Got Dorsiflexion?


The toes, feet and ankles get no respect. I’m not sure a lot of people walk into the gym and say, “Okay, today is foot and ankle day! Gonna work those parts hard and make ’em strong!”  We throw shoes on them and ignore them. Think about this though: It’s only every single step that we need those obscure parts to work correctly.

If we look at the body as a kinetic chain then we start to see that the feet and ankles don’t live in isolation. Movement or lack there of at the feet and ankles may create problems all the way up through the legs, hips, spine and shoulders. If an athlete doesn’t have sufficient motion at the ankles then he or she may not perform at his or her best.

Similarly, limited foot and ankle motion may be a contributor to pain. I’m not just talking about foot pain either. Again, if we consider the interconnectedness of all the joints and limbs of the body then it may not surprise us that faulty foot/ankle movement could contribute to back knee pain, hip pain, back pain — even shoulder or neck pain!


Dorsiflexion: There’s no substitution for it!

In my observing both my clients and myself, I see a lot of us don’t quite have optimal  dorsiflexion. It’s easy to overlook but as I’ve argued, it’s very important. I know in my case, my various plantar fasciitis/Achilles tendon issues have improved as I’ve worked on my dorsiflexion. (Strictly speaking, I don’t know if limited dorsiflexion was a cause or effect of my foot and Achilles pain. That said, working on improving dorsiflexion
has coincided with those problems fading out.)

Dorsiflexion is more than just forward and back motion. There is always a 3D aspect to movement and we want to consider that. Also, We have a couple of different muscles (well… more than a couple but we’re considering mainly just two) that cross at the ankle. The following drills emphasize both the gastrocnemius muscle (the straight-leg drills) and the soleus muscle (the bent knee drills.)

The Short-Foot Exercise for Stronger Feet


Foot/heel/Achilles issues have given me trouble over the years. The same issues are the scourge of many a runner. Plantar Fasciitis, Achilles tendon pain and metatarsalgia are a few of the problems one can experience as a result of faulty foot and lower-leg mechanics.

The causes of these injuries are often multi-faceted and thus are the solution(s). It seems that weakness of the foot muscles may be a prominent issue. One idea on the mechanism of plantar fasciitis is that the intrinsic foot muscles do a poor job of controlling forces going through the foot. If the stresses of running and walking aren’t distributed adequately then we may overstress the plantar fascia and that may trigger pain. We then need to find a way to unload the stressed tissues. (Please note that this may or may not be what causes plantar fasciitis. There are a lot of questions on how this and other lower-limb pain develops. This study discusses the poor understanding of plantar fasciitis and the difficulty in measuring foot mechanics.) If  weak and underperforming foot muscles are part of the problem then how do we bring them back on line?


Lots of muscles and joints in those feet.

Among many strategies to address foot pain is an exercise known as the short-foot exercise or foot doming. As the name implies, this exercise has you using the intrinsic foot muscles to create a dome by pulling the metatarsal heads (balls of the toes) toward the heel, which shortens the length of the foot.

The short-foot or foot dome exercise.

The short-foot or foot dome exercise.

More than anything this is a brain exercise. Chances are that when you first try this exercise you won’t do it very well. You’ll struggle, steam may come out of your ears and you’ll get frustrated. Don’t be a baby and give up immediately though. This is a new skill and it takes focused attention and time to develop skills. Keep at it. It likely won’t take you very long to figure it out. For me, the challenge of mastering this exercise is nothing compared to the frustration of being sidelined by foot pain.

Also, try the exercise on your non-hurting foot. If you’re like me, you’ll find that it’s easier to do which again may be an indicator that the source of your pain are muscles that aren’t doing their job correctly.

You may experience cramping. That’s fine. It means you’re doing the exercise correctly. You can either relax the foot muscles and try again or do what I’ve done and hold the short foot until the cramping passes. It hurts a bit but I’ve found the pain to pass quickly.

The muscles involved in this exercise aren’t given to being big and strong. We need them to work a lot for a long time, so we need to condition their endurance. Therefore we need to hold the short foot position for time and we need to do the exercise often throughout the day. The good thing is you need no equipment to do this and you can do it anywhere. You don’t have to take off your shoes either.

