Pain in the Foot! A look at Plantar Fasciitis

Autumn is here in full force we have survived Octoberfest, and Halloween! These social events put us in contact with new and interesting people. How many of us have been in one of those situations where the conversation not only sucks? But its downright ugly, painfully brutal If you got me on an off day sorry.  When I watch a person move it is a conversation with the world around them, their constant adaptation to different stimuli internal and external allows them to express themselves. While movement can be graceful like a ballet dancer or sprinter in stride it can be downright ugly as well.One of the worst forms of self expression is the knife heel dance that the plantar fasciitis or plantar heel pain sufferers go through every morning or after a long period of sitting. The first five steps are agony, they cannot put the heel down, stabbing pain in the entire bottom of the foot, sometimes going up the leg. This walk of shame can occur everyday multiple times in a day.  At one point I was suffering from plantar fasciitis, as the result of an increase in mileage while being a bit overweight and running in the wrong shoes. It was brought under control through some treatment, trial and error home treatment, and yes I bought into the contraptions. We will speak more about that cottage industry later. Unfortunately 10% of people will suffer from plantar fasciitis in their lifetime with a higher incidence in the athletic population. This is not just a niche problem for the running community the annual cost for treatments is estimated to be between $192 and $400 million a year. The centers for Disease Control and Preventions National Center for Health Statistics has found that plantar fasciitis accounts for 1 million doctor visits per year.  The cost of custom orthotics is between $200 ad $800 per pair and surgery is $10,000.00. This does not even address ongoing cost to the labor force if you are having foot pain and need to be on your feet all day it's likely you are not working that day. Now you can see the importance of the subject, why it needs to be addressed, the ways in which we can all have beautiful conversations.  We will be exploring just that in this article along with some steps you can take to deal with the modern scourge plantar fasciitis. 

So what is plantar fasciitis? It occurs when you overwork the tendons and the thick tissues of the  bottom of the foot. The pain occurs at the bottom of the foot by the heel bone, this was thought to be caused by inflammation but the current theory is that is rather degeneration.  The symptoms of plantar fasciitis are pain in the heel starting gradually ad may radiate to the arch of the foot. Tenderness under the sole of the foot and on the inside the heel when they are pressed on. The pain can either range from discomfort to very painful depending upon the level of damage. The pain is usually worse in the morning as the foot is a relaxed position while we sleep causing the plantar fascia to shorten.The name gives it away in that it’s an inflammation of the plantar fascia of the foot. Leonardo Davinci is quoted as saying “The human foot is a masterpiece of engineering and a work of art.” He may have been admiring one specific foot when he said this, but it does hold true. The foot has 26 bones accounting for a quarter of the bones in the entire body. The foot contains 33 joints, 100 muscles, tendons and ligaments. One of the key players has been left out fascia, leaving us to ponder what is fascia. The simple answer is that it is a thin sheath of fibrous tissue enclosing a muscle or other organ.  Fascia allows the muscles to move freely alongside other structures and reduces friction. It can be found immediately beneath the skin, around muscles, groups of muscles, bones, nerves, blood vessels, organs and cells. The plantar fascia is the muscle and fascial tissue under the foot that forms the arch.  After the first few steps in the morning will lessen or subside. Lets look at the possible causes and risk factors that come into play with plantar fasciitis.   Some of the common causes are repeated stress and strains to the feet where they become to much for the foot to handle. The risk factors are tight calf muscles, obesity, a very high arch, repetitive impact sports, increase in activity ie running, jobs where your on feet for extended periods of time and a faulty walking pattern. 

