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The name plantar fasciitis, so it is called, would indicate there is inflammation (itis) of the plantar fascia, a thick strip of tissue running along the bottom of the foot from the heel bone to the toes. However, there’s been many issues in treating plantar fasciitis over the years and it all starts with what we understand the condition to be. As Dr. Ray McClanahan (DPM) puts it,
“We thought these people were pulling their ligament off of the heel bone and making a bone spur and that was what was causing the problem.”
Dr. McClanahan goes on to talk about the attempted treatment methods recommended by doctors such as elevating the arch to stop the pulling of the heel bone, cortisone injections, pain pills, physical therapy.
You may be all too familiar with these options. If you are, there’s one thing you know for sure: none of these are solutions to the problem. They are all temporary pain relief attempts.
Another doctor, Dr. Harvey Lemont, noticed this and realized that the current treatment methods simply weren’t working for his patients. So in the early 2000s, he took it upon himself to directly study the plantar fascia tissue from his affected patients and see what was actually happening at the tissue level.
What he found was incredibly interesting: of the 50 patients that were suffering from plantar fasciitis, none of them had any inflammation in their plantar fascia ligaments. Dr. Lemont did notice that in every sample, there was dead tissue, also known as fasciotic tissue, also known as fasciosis.
Dr. Lemont ultimately reasoned that something must be shutting off the blood supply that feeds into and nourishes the area where the plantar fascia ligament is. His thinking was that tissue death only occurs when blood is not being pumped in and out of an area.
What was later discovered is that the footwear his patients as well as everyone else had been wearing their whole lives was cutting off that blood supply to the bottom of the foot. Here’s why:
Our footwear has a narrow toe box that forces our toes to reconfigure themselves so they can all squeeze in. When this happens, one of the primary problems is that the big toe gets pushed inward towards the other toes.
Aside from this, the toes are lifted up by the built-in “toe spring” in our shoes. This is the slight upward arc we see at the end of our shoes where our toes sit.
With the narrow or “tapering” toe box and the toe spring, Dr. McClanahan says,
“The medial part of their heel tissues will be pulled distally. In other words, when we take the (big) toe and put it into that shoe position, everybody in my clinic can see how the muscles back here (on the inside of the heel) pull this way (towards the toes).”
There is a muscle called the abductor hallucis sitting right on top of the main artery that needs to feed the plantar fascia ligament. This is the triangular-shaped muscle McClanahan is referring to on the inside of the foot and heel.
When the big toe is pushed in (narrow toe box) and lifted up (toe spring), it pulls the abductor hallucis muscle tighter across the artery that feeds the area and it cuts off enough blood supply to create some dead tissue.
There is not enough blood supply coming in or getting out of this area because of that unnatural restriction being caused and both of those functions are crucial. The tightening of the abductor hallucis won’t let blood flow into the area and the stiffness of our shoes limiting our plantar-flexion and natural flexing of the foot won’t let blood flow out of the area effectively.
So what can you do about this unfortunate process? Dr. McClanahan would suggest, and I agree from my own experience, that you need to start by undoing that process starting with your footwear. Minimalist footwear is an excellent, naturopathic solution to get your feet feeling like feet again.
Here are the exact minimalist shoes I start wearing when I had painful plantar fasciitis (fasciosis) myself. They have a wide toe box, a flexible sole, a non-elevated heel, and more. The important thing is that the shoes will allow your toes to spread so your big toe isn’t getting pushed in and creating the bloodflow problem.
The other thing McClanahan recommends you to do in the meantime is when you’re barefoot, give your feet a proper stretch. This is a stretch for the muscles on the top of your feet by putting the foot into a position it doesn’t experience very often anymore. It also helps with pushing bloodflow out of the plantar fascia area, which cannot be ignored for its health.
If that was a little confusing and you would like some more in-depth explanation, follow along with the video Dr. Ray McClanahan made on the subject:
Interestingly, this information is not even new. It is at least 15 years old and I would imagine Dr. Harvey Lemont had been onto it for much longer than that. You can read the study he conducted on his patients’ plantar fascia tissue here.
I think it is safe to say that we have been mislabelling our heel pain problem for quite a while now. Remember, it’s not inflammation in the area (fasciitis), it’s actually dead tissue (fasciosis).
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