Plantar Fasciitis: Fixes That Actually Work

[0:00] What if that stabbing pain in your heel every morning isn’t a bone spur, bad shoes, or punishment from the running gods? Spoiler, it’s probably plantar fasciitis.

Kathy: Yes, today we’re going to be talking about what plantar fasciitis is, what it is not, and how to tell the difference between that and similar conditions. And we’ll also tell you the truth about some of the popular treatments out there

Jason: like mustard in your socks.

Kathy: Yeah, we’ll get to that one. Okay, this is the PTCH. What happens when a chiropractor and a physical therapist get together to make

[0:30] a health and wellness podcast?

Jason: Chiropractors and physical therapists don’t like each other.

Kathy: Oh, think again. I’m Dr. Kathy Lynch, physical therapist who likes to help people move and get stronger.

Jason: I’m Dr. Jason Young, an evidence-based chiropractor who uses humor just as much as adjustments to help people get better. Welcome to the PTCH Podcast. Remember, there’s no I in PTCH. Okay, we are back and welcome to all of you. Excited to talk about plantar fasciitis today, Kathy.

Kathy: It’s great.

Jason: It’s not, but it’s great to talk

[1:01] about. But speaking of great, let’s talk about our big milestone, our big achievement. Yes. For several weeks now, we have been well over 1,000

Kathy: subscribers.

Jason: Pitches.

Kathy: Yes. Pitches everywhere. That’s right.

Jason: Thank you, pitches, for

Kathy: Yes.

Jason: listening. Yeah, for telling your other friends. And yeah, it’s really

[1:31] good and love the suggestions that we’ve been getting. I think was this one that was recommended by somebody?

Kathy: We probably have enough patients that are asking us like on a daily basis about this. So

Jason: yes. So yeah, so that’s a big deal. And if you have not subscribed yet, just go ahead and do that, because clearly everybody’s doing it.

Kathy: Everybody’s listening.

Jason: Everybody’s doing it. Another important thing, our swag store is live.

Kathy: Let’s go.

Jason: I wrote a note. It’s live.

[2:03] It’s an L with about six I’s, five V’s, and then five E’s. So, however that’s

Kathy: however that’s pronounced. Yeah. So, if you have been waiting all this time for some PTCH Podcast swag, the wait is over. So, we’re going to — shows going forward, you’ll be able to find the link to the PTCH Podcast swag store in the comments or the show description for YouTube as well as Spotify, Apple Podcast, whatever

[2:33] you need. So,

Kathy: yes, I’m ready to go shopping.

Jason: Yeah. What’s on your Christmas — what’s on your Christmas list?

Kathy: You know what I’m going to get myself for Christmas? I’m going to get myself one of those sweet sit and reach champion shirts.

Jason: Uh-huh. And you know, I’ll tell you this because my family doesn’t listen and so I’ll tell you what I’m getting them. They’re all getting PTCH shirts. So

Kathy: yes,

Jason: the stockings. So but for that we have to

[3:04] give a huge thanks to our sponsor for this show, Corvallis Custom. So they’re responsible for putting together our swag store and they’ve been doing great printing in the Corvallis — Albany — like the Willamette Valley for years and years and years, as well as supporting like college athletes nationally with their Athlete Zone brand. Just top-notch, top-notch work. So

[3:34] do you use Corvallis Custom for your printing? Did they print that shirt?

Jason: They printed my Helix shirt. You bet they did. All right.

Kathy: Yeah, we had a tie-dye party, so they printed white

Jason: t-shirts with the white logos when you tie-dye it.

Kathy: Oh, pops. Pops. Yeah. So, yeah, Corvallis Custom. Check them out at corvaliscustom.com. And yeah, they’re fantastic. They take care of all of our printing needs. All of our printing needs. Yes.

Jason: Great. Well, should we jump right into the show? Let’s do this. Okay.

[4:05] What the heel is wrong with my foot? You can tell when we’ve run out of subtitles. What the heel? I mean, we have patients coming in all the time. I got foot pain. What the heel is wrong with it? PTCH.

Kathy: All right. Okay. Come on. Serious. Yeah. This is a PG family show. Okay.

Jason: Yeah. So, I think most of the time when we’re encountering plantar

[4:36] fasciitis, my experience has been somebody comes in and announces it, right? It’s not that like we’re like, “Oh, you know what? This could be — this could be plantar fasciitis.” No, somebody walks in the door and they announce

Kathy: Yes,

Jason: I’ve got plantar fasciitis.

Kathy: I’ve got it

Jason: in both of my feet and one of my hands. Right. So Kathy, why don’t you tell us what the heel is plantar fasciitis?

Kathy: Well, let’s first start with what is a

[5:07] plantar fascia?

Jason: Okay. We’ve mentioned fascia

Kathy: a few times in the show.

Jason: Yes.

Kathy: It’s a connective tissue.

Jason: Yeah.

Kathy: And specifically the plantar fascia is on the bottom of your foot.

Jason: Okay.

Kathy: And it spans the bottom of your foot from your heel to your toes.

Jason: Okay?

Kathy: And is a fibrous tissue. It is not a tissue that contracts and relaxes like a muscle.

Jason: So, it’s not a muscle. It’s not a bone.

[5:37] It’s just some connective tissue, kind of like a tendon or something like that?

Kathy: Sort of. But yeah, I don’t believe the plantar fascia has nerve endings in it, but I could be wrong.

Jason: You know, some tendons have nerve endings in them. Ligaments, too. I would guess that it does. We should have checked on this. Shoot. So,

Kathy: can we stop the show real quick? No, I’m just kidding.

Jason: I’ll leave it in the comments. I would guess that it does just because it can be so painful, right? And

Kathy: Yeah.