Over the summer I had to opportunity to visit with a friend through the course of our conversation her fathers “old man” injuries came up. He is a retired gym rat who along  the way acquired some of the more common gym maladies a shoulder issue from regular use, plantar fasciitis and the consummate knee pain. In his day Tom was not a meathead, but given his age that may be the way he trained as that was the trend of the day. As a  fitness community our knowledge base grows exponentially year in year out with nutrition, exercise science and supplementation. When I started working out going behind the head for pushes and pulls was normal, now you have to be a renegade or a dinosaur to train that way.  I volunteered to write Tom a program for his plantar fasciitis as well as talk to him about his other injuries. After I made the offer I thought this needs to be a post for everyone to benefit from. One thing that was uncovered was the fact that Tom had over a dozen contraptions, like me he made the donations to $400 million. I did some research the average contraption cost is $16.99 -$24.99 per item from providers like durable medical equipment companies and online stores like Amazon. My Uncle Moe is very funny man and happens to be very quotable. When all of his kids lived at home he used to look at the phone bill line by line asking who called this number and who hit star 69 five times? “these kids are nickel and diming me to death!”  Moe is right they are nickel and diming people to millions. Lets get back to the hellish groundhog day opening to the plantar fasciitis sufferer. Its 5:45 am the alarm goes off your hear some bongos then the chant the champ is here! The champ is here! The champ is here! Off like a shot out of bed until your feet hit the ground, the champ goes down like Joe Frazier. Pain in the foot gotta get up before the alarm wakes up the rest of the house,  after a few steps the pain subsides alarm is off. Those of your who go through this on a daily basis I am sure you came here looking for solutions please see below. 

Solutions Table Release-Stretch-Strengthen-Reintegrate

While in Bed before your feet hit the floor 

-Point and flex your toes ten times 

-Make circles with you feet ten times clockwise, reverse that ten times 

When your feet hit the floor 

-Have either a golf ball, lacrosse or a hand ball in the night stand 

-GENTLY roll the ball under your feet ten times front to back 

What the above does is gets the tendons and fascia in the feet moving so that there is some blood flow. It also takes the foot out of the relaxed position by slowly lengthening the plantar fascia.

No more barefoot walking in the house, purchase sandals with a thick heel as flip flops and barefoot walking will collapse your arch

This will not be enough to get your Plantar Fasciitis to subside you will need an exercise protocol. Release-Stretch-Strengthen-Reintegrate

Release Foam Roll the Calf Muscles  

Sit in front of a foam roller, put your legs over the foam roller stacking the legs on top,  start at the top of the back of the shoe roll until you find a tender spot. Then relax and breathe hold for 30-120 seconds, then you find another tender spot. 

Stretch 

Calf Stretch Hold the stretch for 30-120 seconds or until the release is felt. Stand feet hip with distance apart, square your shoulders and hips up to the wall, step one foot back, as you keep the heel down push your hands into the wall and hips towards the wall. 

Strengthen or rehab measures: for this you will need a seat, a hand towel, a dixie cup and some marbles. 

Put the towel on the floor(preferably wood) in front of the chair, take your shoes and socks off. Put your foot in the middle of the towel and scrunch it up with your foot. Did I say this would suck? I must’ve forgot to mention that. Switch feet. 

Onto the monkey foot game!!

Take the marbles dump them on the floor around the dixie cup. 

Now your going to monkey foot the marbles into the dixie cup, by picking the marbles up with the toes of the foot and placing them in the cup. 

Repeat on the other side. 

Reintegrate

This one is really simple Farmers Carry. If you have access to kettlebells they are preferable to dumbbells, use what you have access to.  You will want one bell in each hand the weight should be substantial enough that you have to work to walk with it. The key is going to be walking through the feet this should give you a grounded feeling.  The farmers carrys are great because they will strengthen the feet as well as work on your gait to some degree. 

Bonus Track

My favorite albums have bonus tracks. This is your bonus track for this article, while it may not be The Clash’s Train in Vain. It should help you if your in pain and can’t seem to shake it. All you need is a round water bottle thats frozen solid. Basically with your sock on you roll the frozen water bottle under your foot this will provide some temporary pain relief. You will need to use some of the Release-Stretch-Strengthen-Reintegrate protocol as stated above. Otherwise you are only managing a symptom not the whole issue. 

The above solutions have worked well for me, I am a health and fitness professional but I am not a doctor. So the solutions that are posted here are limited if you are still in pain not getting better it may be time to seek out a professionals opinion like a physical therapist, chiropractor and or a physician. As they will be able to do some manual muscle tests, gait analysis and other tests to diagnose you. One of the ideas as far a training and what I look for in medicine is to treat the whole disease or issue and not the symptom. When dealing with an engineering masterpiece like the body or foot we all want a comprehensive approach with better results. As we age we should all be interested in moving like a dancer with grace, like a boxer with balance, a sprinter with explosive power and a child moving with ease.  In the coming months we will have a holiday primer to help you survive the holidays in shape, a look at working out with spinal injuries, and unconventional training. Please read and share this article and any of the others you like on my site. 