I think this video does a good job of describing the exercise:

The Final Victory Against My Heel Pain Part I: Addressing the Biomechanics


I’m really thrilled to be writing this post because it seems I’ve finally truly gotten rid of a chronic heel/Achilles/plantar fasciitis issue that has been with me for a long time. (I’ve said this before and I’ve been wrong, but for the record I’ve been running a lot and my heel hasn’t felt this good for this long in years.)

This thing has been with me for maybe three years. It’s never been enough to really knock me out. It didn’t derail me from my first marathon and subsequent 10-milers and half-marathons. However, several weeks ago I did a long trail run and it felt like a nail had been driven into my heel. I figured it was time to sort this out. The solution has been a mix of biomechanical and running technique adjustments, and a deeper understanding of pain science.

Before I met with anyone I put a green Superfeet insert into my shoes. I’m a minimalist shoe advocate.  I don’t want to rely on a crutch but I’m also very much willing to do whatever is appropriate to solve a problem. A lot of what I’ve read for addressing heel and Achilles problems suggests putting some sort of insert into a shoe. The idea here was to unload some of the muscles and structures that hold up the foot, including the Achilles. I’m still using the inserts on a lot of my runs but I rarely wear them at work and I do some of my runs with without the insert.

I next met with a couple of guys with a lot of great knowledge and experience. Mike Terborg and Nick Studholme were both very instrumental in my progress.  Mike is a performance and injury recovery specialist in Boulder and Nick runs Studholme Chiropractic. Mike is heavily influenced through John Hardy and the principles of FASTER Global which teaches a process of biomechanical reasoning. Nick studied under the innovative physical therapist Gary Gray. Both guys speak much the same language when it comes to movement and movement analysis.

They both have tremendous ability to explain what they see and communicate the changes they thought I should make. They both used a fantastic and powerful video program called Spark Motion which was created by Nick and a group of other guys. This was just an amazing way to record and analyze movement. Spark is a great tool that I need to look into.

The visit with Mike Terborg: Running adjustments

I first visited with Mike in Boulder a few weeks ago. We spent a couple of hours looking at how I moved. The major issue we found was prolonged eversion of my left foot. The foot stayed in contact with the ground for what seemed a long time. Mike explains his observations and thought process:

“Adhering to the Biopsychosocial or BPS model of pain (vs the Postural-Structural-Biomechanical model), we couldn’t say for sure what was causing the pain other than it could be a combination of things including but not limited to biomechanics. You had chronic pain of the plantar fascia, like to run, and wanted to be able to run more without aggravating this injury so we needed to look at your physiological skills and tendencies relative to gait. We cannot say for sure that eversion and dorsiflexion of the subtalar joint caused the injury (because these are natural motions of subtalar joint and thus normal motions for the PF to decelerate), but we can deduce that less loading of the plantar fascia (less dorsi/eversion) might be helpful in reducing the amount of stress on the PF during running. Our hope was that less stress/load during gait may allow you to run pain free for longer. In sum, we can say for sure that we crossed some type of stress threshold (bio, psycho and or social), so we wanted to ask your body what happened if we backed off on the biomechanical load to the pissed off tissue. 

“Your ranges and sequencing in the breakout evaluation all looked good, so we went straight to your running technique. Using Spark Motion for gait analysis, we deduced that it was possible for you to run in a way that reduced the stress to your PF and apparently that helped. The drills were all part of a progression to not only teach your body the skills and sequence of a more rapid gait but to train your ability to sustain that gait for longer periods of time (strength endurance of a skill). Nothing fancy, just following biomechanical reasoning to look for clues and strategies.” 

I really like Mike’s explanation of the process. He puts his explanation in a very honest way. In saying that we don’t know for certain why the pain is there, nor do we understand exactly how or why it might go away, he reflects the current cutting edge of pain science which reveals that pain is in many ways a baffling mystery.

He directed me to several exercise progressions of which here are three:

We changed my running gait along these lines:

  • Put less pressure through the heel into the ground. Let the heel touch the ground but only lightly.
  • Quicken the stride so the foot stays in contact with the ground for less time.
  • Swing the right leg through faster to facilitate less time on the ground of the left foot.
  • Run with a metronome set somewhere between 170-190 bpm.  This quickens the stride rate. Experiment.

