A Hypothesis To Integrate The Plethora Of Treatments For Plantar Fasciitis Into A Safe And Cost-Effective Approach

FitOldDog's plantar fasciitis data with focus on shoes.

FitOldDog's interactive plantar fasciitis treatment map

Click image for link to our Interactive Map.

WORKING ASSUMPTION: the human disease known popularly as plantar fasciitis, in it’s early stages, is a state of proprioceptive disfunction.

RESEARCH QUESTION: With so many and such diverse treatments for plantar fasciitis being advertised on the Internet, with claims of success for all, what do they each have in common that will permit us to collapse them into a small number of effective and affordable treatments?

A HYPOTHESIS WORTH INVESTIGATING: everyone of these approaches modifies body movement, or biomechanics, in such a way as to permit retraining or correction of aberrant proprioceptive or other myoneuromuscular functions.

FitOldDog's data on cortisone heel shots.

Think before you rush to your doctor for this treatment, which I wouldn’t have for all the tea in China – too dangerous!!

Our goal is to streamline treatments towards those which are most therapeutic and cost-effective, in order to reduce physical and fiscal discomfort on the part of ‘plantar fasciitis’ sufferers.

Our (FitOldDog and Rebecca) approach to this research has been directed towards, (a) collating all treatments into a single diagram (Walter Fraser suggested a video game, a great idea, but beyond our skills), as a visual tool that might reveal meaningful patterns; this resulted in our interactive plantar fasciitis treatment map,  (b) the collection  of relevant data, much yielded by Facebook, and part of which is presented in the graphs at the head of this post and to the left of this narrative, and (c) a search for an integrating hypothesis, a common therapeutic mechanism of action.

Our approach is guided by Occam’s Razor  (This principle states that among competing hypotheses, the one with the fewest assumptions should be selected – we have but one assumption).

This work is in it’s infancy, but clues are appearing, which might well direct future research towards a more effective and consistent approach to treatment, whilst avoiding the dangers of certain methods, such as injecting cortisone or blood products into the dense tissue of the human heel.

FitOldDog's human disease progression for plantar fasciitis

See this link for discussion of the diagram.

Let’s consider each treatment in the graphs in turn, with respect to reversing the early stages of our postulated pattern of plantar fasciitis progression, to seek an exception to our hypothesis. An exception would be a therapeutic approach that has been shown to be effective, but which would clearly be independent of modified biomechanics.

Sports or duct tape: such tapes, pulling on the skin, could most certainly impact the way one moves, through the odd sensation, alone, and possibly via physical impact on neural feedback loops.

Insoles or shoes: there are thousands of nerves in your feet, specifically designed to direct the biomechanics of movement, and what could be more important with respect to standing, walking or running, than the relationship of your feet to your shoes to the ground. My second case of plantar fasciitis was actually triggered by my replacing my arch supports in my running shoes prior to a short run.

ASTRO website

A step in the right direction, and worth further study.

Boots and socks that dorsiflex your foot: theses products pull your toes up towards your knees during the night in order to reduce contraction of the calves. If these products do, indeed, work this way, lengthening of the calf myofascia would clearly have the potential for greater mobility, and thus less pain, in the morning. But do they work this way, I wonder? They have a low success rate, based on our data and my personal experience (anecdotal, though it is!).

Osteopathic or Chiropractic alignment treatments: designed to change your body alignment, and thus your movement patterns would clearly be impacted (just take my displaced pelvis as an example – great to have it back in alignment).

Shock waves, surgery or injections into the heel, have induced-pain in common: surgery may well be needed for organic damage, in later stages of the disease, such as tears in the plantar fascia, but the pain of both surgery or injections into the heel would be expected to modify load bearing by the foot to avoid pain.

calf raises

Single leg calf raises have been shown to alleviate symptoms by a Swedish research study.

Such maneuvers might well be sufficient to overcome a proprioceptive error – the fact that painful shockwaves and injection of cortisone, blood or platelets into the heel, have each been effective in some cases, supports the concept of ‘therapeutically-induced’ pain leading to modified movement.

Analgesic drugs: analgesia by any route would most certainly permit altered movement patterns, but they would not guide corrective action, other than by chance alone.

Exercises, such as calf raises: nothing like exercise to retrain proprioceptive activity. This method was recommended in FitOldDog’s first plantar fasciitis treatment e-book, and subsequently demonstrated experimentally in Sweden.

Massage, stretching and rollers all work to loosen tissues: I’ve used these approaches a lot, and there is no doubt that they can render one more limber, and movements freer, though I suspect that they might also work by modifying proprioceptive behavior. Either way, they fit our paradigm.

FitOldDog's body movement instructors

FitOldDog learned a lot from his famous four, from left to right, Karen, Feldenkrais, Mr. Bones, Anatomy, Rebecca, Continuum, and Tara, Gyrokinesis.

Nutrition: well, to some extent at least, you are what you eat, and what you eat can influence how you feel, and how lightly you move. For an extreme example, consider movement after an excessively large meal or one glass of wine too many. Furthermore, many nutrient deficiencies can impair neural and myofasical activity. One of our favorite followers, Rosemary, swears by crystalline sulfur to keep her plantar fasciitis at bay – wonder if it really works – I tried it and didn’t sense anything much, but then, my sulfur intake and metabolism may differ considerably from that of Rosemary’s.

ASTRO: here is a device worth exploring, as it is based on retraining proprioceptive behavior. I am testing one now, and it certainly moves ones foot in a particular and interesting way, reminding me of our ‘conscious walking’ approach to physical therapy.

Body movement training: the FitOldDog approach, based on the study of Feldenkrais, Continuum and other methods, and the subject of our upcoming book, is clearly designed to modify body movement. Enough said!

FitOldDog's Plantar Fasciitis Roadmap book

Our new e-book is coming soon!

WHERE FROM HERE:  we are working to encourage research designed to develop reliable and cost-effective treatments for plantar fasciitis, through determination of underlying mechanisms of this disease, in order to alleviate people’s physical and fiscal pain.

If you want to be involved in our work, please send your plantar fasciitis story to our Facebook Page, including what worked and what didn’t work, and consider signing up for FitOldDog’s Plantar Fasciitis Research Newsletter.

Wishing you happy feet.

FitOldDog and Rebecca


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Disclaimer: As a veterinarian, I do not provide medical advice for human animals. If you undertake or modify an exercise program, consult your medical advisors before doing so. Undertaking activities pursued by the author does not mean that he endorses your undertaking such activities, which is clearly your decision and responsibility. Be careful and sensible, please.