Jason: Yeah. So, I don’t know.

[6:08] So, what does the plantar fascia do in the foot?

Kathy: Well, I’m so glad you asked. It kind of gives some tension to the bottom of the foot. It helps you propel yourself as you walk. It helps to make up the arch of the foot. So, if you have like an overstretched plantar fascia or a weak plantar fascia, that is one of the things that contributes to a fallen arch or a flat foot.

Jason: And so it kind of helps to hold all that up and it puts a little pep in your step and a spring in your swing. I don’t

[6:41] Yeah. Is that — I don’t know how old people say it. We were talking about old people before we started, right? Kathy: Yeah. Those little people were grandfathered in with plantar fasciitis. Jason: Yes. Yes. Uh-huh. Yeah. Kathy: If your grandfather had it. Jason: Yes. If your grandfather had it, then you have it — definitely, because it’s not hereditary. It’s not hereditary. So, Kathy: so I was way off base. A quick Google search tells me that there’s definitely nerves. Jason: Okay. Okay. Good. So, and is Google now an official sponsor of the show? Because I thought that we were getting all of our information from Wikipedia before.

[7:11] Kathy: I moved up one. Jason: Yeah. I thought that we talked about this at the production meeting. Okay. Well, Google’s probably going to charge us a lot more, but yes. Kathy: Oh, shoot. Jason: Go say hi to our friends Sergey and Larry at Google. Kathy: All right. So, okay. So, we talked about what the plantar fascia is. How do you get to plantar fasciitis then? Because I know “-itis” means inflammation. So, is plantar fasciitis just an inflamed plantar fascia?

[7:41] Jason: That’s what we used to think. And then Kathy: and then science came along. Jason: We scienced it. Kathy: Yeah. And so what science is telling us is this is more of a degenerative condition. You are degenerating as we — hold on. No. Jason: What usually happens — what I tell patients a lot of times is plantar fasciitis is likely caused by a lot of repetitive use. Kathy: Mhm.

[8:11] Jason: So, if you, you know, are kind of a couch potato and all of a sudden you decide to run a 5K and your heel hurts, Kathy: that’s an overuse injury. That’s a repetitive strain injury. Jason: Ouch. Kathy: Mhm. Jason: Yeah. Kathy: And so, Jason: it’s also why we don’t see it in a lot of young people. Kathy: Yes. Jason: Right. Like, some good point. Kathy: Yeah. I had somebody who came in with their eight-year-old and she said, “I think he’s got plantar fasciitis.” Said, “I think he does not.” Yeah.

[8:41] On that one. Jason: So, what is it then if it’s not an inflammation? Kathy: Well, first of all, I think there’s maybe kind of a movement to stop calling it plantar fasciitis and start calling it plantar fasciosis instead. Even if that — Jason: we should come up with a different name. Kathy: I think so. I just abbreviate it PF most of the times when I’m charting. It’s PF. But “-osis” means “condition of,” “-itis” means “inflammation of.” And kind of same thing with people who are like,

[9:11] “Oh, Jason: we took x-rays and we could see the arthritis on the x-rays” — you could not. You can’t. You can’t see the inflammation of the joints on the x-rays. You can see the aftermath of it, which would be arthrosis, but nobody knows that word. They’d be like, “arthrosis” — that’s Kathy: that seems terrible. I got the arthrosis. Jason: Yeah, it’s actually better. So, yeah. So, I think that’s what we should talk about in this episode is like how do we help people to

[9:41] know when they have the PF and when it might be something else. So, maybe we should talk about some of the common misdiagnoses, and then maybe we could wrap back around to like what are the risk factors and stuff like that. Kathy: That sounds good. So, did I get tapped for the misdiagnosis stuff? Okay. Jason: You love the misdiagnosis. Kathy: I do. Yeah. So, plantar fas — PF — plantar fasciosis. Jason: Yeah. It’s one of the most

[10:11] common causes of heel pain. And that’s really the phenomenon that we should be talking about is heel pain, because there’s several things that can cause heel pain, which — a lot of times when you are heading towards a diagnosis of plantar fasciitis, there are a few questions that are going to be asked of you. First of all, number one: do you have pain in your heel? Right? Because that is where that tissue originates, right there at that kind of spur in your heel, and then it goes forward towards your toes. So if you

[10:42] have pain in your heel, that’s maybe clue number one that you have plantar fasciitis. The second question that you’re going to ask typically is: when does it hurt? Jason: So a lot of times you’re going to get some plantar fasciitis — it’s going to be painful the first thing in the morning when you get out of bed and you take that first step and you’re like — right — and then maybe by the time you’re done at the bathroom or the shower, whatever, it’s feeling a little better. Kathy: Feels like you stepped on a Lego. Jason: Yes. Absolutely. Kathy: Totally. Jason: Damn that Lego. Yeah. And then all you can think about is how old you

[11:13] are. Jason: So that’s really kind of the second thing. And then also, if it’s more painful when you’re walking and things like that, or running — because really, if you’re sitting in a chair and your foot is hurting while you’re in a chair, there’s less of a likelihood that it’s something like plantar fasciitis. So, other things that you could have that would be associated with heel pain would be like fat pad atrophy. So, you have your heel, and then you have

[11:45] a pad of fat in your heel. Like, some people are like, “I don’t want any fat on my body.” You want this fat, right? Kathy: You definitely want this fat. Jason: Definitely. So, that fat pad is cushioning for your heel. Otherwise, you are bearing the whole weight of your body on that tissue. Not good. So, if you have atrophy — which is like a decrease in the size of that fat pad — that can lead to heel pain. Kathy: Tarsal tunnel syndrome, which — you’ve heard of carpal tunnel. Well, now there’s tarsal tunnel, for just three payments of $9.99. Yeah.

