You know the old song, "The foot bones connected to the shin bone, the shin bones connected to the...."? Well, it turns out that this reality of anatomy known as the kinetic chain is a good thing to keep in mind when it comes to dealing with pain. Just because you're feeling pain in a particular spot doesn't mean the driver of that pain isn't located somewhere further away.
When it comes to a painful foot condition called plantar fasciitis, it's important to look beyond the foot and ankle for a long term solution. The pain you'll feel with this issue is primarily located at the bottom of the foot, back by the heel bone (calcaneus). People describe an "ice pick" feeling that is especially intense with the first steps out of bed every morning. Most conservative interventions include but are not limited to "rolling out" the bottom of the foot with a water bottle or ball, along with a ton of stretching of the calf muscles. Those steps are certainly helpful, but unless you look further up the kinetic chain, you may be missing something.
The plantar fascia is connective tissue that helps provide support to the undersurface of your foot. It plays a role in the complex mechanics that occur throughout the gait cycle. Your foot goes through a series of pronations (flattened arch) to supinations (raised arch) as it alternates between being a mobile adaptor to feel the ground to a rigid level to propel you forward. But in order to keep the fascia in good working order, the foot must be allowed to do what it's meant to do.
Decreased hip extension may be something that prevents someone from making true strides (bad pun) when it comes to their plantar fasciitis rehabilitation. With all the sitting that's done in today's society, it's easy to see why hip extension may become compromised. When you sit with your hips flexed for hours on end, the hip flexors will get tight, thereby limiting your legs' ability to "get behind you" during the gait cycle.
Why does this matter? Well, for starters, tight hip flexors will tend to pull one into what's known as an anterior pelvic tilt. Think of the bony part of the front of your pelvis aiming towards the floor in front of you. That's an anterior pelvic tilt. When that happens, your center of gravity shifts. In order to maintain an upright position, your calf muscles will have to work harder. Try it. Stand up and tilt your pelvis forward. Feel the weight transfer towards the front of your feet. Unless you want to fall flat on your face, your calf muscles and other foot plantar flexors (toes pointing away from you) will activate. And remember what I mentioned as a common intervention for plantar fasciitis? Calf stretching! You can stretch all day long, but if your lack of hip extension continues to make your calves tighten up, you'll be fighting a losing battle.
Another reason why decreased hip extension may effect your plantar fascia is that when you can't fully get your leg back during the gait cycle, you won't give your foot enough time to progress through that natural toggle between pronation and supination. You'll end up putting more pressure on the plantar fascia in a pronated position, which will only aggravate the situation. Pronation is not a dirty word, as many shoe salespeople at your local Foot Locker may lead you to believe. But excessive pronation may not be so great.
So, if you're dealing with that annoying ice pick pain at the bottom of your foot and it's preventing you from functioning at your best, don't forget to look elsewhere for possible causes. Your best bet is to get assessed by a professional, so that you're not idling away your time fruitlessly rolling out the undersurface of your foot. The potential causative factors for pain can be vast, and it's vital to remember that old song about the connectedness of the human body.
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