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ExerciseFoot & AnklePainPreventionSit Like A Man

Plantar Fascitis

 

If you’re female and over 40, stretch your feet every morning before you get out of bed.

I think this was one of my very first advice-giving posts. Why this? Why was this my first tidbit of advice for my readers? Because I see at least one to two women every day in my office with this problem. I have 35 partners, many of whom each see a similar numbers of patients with plantar fasciitis every day. Our foot and ankle specialists, probably see even more. Do a little extrapolation and you can begin to imagine the amount of plantar fascial pain out there and then the cost of treating that pain. And with a couple of simple preventive measures, I really believe this problem could be eradicated.

You’d probably think my first post would be about some life changing vitamin or some extract that would put cartilage back in your knees. Maybe I have a special exercise that will keep you from tearing your ACL. This foot stretching thing is so…mundane. So uncomplicated. But let me tell you that I’ve been doing it for about 20 years. I started the morning after the first morning I woke up with the dreaded heel pain. And unlike all my patients with plantar fasciitis, I never experienced a second morning of waking up with heel pain. But please don’t wait until you have heel pain to start stretching your feet in the morning.

I think there are a lot of preventive measures we can utilize which don’t affect the quality of our lives and may keep you from experiencing pain and some disease. It just so happens that foot stretching to prevent plantar fasciitis is a great example; a very simple example of that kind of preventive measure. It takes about a minute to stretch your feet and there’s really no downside to it. I love that kind of prevention. Lots of potential benefit…little downside.

Let’s compare it to a mammogram. Now there’s a test with lots of potential benefit, but it comes with some downside. It’s uncomfortable. A complete stranger has to grapple with your breasts. It takes at least four years to get a little used to it. There’s a little radiation exposure. Plus it takes a couple of hours out of your day and you can’t put on deodorant that morning. You see where I’m going with this?

Let’s compare it to taking a baby aspirin every day. There’s a preventive measure with potential benefit, but in some people taking a baby aspirin can cause ulcers. If you are taking aspirin, it could be risky to take other anti-inflammatories like ibuprofen or Aleve, Celebrex or Mobic.

But let me assure you, stretching your feet in the morning will not give you gas or indigestion. It will not cause erectile dysfunction and has absolutely NO untoward drug interactions. The instructions come without a 3-page list of side effects.

In the morning, as you begin to realize that it’s almost time to wake up, begin to wiggle your feet up and down.  Don’t be too aggressive. No need to wake anyone up. Take hold of the top of your flat sheet and gently pull it snug. Then press your toes against the firm sheet, using the sheet to assist in stretching the bottom of your foot. You’re trying to stretch the plantar fascia on the bottom of your foot.

Okay, now there’s your 30 second stretch with a lot of beni’s and few to no side effects or diminished quality of life. But if you want to take it one step further, and I would recommend that you do, then sit up and swing your feet around to the floor. Take one foot and pull your big toe backwards, just to tolerance. Don’t try to dislocate the joint.

While dong this you’ll be able to feel a little band on the bottom of the foot. It will feel like a bowstring. Some of that is your plantar fascia; the thing that gets so tight and causes so much misery. Massage it with your other hand. Do the same thing on the other foot. Then put your feet on the floor. If you feel pain in your heel, then start over with the stretch and massage. Repeat as needed.

What I’m really hoping for is prevention. If you already have heel pain, this might not make it go away instantly, but these stretches are an integral part of the treatment regimen for plantar fasciitis. Just keep doing that every morning before you get out of bed. If you do this before you have pain, in other words, you use it as a preventive measure, you will likely never experience the misery of heel pain.

Let me say first off, that if you’re not the kind of person who would floss their teeth to prevent tooth decay, you probably won’t be interested in this or most of what I have to tell you.

Why is the morning a time when we often experience pain and stiffness? Think about it. Name one other time when you spend six to eight hours in basically the same position. It’s particularly so for the feet. There is not one single moment during the night when you bring your feet to a neutral position or a dorsiflexed (pointed up) position. Your foot is pointed down ALL NIGHT LONG. And honestly, it’s not just pointed down in a relaxed pose. It is POINTED down. Sometimes when people wear splints or casts to bed at night, they get numbness in their toes. Sometimes they can even get blisters. The toes want to point down and the muscles are actually pulling them down. So after 6-8 hours of that, you go and immediately stand up…well, sometimes the feet balk a little. Give them a break. Stretch them. Say “good morning” to your feet. They’re at the bottom of your body and over a lifetime they take a lot of abuse. Give them a little TLC.