[12:16] Jason: From the makers of carpal tunnel. No. So, the tarsal tunnel is just — it’s an anatomical Kathy: area Jason: area, right? And so you have nerves and tendons that travel through there, and sometimes if that gets compressed that can cause pain down the heel. Sometimes people have stress fractures and they’ll mistake that for plantar fasciitis, which you don’t want to make that mistake, because a

[12:46] stress fracture is, you know, complex, and there’s a different way that you treat it. Achilles tendinopathy. So where your Achilles — oh jeez. Okay. Can I share a pet peeve? When people are like, “Oh yeah, I have a problem in my Achilles heel.” Like, “Bro, are you from Greece? Are you from ancient Greece? Your Achilles heel?” No, it is your Achilles tendon. Yes. Only Achilles Kathy: had the Achilles heel, right?

[13:16] Jason: Yeah. Kathy: But yeah, so Achilles tendinopathy though, a lot of times people will mistake that for plantar fasciitis. And I think there’s kind of a good reason because when you have a problem in your Achilles tendon, some of that fascia is continuous with the plantar fascia. And so it can — that can kind of get confused there. And so we want to talk about like how do you differentiate between those and plantar fasciitis? And is it even important? What do you think, Kathy, to know the difference?

[13:46] Kathy: Yeah. I mean it’s going to change how you treat it and how it’s going to get better. Yes. Jason: So, my favorite way to diagnose plantar fasciitis — Kathy: lay it on me — Jason: is usually I haven’t made a judgment about my patient yet, but sometimes the plantar fascia originates right like you were talking about at the heel. The calcaneus is the medical term.

[14:17] Kathy: Yes. Thank you. Jason: Yeah. And on that spot, it’s like the medial part of your calcaneus, right at that spot. And usually I’ll just go right there for the jugular. And I just press with my thumb. Yep. And if they shoot off the table, I’m like, you got some plantar fasciitis going on here. Kathy: Mhm. Jason: The fat pad is more in the center of your heel. Right. Kathy: Right. Jason: And so if I move up into the center of the heel and press there and they say that’s my pain, then we can kind of tell

[14:47] the difference between those two things. Kathy: Yes. Um yeah. So, Jason: well, and that’s a good point because there’s some people who think that plantar fasciitis is just a generic term for foot pain, right? Kathy: Definitely not. It is its own condition. Jason: Yeah. Yeah. And with fat pad atrophy, you’re going to treat that a little bit different. And we have some different taping techniques we’ll do to kind of cushion up the heel if we think it’s fat pad atrophy versus a different technique for taping

[15:17] if we think it’s plantar fasciitis. Kathy: Yeah. Or even like if you have fat pad atrophy, those heel cups — you can get them at like the pharmacy, whichever pharmacy decides to sponsor the show, we will mention you in this spot. Okay. CVS, if you’re listening. So Jason: yeah, Kathy: but yeah, you can just get one of those. You slide it in there and yeah, that can help too. Jason: The tarsal tunnel tap. You tap on the tarsal tunnel which is on the inside of

[15:47] your ankle. You tap on that and you get referred pain into your heel. That’s not plantar fasciitis. Kathy: It is not. Jason: Yeah. Kathy: Mhm. Jason: Yeah. Stress fractures might be a little bit harder for a PT to diagnose because they could have pain right there at where the plantar fascia attaches to the bone, because there could be a stress fracture right there. Maybe the plantar fascia pulled a little bit of the bone off — you know, pulled — yeah — pulled the bone from the other bone. Kathy: Question. Do PTs order

[16:20] imaging? Jason: We cannot. Kathy: You cannot. Okay. All right. So yeah, because that would be something that would help you make a diagnosis of that. Um, so sometimes you can see a stress fracture on X-ray, sometimes you can’t. Jason: Mhm. Kathy: Um, so yeah, but also definitely managed differently. Jason: Yes. Kathy: Absolutely. Jason: Yeah. Um, because with a stress fracture, you’re going to need more rest, Kathy: but with plantar fasciitis, active rehab tends to be the best. Jason: Exactly. What’s some of the

[16:52] like bad advice that you’ve heard for managing plantar fasciitis? Because there’s some old school — I mean we mentioned that our understanding of the pathology has evolved and so there’s some old school methods of treating that I’m like, what? So Kathy: yeah I think we’re moving away from the ice bottle. Jason: Yeah. Kathy: Just because we found out that there isn’t a lot of inflammation in — Jason: Yeah. And so, but at the same time, sometimes the placebo effect

[17:23] Kathy: Yeah. Jason: is worth it to suggest it to people, but it’s not my first go-to. Kathy: I wish — if there was a podcast that was talking about the placebo effect maybe a few weeks ago, you know. Jason: Yeah. Exactly. Yeah. But yeah, it’s kind of funny because if I’m ever like walking out with a patient and I’m like, “Yeah, I’m gonna send you an email with some exercises for your plantar fasciitis, blah blah blah.” And somebody overhears that in the lobby hallway, they’ll be like,

[17:53] “You should freeze a water bottle. Freeze a water bottle and then just roll just—” And I’m like, “Shut up. Kathy: Don’t freeze the water bottle.” Jason: Yeah. I mean, you could do that because icing something makes it numb. Kathy: Yeah. So it’s not going to hurt. Jason: Yeah. But the problem is, does it help? Kathy: Yeah. Jason: And one of the challenges with ice that we’re discovering just in general is that ice can extend healing time for tissues that are not in an acute phase of injury.