The resulting new gait felt like I was some sort of prancing fool–La la la la laaaa!!!–dancing through the daisies.  Fortunately the video Mike shot of me indicated that in fact I just looked like I was running with a quicker step. (I could in fact go running in public this way.) Finally, Mike also suggested I visit with Nick so I did.

Analysis from Nick Studholme & fine tuning the lower leg

Nick put me through a muscle testing process and winnowed out some weak and unstable muscles in my lower leg. Specifically, big toe muscles known as flexor hallucis longus, and flexor hallucis brevis weren’t working up to par. The fibularis muscles (aka peroneals) were also a bit off line.

Taken together, when these muscles work they create and control plantar flexion and inversion of the foot as in the push-off of running or walking, and they create/control dorsiflexion and eversion of the foot as when the foot hits the ground.

Of great importance is the ability to anchor the big toe to the ground while the body passes over the foot. I was missing the mark. Nick taped my foot in a way to help facilitate this anchoring and he showed me several exercises to help me feel, create and control better big toe function while running. These exercises were similar in nature to what Mike showed me.

It’s several weeks later and what are the results? The heel and Achilles quickly started feeling better. I did a series of short interval type runs. The quicker pace (around 175-180 bpm) was challenging at first. I didn’t want to become exhausted while running and lose the technique, thus I only ran 1 or 2 minutes at a time. and walked in between. (Running with my dog tends to be a good way to break up the running with walking.)

Some discomfort remained for a couple of weeks in a stubborn way. It wasn’t terrible but it was hanging around like it was ready to pounce. I was worried that there was something we might be missing. This last bit of hanging-around heel trouble would be gone within 48 hrs after I reviewed the current ideas on pain and the brain. I’ll discuss that in the next post.



Check Out

Standard is a fantastic blog with all sorts of detailed and concise information on movement, injury rehab and all such things. I actually cannot figure out the name of the person who puts it together but whoever he or she is, they’ve done a great job.

The Physioblogger holds degrees in both sports science and physiotherapy. He or she is the Director of Functional therapy for FASTER, and holds certifications from FASTER and Gary Gray’s Gray Institute.  Look here for a full list of credentials.  His or her methods and writings are clearly highly influenced by Gray’s work and the work from FASTER which is to some degree an offshoot of the Gary Gray’s work.

I found the site because I’ve been battling on and off bouts of plantar fasciits and/or Achilles tendon trouble. (I’ve mentioned this stuff in prior posts but my site was hacked and those posts aren’t available right now.)

The Physioblogger holds degrees in both sports science and physiotherapy. He or she is the Director of Functional therapy for FASTER, and holds certifications from FASTER and Gary Gray’s Gray Institute. Look here for a full list of credentials.  His or her methods and writings are clearly highly influenced by Gray’s work and the work from FASTER which is to some degree an offshoot of the Gary Gray’s work.

I found the site because I’ve been battling on and off bouts of something like plantar fasciits and/or Achilles tendon trouble. (I’ve mentioned this stuff in prior posts but my site was hacked and those posts aren’t available right now.) Physioblogger’s series on plantar fasciitis starts with Understanding the Root Cause of Plantar Fasciitis. It follows with Plantar Fasciitis: Treatment Strategies – Part I and Part II.  The treatment strategies are very comprehensive, covering everything from the toes to the ankles, hips, thoracic spine. Two other articles (Mid-Tarsal Joint Treatment Strategies and 5 Ways to Increase Dorsiflexion) are interesting and may prove helpful in addressing plantar fasciitis.

There’s a lot to look through here and I’m just started. Some of the strategies are beyond my skill set as I’m not a manual therapist.  But, I’m getting a lot of good ideas along the way.

Goodbye Plantar Fasciitis???