I also recommend that you stretch the bottom of your feet before standing up after you’ve been sitting for awhile. Many of my patients complain of plantar foot pain in the morning when they first wake up, and less so after they’ve been sitting awhile. Once again, notice where your feet go when you sit, especially if you’re sitting for an hour or more; like while you’re watching a movie, or in church. They relax and they point down. The plantar fascia begins to seek its shortened position. When you stand up, you strain it with the pressure of your body weight bearing down on that tender band. So make it a habit to wiggle your feet up and down a little. Push your feet back against the floor, as if you were trying to stretch your Achilles tendon. Cross your leg and push back your big toe, like I described for your morning stretch.

 

footstretch4small

Okay, now there’s your 30 second stretch with a lot of beni’s and few to no side effects or diminished quality of life. But if you want to take it one step further, and I would recommend that you do, then sit up and swing your feet around to the floor. Take one foot and pull your big toe backwards, just to tolerance. Don’t try to dislocate the joint.

footstretch3small

While doing this you’ll be able to feel a little band on the bottom of the foot. It will feel like a bowstring. Some of that is your plantar fascia; the thing that gets so tight and causes so much misery. Massage it with your other hand. Do the same thing on the other foot. Then put your feet on the floor. If you feel pain in your heel, then start over with the stretch and massage. Repeat as needed.

What I’m really hoping for is prevention. If you already have heel pain, this might not make it go away instantly, but these stretches are an integral part of the treatment regimen for plantar fasciitis. Just keep doing that every morning before you get out of bed. If you do this before you have pain, in other words, you use it as a preventive measure, you will likely never experience the misery of heel pain.

 

Let me say first off, that if you’re not the kind of person who would floss their teeth to prevent tooth decay, you probably won’t be interested in this or most of what I have to tell you.

Why is the morning a time when we often experience pain and stiffness? Think about it. Name one other time when you spend six to eight hours in basically the same position. It’s particularly so for the feet. There is not one single moment during the night when you bring your feet to a neutral position or a dorsiflexed (pointed up) position. Your foot is pointed down ALL NIGHT LONG. And honestly, it’s not just pointed down in a relaxed pose. It is POINTED down. Sometimes when people wear splints or casts to bed at night, they get numbness in their toes. Sometimes they can even get blisters. The toes want to point down and the muscles are actually pulling them down. So after 6-8 hours of that, you go and immediately stand up…well, sometimes the feet balk a little. Give them a break. Stretch them. Say “good morning” to your feet. They’re at the bottom of your body and over a lifetime they take a lot of abuse. Give them a little TLC.

I also recommend that you stretch the bottom of your feet before standing up after you’ve been sitting for awhile. Many of my patients complain of plantar foot pain in the morning when they first wake up, and less so after they’ve been sitting awhile. Once again, notice where your feet go when you sit, especially if you’re sitting for an hour or more; like while you’re watching a movie, or in church. They relax and they point down. The plantar fascia begins to seek its shortened position. When you stand up, you strain it with the pressure of your body weight bearing down on that tender band. So make it a habit to wiggle your feet up and down a little. Push your feet back against the floor, as if you were trying to stretch your Achilles tendon. Cross your leg and push back your big toe, like I described for your morning stretch.

Hold hands with your feet.

One thing you see as you age is that your feet get more and more stiff. Especially us gals. Our feet have taken some serious abuse with our shoe wear and after 40 plus years of pointy toe high heels, the nerves and joints in our feet have had it. It’s payback time. It’s force-you-to-wear-wide-black-velcro-SAS-shoes-no-matter-what-color-your-outfit-is time. I promise you that you will pay, some of you sooner than later.