[18:24] And so, Kathy: what do you tell people to do? Heat up their plantar fascia Jason: in a sense. Kathy: Yeah. That’s what I tell them, Jason: right? Uh, you know, depending on how irritable the symptoms are, because sometimes people wait too long Kathy: to come get treatment — like, I thought it was going to go away. Jason: Yeah. Kathy: I did this in January. Jason: Yeah. Kathy: It’s a pretty good treatment method. The watchful waiting. Jason: Yeah.

[18:54] Kathy: Mm-hmm. Jason: So, usually, you know, again, it depends on how irritable it is, which direction we’ll go. If it’s super irritable — so I’ll usually test a lot of different things like, why did this happen? And what’s kind of causing it there? So, there are several things that can contribute — yeah, yeah, yeah — contribute to

[19:25] plantar fasciitis, and part of it is weakness in the calf, in the gastrocnemius and the soleus. So that’s usually one of the first things I look at. And I’ll just look at their calf muscle. And a lot of times I’ll just see that one is smaller than the other. So that’s my first clue. And then I’ll have them do heel raises. And then I want to see them do single leg heel raises. And usually what I’ll see — and this is one of those chicken or the egg things — is I’ll see that they can’t do as many single leg heel raises on the involved leg. And it might be limited because of their pain, but it also could be limited because they

[19:56] just weak. Yeah. And so they went out running on this weak calf muscle and overloaded the calf muscle. And so what I usually tell people about plantar fasciitis is if the muscle attached to that joint, or that moves that joint, is not strong enough to carry the load that you’re putting through it, that load is going to go somewhere. That force is going somewhere. Yeah. And it usually goes to a tendon or it goes to a ligament, whatever is there. And in this case with the foot, it goes to where? To the plantar fascia.

[20:26] Right. Well, because then that plantar fascia — Yeah. I know what you mean. Yeah. The plantar fascia. Yes. Right. The plantar fascia is supposed to hold tension. Yes. And so that is part of the reason that it does get transferred right there, is because it’s already under tension because that’s part of what it even does, right? And so you’re saying that people who are deconditioned haven’t ramped up to a certain

[20:58] workload — and that doesn’t have to be a run. Sometimes it is, um, I helped my college student move to their dorm on the third floor, right? And so it’s like now I’m doing a whole bunch of calf raises and I’ve got boxes in my hands, and it just causes little microscopic tears in that fascia, and it doesn’t always hurt right away, right? Um, I think if you look under a microscope at an injured

[21:28] plantar fascia, you will see what’s called myxoid degeneration, which it sounds like I made it up, right? That’s a fun word to say, though. If you’re at home or if you’re in your car, try saying the word myxoid. It’s so fun. It’s a great word, right? So myxoid degeneration — what happens is you get little micro tears, and then as it’s healing, those tissues, those fibers will kind of roll into kind of cords. So you get this ropey, cordy

[21:58] plantar fascia. And that’s one of the reasons why it reoccurs over and over, because you’ve had a physical change in your plantar fascia. And so then it gets a little challenging to manage. And so there is not a — I mean, sometimes people are like, “Hey, is there an adjustment for plantar fasciitis?” And it’s like, no, there’s not. Um, you can get your foot adjusted, you can get your

[22:28] ankle adjusted, and it’ll give you some relief because maybe we’ve improved the biomechanics of your foot or your ankle, but you’ve had a change to that tissue, and it’s going to take some more consistent intervention, I’ll say, in order to get that to work like it should. So, fun fact. Fun fact. Yeah. I’m sitting here with plantar fasciitis, right? You are. All right, let’s go. Amazing. Oh, yeah. Uh-huh. Yeah. Well, maybe you’ll say something today that’ll help you.

[22:59] Well, I guess — but we should talk about how common is it? Yeah. Yeah, it’s very common. Well, I guess as things go, it’s pretty common. It’s pretty common. Yeah. Uh, let’s see. I think the number that I found — if we want to do statistics and stuff — is that it is 15% of all foot pathologies, and it’s most common between the ages of 40 and 60. So you’re a little young. You’re a little young to have plantar

[23:30] fasciitis. But yeah, so there’s a very good — I’ll put it this way. There’s a very good chance that you know somebody who is dealing with plantar fasciitis, or will have it. Yeah, exactly. If they haven’t had it, they will have it. Right. Right. But is it avoidable? Um — yeah, it certainly is. Certainly is. Think about that. It’s also somewhat cultural too. Um, so another piece of advice — so the

[24:01] footwear, okay, footwear is another area where you know people start getting some wacky advice. Like, I had a patient who — do you remember those Z-Coil shoes? Yes. Yes. So she swore by the Z-Coil. I had one of those patients who would wear them everywhere. And I’m like, this isn’t good. She’s like, “It’s the only thing that’s helping my plantar fasciitis.” I was like, “You don’t have plantar fasciitis. You have some other problem.”

[24:31] Yeah. But, uh, so footwear matters. Does. Um, plantar fasciitis — there’s some cultures that don’t get it as much. And ironically, it’s a lot of cultures that don’t wear shoes. Yeah. Ah, so like, from what I’ve looked at, people on Polynesian islands, or who are wearing flip-flops a lot and stuff like that, don’t deal with plantar fasciitis as much. And so I don’t think there’s a whole lot

[25:01] of agreement as to why that is. But one of the things — kind of ironic — is that the first thing you get told if you have plantar fasciitis is, well, don’t walk anywhere barefoot. That’s right. Yeah. Yeah. Um, do you — how do you feel about zero drop shoes when it comes to plantar fasciitis? I’m a fan. Yeah. Yeah, I am a fan. I like the holy trinity of good footwear, which is zero drop, wide toe box, and um, I can’t remember the third one. The third one’s really important. Uh, yeah. Jeez. Zero drop.