This is a quick update to my recent plantar fasciitis posts (Part I and Part II.)  I met recently with Denver-area Z-Health movement specialist Brain Copeland and it seems he may have helped me find a titanic breakthrough in my PF!  Briefly, he assessed whether or not my arms and legs were coordinated properly during gait.  He used muscle testing as part of this assessment.  Turns out I had really only been cheating at walking and chewing gum.  My gait looked normal enough but I was weak in certain positions where I should’ve been strong, and I was strong in some positions where I should’ve been weak.  He then introduced cross-crawl patterns to me.  Since then, my PF pain has decreased significantly and it has stayed that way.  (I saw him on Saturday and this is Wednesday.) In some circles, this is known as a “WTF?” moment.

“Imagine you hire three people to work at a company to perform three separate jobs. But two of the employees are trying to do the same job and the third job is getting neglected. This is how I envision neurological disorganization.” Brian Copeland, Z-Health Movement Specialist

Goofy? Yes. Effective? Also yes!

The Cross-Crawl

Cross-crawl patterns are, as the name implies, movement patterns that resemble crawling.  That is, the right arm and left leg converge and vice versa for the left arm and right leg.  These are remarkably easy patterns and they can be created while standing, seated, prone or supine.  Some of this stuff resembles some goofy old-school “aerobics” class movements (‘Knee to elbow everyone!!”)  The supine cross-crawl looks like the “dead bug” ab exercise while the prone cross-crawl is essentially the same as the “bird-dog” low-back rehab exercise.  Still another version looks like some sort of Irish jig.  Fun stuff right?!  (The good news is these moves are really easy and at least in my case, very powerful.)  I’ll post video of cross-crawls soon.

What’s at Work Here?

I asked Brian Copleand several questions:

Q: Who might benefit from cross-crawl patterns?

A: “Everyone can benefit from cross-crawling patterns as the movement helps strengthen certain neural pathways in the brain that are beneficial. For instance, when you run, jog or walk and you step forward with your right leg which arm swings forward? It better be your left or you are a toy soldier. This cross lateral pattern of movement is key in both athletes and non-athletes. If you ever see a martial artist throw a very powerful kick with their right leg you will see their right arm go back and left arm come forward. This has to do both with rotational force and rotary stability in the trunk to maintain balance. So cross crawling movements are basically a part of our everyday lives. When the movement patterns become switched then we see all number of strange neurological issues arising such as unexplained pain that has no pathological explanation, clumsiness, troubles with memory and other cognitive issues depending on the severity of the neurological switching.”

Q: How do we identify those who may have this neurological switching?

A: “There are some specific tests that a Level 4 Z-Health Exercise Therapist can give to ascertain if someone has neurological disorganization and no one should self diagnose, but having said that people can get an idea if they have this by looking for the following things. Typically someone will have had some head trauma at one point in their life, even if it was as a child. People might be socially awkward and not know why. People may have a hard time remembering things and have to be shown something over and over again. People will often say things like, ‘things always work different for me than other people,’ and they don’t know why. Frequent clumsiness is a possible indicator as well.”

Q: What do cross-crawls achieve?  Can you describe what these patterns do for our brains?

A: “Well that is the $64,000 question. Researchers are still discovering the how and why but for now we know that it does work. As I’ve been told before, science is the observation of repeatable phenomenon. So even if we don’t have the full picture yet we know that it works. But if I may hypothesize just a little… It is classically understood that the left hemisphere of the brain controls the right side of the body and vice versa, there is some variance in there but as a general rule it is true. We also know that many of the natural movement patterns that we have are cross-lateral in nature, in other words right leg, left arm and vice versa. These patterns help to stabilize our torso and provide balance and efficiency of movement.  Now imagine if all of a sudden the right hemisphere of your brain decided that it would control the left side of your body, except it would also control the right thumb but not the fingers. Now the left side of the brain is having signal feedbacks or misfires as it tries to control your right thumb. Now the pre-cognitive brain (the automatic part that controls the behind the scenes stuff) encounters confusion and we reach what Z-Health founder Dr. Eric Cobb, D.C. calls a threat response. I can already tell that I am about to open a whole can of worms so I’ll digress a little. Imagine you hire three people to work at a company to perform three separate jobs. But two of the employees are trying to do the same job and the third job is getting neglected. This is how I envision neurological disorganization.”

