforating Fat Injections for Chronic Plantar Fasciitis: A Randomized, Crossover Clinical Trial. Plastic and Reconstructive Surgery: February 2022 - Volume 149 - Issue 2 - p 297e-302e. doi: 10.1097/PRS.0000000000008765. https://journals.lww.com/plasreconsurg/Abstract/2022/02000/Perforating_Fat_Injections_for_Chronic_Plantar.37.aspx