[25:34] Wide toe box. And yeah, I can’t remember the third one. Maybe it is arch support. Yeah, I had a rough day yesterday. I’m just lucky to be here, Kathy. I’m happy you’re here. But yeah, I think wearing some good quality shoes is important. Um, a lot of the footwear that we have — like if you look at a baby’s foot, a baby’s foot is shaped like a fan, right? Um, and they’re cute, right? Like you see people with tattoos of their little baby’s footprint and stuff. That’s so cute. They don’t look like adult feet,

[26:04] though. Adult feet look like an hourglass. And the reason is because shoes look like an hourglass. Um, our shoes are framing our feet. They absolutely are. Yeah. Um, because you’ll find some people that have fan-shaped feet, and you ask them what kind of shoes do they wear, and a lot of them are wearing flip-flops, or they’re like, “Oh, I hate shoes. I go barefoot all the time.” So you can maintain that fan-shaped foot, which anatomically is advantageous. You get better balance when those toes can spread out. Um, I imagine you can

[26:36] like kick better in the water and everything. Jason: Survival of the fittest, I guess. So, flat feet. Kathy: Yes. But, you know, you get in these hourglass shaped shoes and they don’t have much of a sole or support. Jason: Mhm. Kathy: I mean, I’m not saying it’s going to cause these problems, but it’s like sometimes you’re just trying to look fancy. Like high heels, those are great for you, right? Jason: No. No. Kathy: So, and I’m not a shoe expert. No. Jason: Surprise. Kathy: No. But I’ve seen enough of this

[27:07] that I know that some people’s footwear contributes to their foot problems. So Jason: yeah, there’s no doubt about that. Kathy: Mhm. And I think that when people do start to fix their foot problems, one of the reasons they get told, “Don’t walk around barefoot,” is because when you’ve been cramming your feet into these shoes for a long time and then you start to go just barefoot, it hurts at first because you’ve had years of conditioning your foot into a shape that at first,

[27:38] yeah, that actually is more painful. But over time, as your foot starts to change some more, I think it’s actually a healthier way to be. So Jason: your foot gets bigger as you age. Kathy: Yes. Spreads out. Jason: Yes. Oh, I remember the third part of the holy training. I knew it was going to come back. Kathy: Yeah. So it’s zero drop. Yeah. Wide toe box. And this is so weird. Have you ever noticed how a lot of shoes they’re like elf shoes? Like the toe is like curled up.

[28:09] Jason: Yeah. Yeah. Yeah. Yeah. Yeah. Kathy: And it’s like real toes don’t really do that. And so I don’t know why they do it in shoes. Maybe it just looks cool or we like elves or whatever. Jason: So yeah, I like a shoe — told you I’m struggling — I like a shoe where the toe doesn’t curl up. So it’s like forcing me into extension. So Kathy: yeah. Jason: Yeah. That would put a lot of force on the plantar fascia. Kathy: Yeah, because it’s stretching it out the

[28:39] whole time. Jason: Absolutely. So, Kathy: yeah. Okay. So, I’m going to talk about how I’m going to treat. Jason: Yes. Tell me. Tell me. Okay. Kathy, I come to you. I have the PF. What are you telling me to do? Kathy: I’m definitely digging my thumb. Jason: I come in with my frozen water bottles. Kathy: Yes. Jason: It’s not working. Kathy: The frozen water bottle’s not working. The bottles aren’t cold enough. They aren’t cold enough.

[29:12] Kathy: So, from my perspective, what I’ll do — I kind of touched on it a little bit — is I check strength of the calf muscles, the gastrosoleus. I’m looking at people’s arches. Do they have flat feet or do they have high arches? That’ll help me to decide as well. So usually I will find weakness and again chicken or the egg — is the weakness because it’s

[29:43] painful to do the heel raise, Jason: or was it weak and that’s what’s caused the plantar fasciitis? Kathy: Either way I know that that calf muscle needs to get stronger to carry the load so that the plantar fascia doesn’t have to carry it. So how do we treat that? There’s a couple different ways and, you know, recent evidence in the PT world — at least the rehab world — is we start with, depending on how irritable it is, we

[30:13] start with isometric strengthening. Jason: I knew there was “ice” in there somewhere. Kathy: “Iso,” not “ice.” Jason: Not “isometric” — not “ice bottle.” Kathy: So what’s an isometric exercise? An isometric exercise — what’s the scientific way to describe this? But basically I’ll just explain what an isometric heel raise is. You go up onto your toes and you hold that position.

[30:44] You don’t repeat it up and down, up and down. Jason: That’s concentric. Yeah. So that’s the shortening of the muscle. Kathy: So if you break down the word isometric, “iso” means same. Jason: Yeah. Kathy: “Metric” means length. Jason: Same length. Kathy: Yeah. You’re getting that muscle to one length and you’re holding it there, right? So, this is an isometric contraction of my arms, right? As opposed to what I’m normally doing. So, Jason: yeah, I’m sure I learned that — 100% positive —

[31:14] a couple times probably. Kathy: I used to teach medical terminology in another life. Jason: Okay, there you go. Kathy: Back when the clinic was young and I had to have side hustles. Jason: Okay. Kathy: Yeah, Jason: there you go. I couldn’t get a job at McDonald’s so I had to teach medical terminology and pathology. So Kathy: yeah. So with the isometric exercise, we’ll start there because a lot of times plantar fasciitis started with repetitive movement over and over, you know, walking up and down those three flights of stairs with,

[31:45] you know, the comforter and the TV to your kids’ college dorm, right? So, we don’t want to do that in PT. Jason: Yeah. We don’t want to recreate the injury over again. Kathy: Let’s not do that. Right. So, we’re going to do isometric holds. That’s where I’ll usually start with a person when it’s really highly irritable. I will also do some manual therapy, and that includes something that looks like a butter knife. Jason: Mhm. Kathy: There are several branded

[32:17] tools out there, one of which is called Jason: IASTM. Kathy: You could be a sponsor. Jason: Yes. Kathy: Yes, they could be a sponsor. And that basically you’re scraping the bottom of the foot. Jason: I think we should do a whole episode on scraping. Kathy: I definitely agree with that. Jason: I think that’s a good idea. Kathy: That would be a fun one. Jason: Tune in. Tune in. Yeah. Kathy: Scraping and what tools to use. So we’ll do a lot of manual therapy with that. But usually the other thing we’ll see with somebody who has plantar fasciitis is reduced dorsiflexion. Mhm.