Q: What else should we know about cross-crawl patterns?

A: “Well there is always more to know but it can become quite complex. I would just say make them a part of your daily warm up for your exercise routine, 20 or so should suffice as preventative medicine. If you have neurological disorganization you may need to do more reps than that. And ultimately each person will respond uniquely different, the amazing and frustrating thing about the human body.”

“Folks can learn a little more about Z-Health and how the human nervous system has an impact on both the pain we feel and our potential for athletic ability by checking out these articles: What is Z-Health and Why It Works and How to Eliminate Pain, Stiffness and Weakness Forever.”

So that’s a fairly thorough discussion on cross-crawling and why it may work.  I don’t want to promote cross-crawling as a magic cure-all panacea for everyone.  That said, these are very easy movements to execute and they may very much be worth a try.  If you have lingering pain that isn’t responding very well to treatment, give cross-crawling a shot.  In my case I’ve had tremendous results.  (Now of course the challenge is to remain conservative as I add back in running, biking, etc.  The temptation is to ramp up to 1000 mph.  Not a good idea.)

Further information on cross-crawl patterns can be found at the following sites: Head Back to Health, Natural Health Techniques.

Hello Plantar Fasciitis :-( Part II


Part I of this post ended mid-way through my explanation of various strategies to combat plantar fasciitis (PF).  Here are more treatment methods.


Various taping strategies may be used to help alleviate PF symptoms.  Tape should help support the arch of the foot and help shoulder some of the burden borne by the plantar fascia.  There are two options.  First is the traditional white athletic tape.  This stuff can be rigid and uncomfortable but possibly effective.  Here’s a video on how to apply athletic tape in order to relieve PF.  And here is a slightly different method.

The other taping option is elastic therapeutic tape, (aka Kinesio tape.)  Elastic therapeutic tape became popular during the 2008 Beijing Olympics where many athletes were seen wearing the strange, multi-colored blotchy looking stuff on their legs, shoulders and other body parts.  Kinesio tape supposedly goes beyond simply providing support to injured areas but also may influence the healing process.  Here’s resource on how to apply this stuff.

Night Splints & Socks

For anyone interested in a more medieval approach to PF, you may enjoy the night splint.  Similar to the night splint is this specialized sock.  Both items are designed to provide a prolonged stretch to the plantar fascia and Achilles tendon while you sleep.  I recently spoke to an employee at a local running shoe store and she said these things are fairly uncomfortable.  Still, several posts I’ve read on various forums proclaim these things as useful.

Other methods

This guy swears by walking on gravel in his sock feet.  I think it must be the same principle as using a golf ball to break up the scar tissue associated with PF.  Other sources suggest freezing a can of coke and rolling it underneath the foot.  Here’s an example of a specific plantar fascia stretch from which some folks have had success.

I would suggest staying away from cortisone injections.  Cortisone is a powerful steroid that can provide very quick relief from PF pain.  The big drawbacks are 1) it’s a symptom treatment; it doesn’t fix anything, and 2) too much cortisone weakens connective tissue thus creating a risk of a rupture.

Nor can I see much benefit to plantar fascia release surgery.  This again doesn’t solve a problem but may create more problems.  Part of this surgery includes cutting the plantar fascia in order to release tension.  Problem is the plantar fascia is a major shock absorbing part of the body.  Altering that structure doesn’t seem wise to me.

My Strategy:

As I’ve thought about my own PF, I realize a couple of things: 1) I changed my gait and therefore changed how my tissues were being stressed.  2) I simply didn’t give myself enough time to adapt to this change.  3) I believe my PF is part of a larger puzzle involving faulty movement patterns.  Here’s my plan.


The one common theme I’ve seen and heard from those who’ve overcome PF is that rest is necessary.  Damaged tissues must be allowed to heal.  Therefore, I’ve greatly reduced my running and biking.  There seems to be no way around it.

Joint Mobility

If, as I believe, I have faulty biomechanics (i.e. I don’t move well) then no matter how much I rest and treat my injury, I can expect it and/or other similar symptoms to return once I start running again.  Thus I must search out those resources that will help correct my movement problems.  Z-Health is my chosen rehab system.  Why Z-Health?  Because the Z-Health methodology recognizes that there is probably more to my PF than simply heel pain.  My whole body–especially my nervous system–must be addressed in order to move better.