Tabata and the Bookworm A Love Story !

Over the years we have seen an increase in exercise initiatives at first we had the Presidents Council on Fitness, the First Lady has Lets Move now, the NFL has the 60 campaign looking to get kids moving 60 minutes a day. They also have them at jobs with fit bit competitions, wellness evolutions, or companies encouraging folks to work out at lunch. They are all great programs I applaud you for your efforts in fighting obesity  and getting people moving.  I psyched you out we are not talking about physical fitness programs. Don’t be disappointed, and please don’t be butt hurt. We are talking about exercise it has many benefits one of which is in learning.  This subject came from two places a New York Times article outlining two studies one showing exercise benefiting learning, the other study showed a benefit but the study was flawed. When we look at it you will see why! I promise. This subject also came to me from another angle my interest in the conscious and subconscious mind as well as methods of reaching both with information namely learning. I always wonder about yoga where you put in work physically but the juicy part of yoga is in Shavasana or relaxation in the end. Where it is said you get the greatest benefit, the idea crossed my mind if we could tap into that to access different parts of the brain to learn. Some people are experimenting with learning language and sensory deprivation tanks with some success. To date it has self experimentation by biohacker’s without medical based evidence.  Exercise is not only good for body, its good for your soul you know you feel good when your on track with your fitness goals, its also good for your mind and getting your learn on. 

The first study up is titled Physical Exercise during Encoding Improves Vocabulary Learning in Young Female Adults Citation Schmidt-Kassow M, Deuser M, Thiel C, Otterbein S, Montag S. 2013 Published in Plos One. The participants in the study 105 right handed german females between the ages 18-30 were broken up into three different groups Relax, Post and Sim. The Relax groups task was to learn a word for 30 minutes and relax in a chair for the same amount of time. The Post group cycled at a hard effort for 30 minutes prior to learning new words for 30 minutes. The members of the Sim group learned while they cycled for 30 minutes. This resulted in all of the women learning some new words  but the women in the Sim group faired the best. They had better recall of information, the Relax group performed better than the post group which faired the worst. The testing of the subjects took place two days after learning the words.  The next study up is The Effects of Acute Exercise on Retention and Learning Mastrocola M, Exercise Science Elon University NC. They took 11 female college students who read a chapter in a nutrition text book during 2 separate elliptical sessions lasting 30 minutes which was to be moderate to hard or sitting. The group that studying quietly tested better immediately after the rest than the exercise group. After 24 hours there was no discernible difference in the groups retention. The study was flawed in my eyes as they had two problems no moderate to mild exercise group and if you have exercised hard even on an elliptical reading is not easy. You will get queasy or feel see sick and lose your place, a better option would have been auditory learning materials, in an effort to avoid the previously mentioned pitfalls. I do applaud the efforts of the researcher in looking at this topic. 

I believe the difference in the studies are the result of two differing forms of exercise, the fact that a moderate to hard effort lights up your central nervous system. This is a variable that cannot be discounted as it has a direct correlation on the brains ability to focus and learn.  Do you learn a new skill when your all light up with your body and mind ready to move?  No look at Jiu Jitsu practitioners they practice moves breaking them down into mini moves going over them slowly and working them before going live.  The same can be said for wrestling, combat sports, and football. The likelihood is that during physiological arousal certain chemicals are released that affect memory formation according to Dr. Schmidt but this has not been proven. If you have a test in a few hours study and review in quiet, but if the test is a couple of days away try some mild exercise.  

I mentioned exercise initiatives earlier in the article, one program has added a new element to their program academic benefit of learning during exercise. At the Take 10 Program the core of the program are 10 minute activities combining exercise and learning. One appeared in the journal Preventative Medicine called Invisible Jump Rope  the objective is to recall basic counting, addition and subtraction facts while jumping. The teacher calls out numbers from 1-10 starting with one, everyone jumps as they count up to that number. Then you start at 20 and count backwards as students do the invisible jump rope backwards. This is the beginner level of a three level system. It is backed by case studies posted on their website http://www.take10.net/case. 

