If you’re a football fan, you may have heard of plantar fascial tears thanks to Peyton Manning. News of his partially torn plantar fascia made headlines and contributed to his missing much of the NFL season this year.
Over the years, I’ve seen my share of patients with plantar fascial tears. Feared by runners and CrossFit athletes alike, they are unusual if not rare. A rough estimate for my experience is 20 plantar fascial tears to 15,000 cases of plantar fasciitis.
Let me discuss the typical history for Plantar Fascial tears.
Tearing of the plantar fascia usually arises from recurrent plantar fasciitis—usually not the first time around!
Plantar fascial tears are sudden and often occur with little effort. This is because they are the proverbial straw that broke the camel’s back. The pain can be minimal to severe, and in some cases the chronic preceding pain is resolved in days.
The treatment is not different from the treatment of plantar fasciitis: palliative treatment for pain, keeping one mobile, while mother nature does her thing, and that sometimes includes ice, rest, reduction of any increased pain-producing activities, use of a walking boot, arch supports/orthotics….well, you get it, as the list goes on.
But if you want to really solve the problem you must look north…by that, I mean look to the cause.
The problem is the underlying cause, the equinus or isolated gastrocnemius contracture, which continues on and is now even more threatening. Your calves are TOO tight…it’s just science! As an orthopedic surgeon and a scientist, I can tell you this is what caused the problem in the first place, but it is almost uniformly ignored.
Treat the foot only and you are completely missing the target—you are completely ignoring the real cause of the problem.
Here is the bigger problem with a plantar fascial tear: one of the major supporting structures for your arch is now gone. Not to get too technical, but the calf being too tight creates increased rotational/depression forces in the arch and many other areas of the foot and ankle, with every step leading to new and not-so-wonderful problems. Now this leveraged force is coming to bear on a much more defenseless foot structurally speaking. The evidence is undeniable linking equinus as a cause of 22 other non-traumatic acquired foot and ankle problems (Achilles tendinitis, midfoot arthritis, 2nd MTP synovitis, PTT dysfunction/acquired flatfoot deformity to name a few).
These problems arise with regularity in years to come if the isolated gastrocnemius contracture is not addressed, even if (or when) the plantar fasciitis is resolved.
It’s Just Science
…Which leads to my next point: if you want to know the common denominator between foot/ankle problems that you have had in the past (think: plantar fasciitis) and the foot/ankle issue you have that has cropped up years later—those ailments, in the majority of cases, have the same underlying cause.
For some who understand the importance of calf stretching, the “problem” is that they QUIT their stretching protocol after they found relief in the past.
Patients do not see—or in most cases, even know about—the connection between the two. Instead, they may think the new problem is random or completely separate.
Who could blame them: after all, this is information most of us don’t know, not even Payton Manning.
But now you know.
About 70 percent of those I see with very common ailments including second MTP synovitis, PTT rupture/acquired flatfoot deformity, insertional Achilles tendinosis, midfoot arthritis, are people who had plantar fasciitis in the past. Just think of how many people could save themselves so much future pain, discomfort, and money if they would continue their stretching, past the point of relief!
So, the next time you get foot pain—whether you have stretched your calves in the past or not—especially if you have a history of plantar fasciitis, just start stretching your calves before you run off to the doctor…You will be amazed, really!
Don’t fight the science. Stretch your calves and save your feet.
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