Z-Health has helped tremendously with my back and shoulder pain, and I’ve seen numerous others improve their performance through Z-Health.  I’m a certified Z-Health trainer but I recognize that I can’t solve all my problems on my own.  Twice recently I’ve visited with certified Z-Health practitioner Brian Copeland of Core Fitness in Aurora, CO.  I’ve been very impressed with my results thus far–especially after yesterday.  We did further testing on my neurological system and found that certain fundamental aspects of my movement coordination aren’t functioning quite correctly.  Among several exercises, we recently implemented cross-crawl patterns into my process.  All I can say is I’m stunned at how much better my heel feels!  In 24 hours the pain has subsided very significantly.  I believe correcting my movement patterns is the most significant and most complex part of my plan.

Structural Integration

I haven’t experimented much with massage though I’m aware of its role in many athletes’ lives.  Structural integration (Rolfing is a type of SI) involves manipulating connective tissue including the fascia.  In this way, my body should interact better with gravity.  Posture should improve, pain should diminish and I should move better.  Donielle Saxton is the Denver-area massage therapist with whom I’ll be working.  The details and principles behind this process is really fascinating.  For further information check out Anatomy Trains and KMI (Kinesis Myofascial Integration).

Cold Laser

Finally, I’m getting a bit of cold laser therapy at Mederi Health in Denver.  This is pure symptom treatment–and I’m OK with that.  Reducing the pain should help calm my nervous system and speed my return to normal function.

Shoe Insert and Taping

I recognize that my arch may need some help.  Therefore I’m going to bolster the area by way of a grocery store-bought arch support and Kinesio tape.

We shall see what happens.

Hello Plantar Fasciitis….:-( Part I



Here is a major drag in my life.  I’ve run into injuries off an on over the past few years.  Just as I get healthy a new one seems to crop up: back pain, shoulder pain, Achilles tendon pain…  The latest and greatest issue is heel pain aka plantar fasciitis.  (I’m going to call it PF.)

Minor symptoms showed up a few months ago but they sort of came and went.  Pain on the outside of my heel wasn’t severe and it faded out rapidly.  (I associated plantar fasciitis with pain along the inside of the arch of the foot.)  I’d been running some and biking a lot.  I’d changed my gait and I was running a good bit in my Vibrams–and I was feeling really good!!  (Interestingly, my new gait pattern had helped my Achilles tendon pain.  Seems I shifted the stress elsewhere.)

I’ve read up on the issue.  What have I found?  It seems that one person’s PF is very different from another’s PF.  Some runners insist that once they went barefoot, their PF went away.  Other runners swear by the opposite end of the spectrum and that orthotics were the cure.  Still many many other runners have tried many different treatments but with limited success.  Some people suffer with PF for a few weeks or months.  Others deal with it for a decade.  Much of PF is a big mystery.  What’s important here?

Causes of plantar fasciitis:

This is hard to figure out.  Like most things involving bodily pain,  there’s likely more than one cause.  “Improper footwear” is one culprit.  Biomechanical glitches such as leg-length discrepancy or tight calves also get blamed, as do high arches, low arches, leg length discrepancy, poor glute firing patterns, tight illiotibital bands.  Some sources suggest that PF is due to trigger points, or knots in the muscles.  There are many potential culprits for this crime, and most likely some of them are working together.

(I’ll go a little further and suggest that all these issues have causes.  If we’re not asking WHY the arches/glutes/IT bands/trigger points are tight/slack/dysfunctional then we’re definitely not getting to the true cause(s) of PF.)

Improper footwear is an interesting issue.  Much of the conventional wisdom says we should run in well cushioned shoes that fit our foot type, support our arches and guide our feet properly.  Funny thing is military studies such as those discussed in the previous post show that footwear matched to foot type does nothing to decrease running related injuries.  Ask barefoot runners and they’ll tell you that any footwear is improper footwear.  So what is improper footwear?  Seems it’s dependent on the eye of the beholder.