[32:47] And what that is is the movement of your ankle — bringing your toes up towards your head. Jason: You’re moving your ankle and bringing your toes up towards your head. That’s dorsiflexion. Kathy: Yes. Jason: And so people with limited dorsiflexion will have — I tend to see that people with plantar fasciitis have limited dorsiflexion. So Kathy: what we’ll do is try to improve the mobility of the ankle. So I’ll do some manual therapy and mobilizations of the ankle. And there’s probably a manipulation for that, right? Jason: Sure. Yeah, there might be. Yeah, there

[33:18] Definitely is. Well, and really the thing is any manipulation — the purpose is to restore or enhance movement, right? So certainly if people have restricted dorsiflexion, some of that might live in their ankle joint, or it could be in, you know, their tarsal metatarsal joints. And so, yeah, that’s what that would be aimed at. Yeah. So then I’ll give them some ankle

[33:48] mobilizations that they can do at home. And the other thing just kind of went in my brain and — oh, sorry. Got it. You came back. Kathy: Got it. Do it. Jason: So there’s muscles actually in the bottom of your feet. Kathy: What? Jason: Yeah. Not kidding. I am not kidding about that. They’re called — well, as a group, they’re called the intrinsic foot muscles. And as you alluded to earlier with the footwear that we have, those intrinsic muscles are like on vacation most of the time. Kathy: Yeah. They get inhibited. I think that

[34:19] Robin talked with us some about that. Kathy: She did. Jason: Yeah, whenever she was here. It was a great episode. Go back and watch it now, and then come back and watch this. Kathy: Robin Pester. Jason: So we will try to help strengthen those intrinsic foot muscles. Kathy: And some of those exercises are so freaking fun, aren’t they? Jason: Oh my gosh. Like I like them because some of them — they’re almost like drinking games, right? It’s like, “Oh, let’s see who can pick up these marbles and put them in

[34:49] this bucket the fastest.” Kathy: Right. Exactly. Oh, you want to do — we’re going to play like ring toss but with our toes, you know? Jason: That’s right. Can you scrunch this towel? Kathy: Yeah. Jason: Okay. We haven’t come up with other exercises. Kathy: Or — you ever do the rice bucket? Jason: Oh no. Kathy: Oh gosh. Yeah. So this is a waste of rice. Jason: Okay. And you definitely want to make sure that this rice is labeled as therapeutic use only — Kathy: foot rice. Jason: Yeah. But like, getting your foot in a bucket of rice and moving

[35:19] around against some resistance and stuff — Kathy: or hiding things in the rice bucket. Yeah. And then you got to go and like dig around and reach for them. Yeah. It’s fun. Jason: A needle in the rice stack. Kathy: Exactly. But don’t put needles in the rice. That’s our episode on acupuncture. Jason: That’s coming up soon. Kathy: That’s coming up. Jason: Stay tuned. Kathy: Geez. But no, the rice bucket one is fun, you know. Jason: That’s a good one. Kathy: Yeah. I think when I learned about it, one of the things that they did

[35:49] was they had these little tiny — kind of like the army men — and they would just hide them in the rice bucket like — Jason: Oh yeah. Kathy: Can you find all the army men in there? Because it really involves you reaching all around with your foot, and so it turns those intrinsic foot muscles on. Jason: Interesting. Kathy: Great time. But mark your rice. Don’t feed anybody like nasty foot fungus rice Jason: at your house. Kathy: What else you got? You got any other

[36:19] treatments you — Jason: Well, I just wanted to jump back real quick to the scraping and talk about what that does, because one of the things with scraping is — like I talked about the myxoid degeneration, how you have these micro tears, you develop these ropey cords, some scar tissue that shows up there — and that scraping, the thinking behind it is, let’s try and reorganize some of these fibers so that they’re all going the same direction, right? So it causes a little bit of damage, a

[36:49] little bit of inflammation in there to try and remodel some of that tissue down at kind of the fiber level. Like if you think about if you had a pile of toothpicks, Kathy: right, for some reason — just a random pile of toothpicks — and you wanted to get all those toothpicks lined up and going the same direction. Jason: Yeah. Kathy: Really quickly. Jason: Yeah. You could go and take each individual toothpick and move it. Or if you just take your hand and you run it across the pile of toothpicks

[37:20] perpendicular to the direction you want those toothpicks facing, Kathy: yeah, Jason: they will reorient themselves that way. Kathy: Yeah. I mean, think about it. Straws. Jason: Yeah. Yeah. Yeah. So doing that with the scraping is one way to kind of help reorganize some of that tissue. At least that’s the theory. So that kind of thing can be really helpful. I thought that might be good to throw in. But one thing that we do in our clinic — Kathy: because we like Star Trek Jason: and like space age stuff. So, Kathy: are we past the space age or is like

[37:51] the space age coming up? Jason: You’re living in the space age. Kathy: We are. Okay, good. Because I know in the ’60s they talked about space age a lot. How would I know that? Well, it’s because I was born in 1977. Jason: Anyway, never mind. So we use extracorporeal shockwave therapy. Kathy: That’s a big word. Jason: Yes. Or we just call it shockwave therapy, Kathy: but it’s really confusing sometimes because people are like, shockwave — so like electricity? Jason: Yeah. So no, it’s not electricity. And a lot of times when

