- 1. Plantar Fasciitis: A Degenerative Process (Fasciosis) Without Inflammation. Lamont, et al. Journal of the American Podiatric Medical Association (2003) 93:3 234-237.
- PMID: 1275631 | DOI: 10.7547/87507315-93-3-234
- 2. Passive hallux adduction decreases lateral plantar artery blood flow: a preliminary study of the potential influence of narrow toe box shoes. Jacobs, et al. Journal of Foot and Ankle Research (2019) 12:50.
- PMID: 31700547 | DOI: 10.1186/s13047-019-0361-y
- 3.
Improving Foot Circulation to Help Heal Plantar Fasciosis
Blood flow is essential in maintaining tissue health, especially following an injury, as it provides the vital reparative factors necessary for healing. Compromised blood flow, then, can significantly inhibit tissue healing. In regards to the feet, the posterior tibial artery of the lower leg supplies blood to the plantar region (bottom, sole) of the foot, including the plantar fascia via the lateral plantar artery.
Plantar fasciitis, a highly prevalent injury and one of the most common causes of plantar heel pain, remains poorly understood in conventional podiatry. However, as Dr. Harvey Lemont, DPM, et al., found in their 2003 research study reviewing histological findings in chronic plantar fasciitis cases, plantar fasciitis is significantly more often accompanied by degenerative changes rather than active inflammation. Thus, these degenerative changes in the fascia are best classified as a "fasciosis" rather than fasciitis. While degeneration and inflammation are not mutually exclusive, most conventional podiatry will only treat for inflammation.
So, what about all the degenerative processes then?
Given the importance of blood flow in tissue healing, blood flow may help explain the 46% recurrence rate of plantar fasciitis reported in previous research. An adducted hallux (when the big toe is displaced towards the other toes, like in a bunion), as seen within narrow shoes with tapered toe boxes, can put passive tension on the abductor hallucis muscle (which attaches to the big toe and the heel bone), compressing the lateral plantar artery and restricting blood flow to the plantar fascia.
A study by Jacobs, et al. from 2019 published in the Journal of Foot and Ankle Research used ultrasound to compare lateral plantar artery blood flow before and after passive hallux adduction. The lateral plantar artery was imaged deep to abductor hallucis for 120 seconds; 60 seconds at rest, then 60 seconds of passive hallux adduction. The volume of blood flow was 22.2% lower after passive hallux adduction compared to before, with an initial drop of about 60%. Blood flow was also compared with arch height, and as arch height decreased, there was a greater negative change in blood flow, meaning individuals with lower arch height appear to have a greater risk of decreased blood flow with passive hallux adduction. These findings of decreased blood flow through passive hallux adduction indicate conditions that elicit passive hallux adduction (e.g. wearing narrow-toed shoes) may have important effects on foot blood flow. Many shoes also simultaneously compress the foot in multiple directions, which may influence overall blood flow in the foot and reduce the potential for compensatory increased blood flow in collateral arteries. A decrease in blood flow, due to footwear or otherwise, could have a negative impact on tissue health and healing as has been seen with the Achilles tendon, scaphoid, and patella.
So, how do I restore optimal blood flow to my plantar fascia?
First, we remove the obstacles to cure: stop wearing narrow shoes with tapered toe boxes. Eliminate the force that deviates the big toe laterally towards the other toes. Instead, wear more natural footwear with a toe box widest at the ends of the toes that accommodates a full splay. See our list of Correct Toes Approved shoes.
Second, try Correct Toes. Correct Toes restore your toes to their natural and anatomically correct alignment—a wide splay. Getting your big toe back to its natural alignment with the first metatarsal bone will take the tension off of the abductor hallucis muscle, reducing its compression on the lateral plantar artery and increasing blood flow. Wearing Correct Toes while weight-bearing and active will yield quicker and longer lasting results as the intrinsic foot muscles are encouraged to engage and strengthen in a healthy alignment.
IR circulation images
Plantar venus plexus - met pads
Toe extensor stretch
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