Start giving your feet a break now. Austin, Texas is an interesting place in this regard. Wearing healthy hippy shoes is almost always acceptable, even in young women. It’s important to give your feet the luxury of healthy shoes now and then. Shoes like Keens, Mephistos, Dansko clogs, jogging shoes, wide toe western boots, etc. You know what? I’m just going to take the time now to talk about shoes; what’s good and bad out there. Some of this is intuitive. Stilletos are not good for your feet under any circumstance…unless they lead to a bonafide toe sucking foot massage. Birkenstocks, while they rarely lead to foot sex, are pretty much known to be easy on your feet.

So let’s start from the top. Everyone knows this but since I’ve decided to discuss shoes, I may as well reiterate the problems with high heels. Needless to say, they’re bad for your feet. So why did I say it? Because I love high heels and I continue to try to wear them despite the fact that they wreak havoc on my feet for about a week after I do so. Like most women, I worship the high heel. It goes much deeper than just a look. Because I’m 6 feet tall, high heels were anathema to me until I was old enough to get a job and buy my own pair. And believe me, I bought the highest pair of stacked heel shoes available to mankind at the time. That made me 6’4” tall and assured me of a cherished position on the second to the top row in the middle of the bleachers, in the middle of all the football and basketball players, in my senior class picture.

I even scheduled my bunion surgery in early February of my senior year in high school so I could squeeze my feet into the strappy high heeled sandals that were so popular at that time. And strap them in I did. By the end of the evening my feet looked like cured sausages.

Now, almost forty years later, I still attempt to cram my war ravaged feet into pumps. But it’s all carefully choreographed. I wear my Dansko’s until just before I get to an event in which a pump might be appropriate. Then, once seated, the shoes are loosened from the forefoot…and so on and so forth. In general, an entire evening event might only result in 20 minutes of intermittent shoe wearing, but by the time the night is over, those dogs are scareeeeming. Absolute high-heels-required events are fortunately few and far between in my life.

Now here’s some good high heel news; boots. Boots aren’t so bad and I love the fall because I can start wearing high-heeled boots. Pumps and stilettos are held on to the foot through the toe of the shoe. Your foot slides down and basically crams itself into the toe and that keeps it on. They’re not sturdy enough for the heel of the shoe to assist. In most instances the heel is too small and the surrounding leather of the heel, if it even has a heel, is not supportive. So you basically walk on your toes…which are crammed down into the shoe. Not good. But a boot is different. It is held in place by much more leather around your midfoot and heel. And in many cases, the actual high heel is thicker and more weight can be borne upon it. This frees up the toes and forefoot, allowing the toes to relax and keeping them from bearing all the weight. If you’re dying to wear high heels, in the fall and winter wear more boots.

I want you to go to your closet right now and get every pair of mules or backless shoes you own and toss them…or give them to your enemy. Half of the patients I see for foot problems come into my office wearing mules. People say “mules and backless sandals are comfortable” and I say the reason for that is because you can slip them off. There are two ways a mule stays on your foot. One way is for your toes to hang onto them when you lift up your foot in the swing through part of your gait. Pay attention next time you wear your favorite mule or backless sandal. Feel how your toes scrunch up against the bottom of the shoe as you lift your foot. You’re basically training your toes to become hammer and claw toes and this eventually guarantees you a visit to the orthopod or podiatrist.

The other way a mule is held onto your foot is by pressure. Right. You just cram your foot into it and when it’s tight enough, it stays on. “But they’re so comfortable. They’re my most comfortable shoe!” As I said before…that’s because when they don’t have a back, you can easily slip them off, giving your foot a much needed break.

I’ve recently updated this post, and my Sit Like A Man  (S.L.A.M.™) program (https://drbarbarabergin.com/sit-like-a-man-s-l-a-m/)

has also added plantar fasciitis to the list of conditions which might get some benefit from doing it. But it’s not because of the mechanical stresses across the lower extremity in women that this is effective for plantar fasciitis. It’s simply because when we sit in a manly way, most often our feet are flat on the ground. Women’s feet don’t always reach the ground, and even if they do, we often have them curled up under ourselves somehow, thereby shortening the plantar fascia. But in my opinion, one of the reasons it’s women who most experience plantar fascial pain, is that we sit with our feet pointed down, and men do not. So try to sit flat footed as much as you can during the day.

And stretch those feet out every morning before rising!