[38:21] I bring this up to people, they’re like, I’ve tried shockwave and it didn’t work, but they’re thinking about like the electrode pads. Kathy: Yeah. It’s different than that. Jason: So shockwave therapy — what it is is you’ll have like usually a kind of applicator. It’s kind of like a tube or something that you hold. It’s got a little projectile in it, and that projectile gets kind of slammed against a plate, and the energy from that collision gets transferred into the tissue. It makes —

[38:52] Kathy: I mean, people say, “Oh, it makes sound waves.” Jason: Everything makes sound waves. Like I’m making sound waves right now. Yeah. And so all energy produces like some sort of sound wave. I don’t know if I can really back that up. Kathy: Yeah. Jason: But yeah, I think — maybe, right? Kathy: I’m going to go with Jason: some light, some sound, something like that. We’ll get a real expert on here. Kathy: But so yeah, there are some sound waves — like it sounds like, you know, over and over. But what’s happening is that pressure wave

[39:24] Jason: — is going into the tissues and like an easy way to think about it is it’s causing the healing effects of inflammation without causing damage — Kathy: — which is really kind of a cool thing. Jason: And the reason I bring it up right now, we use it for all kinds of things like tendon, ligament, muscle injuries. It actually is one of the few kind of modalities that’s effective for helping with like a fracture. So, it’s effective for stress fractures, too. Because what it

[39:54] does is it causes — the upregulation of stem cells to the area, which everybody loves a good stem cell. — Everybody — most people love a good stem cell. — And I should explain what stem cells are because we talk about them like they’re magical and they kind of are. But what a stem cell is is it’s basically like a blank cell. — Kathy: Mhm. Jason: But it’s not just like an empty cell. It’s a cell that can become another type of cell. So like when you are a fetus, you’re just full of

[40:24] stem cells and those stem cells are turning into other types of tissue and then they make a human body. So there’s been a lot of research done and it’s been shown that stem cells in the areas where you have like some sort of an injury or damage can be helpful in regenerating tissue. Okay. So it’s kind of cool because this is a regenerative therapy in that it’s stimulating the stem cells to come to that area.

[40:54] Um, it can also cause what’s called neovascularization. So that is your body wants to bring blood flow to an area. So it will actually build new capillaries and blood vessels to try to bring blood flow to the area. You have to have blood flow to an area if you want it to heal. Um, one of the reasons that like a meniscus is tricky to heal, a plantar fascia is tricky to heal. Um, any sort of ligament injury is difficult to heal is because there’s no blood flow to

[41:25] them or there’s very little blood flow to them. Muscles heal easier because Kathy: you get tons of blood. Jason: So, um, that’s another advantage of the shockwave therapy is you get some blood flow to those tissues. Um, it also causes some endorphin release — endorphins, they are — it’s endogenous morphine — so it has a pain relieving effect — and like I talked about with the scraping, one of the reasons I brought that up is because that energy of the

[41:56] shock wave actually helps to kind of break down and reorganize some tissues. Kathy: Okay. Jason: So the reason we talk about this in this episode is that plantar fasciitis is the condition that is the most studied with shockwave therapy and it has the most efficacy for — and so I’ve had some people that, especially with chronic plantar fasciitis, like you’ve had it for 6 months or 6 years or something like that, um, and so

[42:26] you have a lot of damage and kind of reorganization to those fibers in the plantar fascia. Um, we’ve had really good success helping people to get through that. Um, it takes a few treatments — like we’re doing anywhere between like five to seven treatments to arrive there — but it’s a really good therapy for that. Now it is not like a standalone therapy for it. It’s most effective if it’s used in combination with — frozen water bottles. Frozen water

[42:56] bottles and avoiding ever being barefoot. Kathy: No, no, not frozen water bottles, but it’s all the things that you’re talking about, right? So, we have to rehab it. So, once we have that tissue in a state where it’s going to be healing, right? We got some stem cells there, we got some blood flow, we’re kind of breaking down some of that injured tissue, now we have to build it up and we have to apply forces that are going to direct the healing. And so getting those calf raises done, uh,

[43:26] developing some of that strength — those are things that really are helpful. Um, I think a lot of the management of plantar fasciitis is really kind of band-aid methods, Jason: where it’s like, hey, we just take some NSAIDs. Kathy: Yeah. Jason: You know, um, hey, wear this sock that’s going to keep your toe from pointing. Kathy: Yeah. And I mean, I’m not mad at people about that because if we had had this conversation Jason: 10 years ago,

[43:56] most of what I would have been talking about was what you need to do is you need to wear this special sock Kathy: at night. Jason: — which helps with symptoms, but — I’m not going to say the root cause, but um what I’m saying is understanding the pathology and doing things that are going to help to rebuild, regenerate, and remodel that plantar fascia. That is what tends to be most effective for people until they go out and they do exactly the same thing. They sit on their couch and then they’re

[44:26] like, I’m going to run a half marathon this morning. Kathy: Let’s go. Jason: Yeah. So, um, so yeah, we’ve been getting really really good results with the shockwave therapy and the plantar fascia. So, um, we like using that in the clinic. Yeah. Kathy: And Jason, um, Jason: I would like to invite you to come and get — Kathy: Let’s do it. Jason: Your plantar fasciitis. Kathy: We could videotape it. That would be like a good bonus thing that we could put on the YouTube channel. Jason: That’s a good idea. Kathy: Yeah. Yeah. Let’s fix your plantar