In this article we have looked at three different studies with varying methodologies, age groups and sexes. Some of the results have fallen in line others have changed due to different variables. One thing is evident that the test subjects who studied during mild exercise faired the best out of the exercise groups having the best retention. If you think about it with runners in mind it holds true, many runners myself included feel that while you run you can really work out problems or issues once you catch a rhythm. I feel that exercise can help to stimulate learning, but like everything else you need to apply the appropriate form of exercise don’t go all out in a training session then expect to sit down and be ready to study. People learn in different ways so please experiment and find what works for you and your kids as far as learning goes.  This weekend we will be looking at Gut Microbiota, next week a summer wrap up list of movies, music, books and other entertainment.  Please read and share. 

What is your mind on?

Foundation Nutrition: Somethings Fishy

The past few weeks have reminded me that we are looking for answers and most of us want a straight answer. We need to take in the information decipher it and solve the puzzle the best we can.  This has been an ongoing thought in my mind, it is why I have switched to free range poultry, grass fed beef, bison, elk and other game meats as well as a mostly organic fruit and vegetable diet. But at times I scratch my head to like when we need to be conscious of the animal’s state of mind prior to slaughter. So we do not take in any unnecessary cortisol the stress hormone or other poisons. It makes sense but makes me wonder if you’re trying to just bust my balls or you are serious. 

Fish Oil and Omega 3 Fatty Acids have been in the news again due to a new article published in July 2013 issue of the Journal of the National Cancer Institute. The article suggests that there is an association between elevated plasma omega 3 fatty acid levels and a heightened risk of prostate cancer.  We must take the results of this article with a grain of salt  given the following factors; the data used in the article was taken from a much larger study previously conducted that was not designed to determine any of the conclusions reached in the analysis found in the article. Findings published in the article are contrary to other studies which have found omega3 fatty acids can offer some protection from prostate cancer. The study that had this finding designed to do so "Consumption of Fish Products across the lifespan and Prostate Cancer Risk"1.

They noted the physiological marker of elevated Omega3 levels in men with prostate cancer, but failed to showed causation. The problem with causation is twofold in that the study only measured the Omega3 levels one time with a plasma test, the levels can be influenced by diet and or behavior. Nor did they review any of the participant’s dietary intake of fatty fish or supplementation of Omega 3's basing the conclusion of the study on one blood test. This could have been avoided if they used the Omega-3 index test this measures EPA and DHA in red blood cells, and is noted to be a more accurate indicator of long term omega-3 intake than the plasma omega-3 level which is influenced by day to day variables. 

A number of risk factors were present in the study may have had an influence on the purported results of the study. It is of note that 53% of the subjects with prostate cancer were smokers, 64% of the cancer subjects regularly consumed alcohol, 30% of the cancer subjects had at least one first degree relative with prostate cancer and 80% of the cancer subjects were overweight or obese. Most of all the article fails to show or suggest a biological mechanism that would explain why the fatty acids may increase tumorigenesis.

The benefits of eating fish and supplementing with Omega 3 fatty acids have been researched, and are well documented. Omega-3 fatty acids have been shown to improve cardiovascular profiles, as well as reduce chronic pain and inflammation.A dose of 2 grams of  EPA-DHA daily reduced pain in almost 60% of patients with neck and low back pain 2 In this case we are lucky the medical based evidence make it starkly clear that it would not be prudent to alter your current meal and supplementation plan with omega 3 fatty acids. We need to be vigilant in researching the researchers, was this an unbiased study, what were there sources of information. In this case was the data or study flawed from the outset, or what was said data truly intended for.  Often times we do not get a straight answer, we need to dig, research, get our hands dirty and work for it. But working for it is not always a bad thing. Sorry the postings have been sparse the last two weeks, we will get back on a normal schedule. The ideal amount of posts is three with the occasional weekend list. I have been busy doing some writing that will be up here in the coming week. Sunday I have a post about desire and will, the supplements and foods for joint health will be coming as well. As always please read and share this blog !

Sources

Torfadottir JE, Valdimarsdottir U, Mucci L. Kasperzyk J, Fall K, Tryggvadottir L, Aspelund T, Olafsson O, Harris T, Jonsson E, Tulinius H, Gudnason V, Adami HO, Stampfer M, Steingrimsdotti L, Consumption of Fish Products across the Lifespan and Prostate Cancer Risk PLOS ONE 2013 8 (4) e59799

Maroon JC, Bost JW. Omega3 fatty acids as an anti-inflammatory: an alternative to NSAID fir Discogenic pain. Surg Neurol 2006 65 (4) 326-331