Treatment of Plantar Fasciitis:

Conventional treatment includes rest, ice, anti-inflamatory medication.  Orthotics are often prescribed as are calf and foot stretches.  Further pharmacological treatment may include a steroid shot.  That’s the conventional stuff.  What else is there?  Well, there are a multitude of therapies and strategies.  As I mentioned, it seems that every case of PF is different from every other case.  Therefore there are many variations on treatments.


Rolling a golf ball, lacrosse ball or similar ball along the bottom of the foot helps many PF victims.  This is supposed to help break up scar tissue and keep the plantar fascia supple.  A similar strategy involves using a foam roller to massage the calf, hamstring, illiotibial (IT) band, glutes, etc.  These are forms of self-massage.  More formalized massage methods may proove beneficial.  Myofascial release, Active Release Therapy (ART), deep tissue massage, trigger point therapy, Structural Integration (aka Rolfing) are examples of massage-type techniques that may prove beneficial in addressing PF.


Lots of options here!  From barefoot to orthotics and all points in between, what you put on your feet (or possibly take off of your feet) may strongly influence PF.  This series of posts on the Runner’s World Forum encapsulates the issue very well.  One poster emphasizes wearing orthotics ALL THE TIME, while another poster says, “I think the thing that finally was a breakthrough for me was walking barefoot in the sand.”  I’ve found very similar statements throughout my reading.  So while there doesn’t seem to be any one shoe-based solution for everyone, consider the idea of changing footwear.

Orthotics are usually expensive.  Cheaper options include grocery-store bought arch supports and heel cups.  Superfeet and Sole Supports are similar to orthotics but also less expensive.

Joint Mobility/Strengthening

Weakness of the foot muscles may be causing your PF.  Therefore, strengthening the foot and lower leg and improving mobility/stability is vital.  We may not spend much time thinking about strong feet but hey, we only have to use them all the time every single day right?  Maybe it’s actually important!   I look to Z-Health R-Phase and I-Phase drills to enhance neural communication and awareness in feet and lower legs.  I’ll give some examples.

Start by simply moving the foot and ankle in all available directions.  Make circles with your feet.  Turn the sole in and out.  Flex and extend the toes along with the rest of the foot (make foot waves).  Ball-of-foot circles, toe pulls, and knee circles may help as well.  You must concentrate and try to make the movements as smooth and refined as possible.  Stay relaxed and breathe.  Single-leg balance drills may be beneficial too.

My personal opinion is that at some point, barefoot or minimal shoe work should improve foot strength.  (Again, some people insist this is the key to their overcoming PF.)  It may be too much though if your foot is injured.  The plantar fascia may be further damaged if you overload the region.  So it may be a progression similar to adding weight to a strength program or mileage to a running program.  Start with a small amount of barefoot balance work while still wearing whatever supportive footwear you’ve got.  You may gradually add in more barefoot work if the pain decreases.  Back off if the pain increases.

Ultrasound, Cold Laser, Shockwave Therapies

Physical therapists and chiropractors often use ultrasound therapy on soft-tissue injuries.  The idea is to bring heat to the area and facilitate healing. Research is mixed on effectiveness.

Cold laser therapy is a somewhat new therapy that may aid healing of PF.  The evidence is unclear though.  Research continues as to what wattage laser is ideal, what wavelength should be used, and how often one should receive treatment.  A Runner’s World article profiles one runner’s positive experience with laser therapy.

Extracorporeal shockwave is yet another electromagnetic method of addressing soft-tissue injuries.  Similar to ultrasound and cold laser, research is mixed, which shouldn’t be surprising.  If we’re dealing with a problem that may have multiple and varied causes it makes sense that one or another type of therapy may or may not be effective.  Further, ultrasound, laser and shockwave therapies deal with focused energy.  That energy can vary in terms of power and wavelength.  An injury may be exposed to varying amounts of energy for varying amounts of time.  Thus there are numerous factors that may or may not lead to healing of PF.  Lots of choices….

I’ll continue this post with a look at night splints, walking on gravel, magical ceremonies and everything else used to drive out the evil spirit that is Plantar Fasciitis (plus my own strategy in overcoming this issue.)