[44:56] fascia. All right. Um, and I’ll bring the frozen water bottles. We’ll have some ice water. So, Kathy: is it game time? Jason: Oh, you know what? I do have a game. This is a fun one, too. Kathy: Let me see. Jason: Here we go. Kathy: Let me get to my files here. All right. This game is called Heel or No Heel. Jason: Now, this one is just straight trivia,

[45:26] Kathy: okay? And it’s trivia that is in some way, shape, or form related to the foot. Jason: So, if it talks about a foot in the question, Kathy: then you know, the answer probably doesn’t have like the word foot in it. Okay? Jason: But if it doesn’t talk about a foot in the question, you might need the word foot in the answer. Does that make sense? Okay. Kathy: All right. Here we go. Jason: Oh, boy. Kathy: Let’s see. Our first category is going to be pop culture. Jason: Oh. Kathy: All right, here’s the question. What

[45:58] 1996 Adam Sandler comedy features him as somebody who inherits a fortune and a butler who he stabs in the foot with a poker. Jason: Oh gosh, that’s — stabbed somebody in the — Kathy: Yeah, it was John Turturro Jason: who he stabbed in the foot. Kathy: Can’t remember. Jason: I know. Yeah. And he had frostbite, so his foot was all black. Kathy: They didn’t feel it. Jason: No, Kathy: that was Mr. Deeds. Jason: Oh, Mr. Deeds, right?

[46:28] Jason: Yeah. Not the best movie, but that’s — that’s an epic scene. Epic scene. Kathy: Wow. Sorry, Mr. Sandler, if you’re watching. Jason: I like Adam Sandler, don’t get me wrong. Kathy: Okay. Yeah. Happy Gilmore 2 was — was a delight. Loved it. Thank you. Jason: History, right? Here we go. The world’s most famous cryptid said to roam the forests of North America is known as what? Sasquatch. Bigfoot. Kathy: Bigfoot is correct. We would have accepted Sasquatch. All right. Very

[46:59] good. Kathy: Look at that. One Jason: from Kathy: one for two Jason: from literature. Okay. In the Lord of the Rings, hobbits are known for their large feet. Jason: Besides being large, what is the other distinct feature of hobbit feet? Kathy: Only four toes. Jason: I — I think they have five. Unless something terrible has happened. Kathy: Jake says they have five. Jason: Jake, what’s the answer? Do you know Kathy: what’s the answer? Jason: Hair on the top. Kathy: They are hairy. Hairy, hairy feet. Good

[47:29] job, Jake. Jason: All right, now to sports. In football, a yard contains how many feet in football? Kathy: Oh, I didn’t know that there was a difference, but I was going to say three feet. Jason: Three is correct. I was trying to throw you off. Yeah, man. You’re smarter than that. Good job. Jason: All right. The category is idioms. Okay. All right. When you embarrass yourself, you are said to put your foot in this odd place. Kathy: Your mouth. Jason: Okay. Yes. Not my mouth. Your mouth.

[48:00] Kathy: Definitely. Jason: All right. Medicine. A fungal infection that often plagues locker rooms is commonly known as Kathy: athlete’s foot. Jason: Very good. All right. Geography. The mountainous region at the base of the Himalayas is known as the Kathy: foothills. Jason: Very good. You’re — you’re on a roll. Kathy: I’m on it. Jason: You’re going to nail this one. Ready? Film. Kevin Bacon danced his way through small town censorship in this 1984 classic film. Kathy: Yes. Footloose. Jason: Footloose. All right. And from science.

[48:33] See if you can make it a clean sweep here. The family of animals that includes snails, clams, and octopuses is scientifically called what? Meaning soft foot. Kathy: Wait, what did you call them? Snails or what? Jason: Snails, clams, and octopuses are this kind of animal, and the name means soft foot. Kathy: I don’t know. It’s a Jason: tricky one. That’s a mollusk. Kathy: Oh, no. Never would have come up with that. Jason: Okay, good to know. Kathy: Brain only has so much.

[49:03] Jason: Hey, you did great. I think that — I think that you got like over 90% — better ones. Yeah. Kathy: Yeah. Thank you. Thank you. Jason: All right. So I think that it’s time to wrap it up. So, what are our takeaways? Frozen water bottles. What? Kathy: Take those away. Don’t bring them back. Jason: Plantar fasciitis should be called plantar fasciosis. Kathy: Yes, Jason: it is an injury of the

[49:36] Kathy: plantar fascia, Jason: not inflammation of the plantar fascia Kathy: often. Not. And it’s tricky because sometimes NSAIDs do work for it, right? It’s like Jason: Yeah. Kathy: Yeah. So, and who knows why — you know, what it might — what it might be is you might get some inflammation in those intrinsic foot muscles as a result of your plantar fascia not working like they should. Jason: Who knows? Kathy: Yeah. My — let’s see — my take-home — it’s just a reinforcement that active care — yeah,

[50:07] Jason: active care is the key Kathy: for long-term, long-term success Jason: over plantar fascia problems. So Kathy: that’s good stuff. All right. Jason: Okay. Kathy: I think this is a fun episode to do. It’s like good to get some of this stuff off my chest because now — now whenever I have some people coming in, or that person sitting in the lobby, I’m just — let me push play on this episode for you. So, yeah. So, that’s going to wrap it up for us.

[50:38] Definitely like, subscribe, do all the things. In the comments — I think it would be really cool if we could hear like what’s maybe the weirdest cure or treatment that you’ve heard for plantar fasciosis. What bad advice have you gotten? Jason: Yeah, like the mustard in the sock thing. That’s a real — that’s a real like remedy for plantar fasciitis. It was probably developed by the people at Heinz or something like that. So yeah. Oh, but there is one more

[51:08] important thing that we need to tell all of our listeners. Everybody needs to know. Kathy: Yes, there’s no I in PTCH.