A good friend of mine, who happens to be one of the most famous physical therapists in the country, Gary Gray, once said, “When the foot hits the ground…everything changes. The comedian George Carlin quipped, “When you slam on the brakes, your life is in your foot’s hands.”
The foot is our wheel, our contact point to mother earth, the connection between body and ground. A shock absorber and propulsion unit all dressed up in one, but most of all a good place to stand on. With 26 bones, the foot trails only the hand as skeletally the most intricate structure of our bodies. It may not grip things like the hand, but to grasp its wondrous properties opens the door to understanding how we function.
The hip joint, knee and ankle have bones that basically sit on top of one another creating a natural stacking stability. The bones in the mid-tarsal region of the foot (the arch bones) run parallel to each other creating an arch. Stepping down on your foot poses a great challenge to the arches ability to resist collapse since gravity beckons the bones to slide down toward the ground. At the same time the body weight from above crashes down on top of the foot with every step.
Though we have 57 muscles in the foot and ankle, they cannot create enough force jointly to prevent the arch from falling. In reality, during normal walking and running, almost every muscle in the body must generate forces to create shock absorption, stability and propulsion through the foot that is on the ground.
Some feat! If we look at the inner arch of the foot we see that the bones in the mid-foot are compressed together by their arrangement, but forced at the same time to drop toward the floor. There is one unique ligament, broad in width and spanning the distance from the bottom of the heel to the base of all 5 toes, the plantar fascia. This tissue creates a passive suspension sling helping to stabilize the arch from dropping. If you look at the arch as a bow and the plantar fascia as a sling, you can visualize how the plantar fascia works. If you place a bow down with the bowstring on the ground, you can see how downward pressure on the middle of the bow is resisted by the tension it creates in the bowstring.
The bowstring takes advantage of the collapse of the bow by generating a tension that resists the collapse of the bow itself. The fascia does the same thing. As the heel falls inward and the arch collapses, the plantar fascia is loaded and stretched. This load and stretch tightens the band and helps reduce the collapse of the foot. Anything that makes the arches collapse further or faster can place too much tension on the plantar fascia and pull length wise on its attachment to the heel. This creates micro-tearing of the band and produces…plantar fasciitis. It is An inflammation of the tendon as it approaches the heel.
This result is a painful heel. In fact, plantar fasciitis is the most common cause of foot pain in adults. It has shortened the careers of great athletes from Joe DiMaggio to Bill Walton. John Lennon was quoted as saying, “Time wounds all heals”, and in this case he was pretty much right on. No pun intended.
At PróMotion Physical Therapy we specialize in evaluating and treating this common problem. Physical Therapist Michael Kane has taught courses both in the United States and abroad on how to treat foot and ankle problems with exercises and orthotics. If you have heel pain that is keeping you from doing what you need or want to do, call PróMotion Physical Therapy.