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Plantar Fasciatis and Carpal Tunnel: Feet/Ankles & Hands/Wrists

Kimberley Anne Shone BA(Hons) BTEC L.5 SRMT
Jun 12, 2018
7 min read

It's Summer time meaning flip flops and sandals, thus, shoes with less support. It also means harder off-road surfaces so placing more pressure on the feet. Overall, increasing the chances of plantar fasciatis and calf cramp.

Regarding the hands, we use them every day, but when do you take care of your hands? Also, when do you consider how you use them?

This blog contains the hows, whys, and advice to both prevent and correct problems in the feet and hands, noting that these issues can continue to the knees and hips, and elbows and shoulders!

THE FEET:

The big toe, medically known as the hallux (plural: halluces), has been a main form of balance since we were primates. With each step, it SHOULD absorb an equal force to twice your body weight.

The less you use your big toe, it increases the pressure placed on the arch, and outside of the foot.

- The dysfunctional pressure into the arch can create flat feet and inner (medial) knee pain, which can increase IT Band tension and thus, weaker glute minimus and medius, with tighter lateral rotators such as the Piriformis (referring back to a previous blog of how the Piriformis muscle is a common cause of Sciatica).

- The lack of support from the arch means the bones of the feet become dysfunctional regarding stability, creating increased pressure on the Plantar Plate (balls of the feet), which can cause hammer toes and bunions.

Either way, the base in which we absorb our weight is dysfunctional, meaning the ankle is dealing with an imbalance of forces, thus the muscles and fascia are dysfunctional, and ankle and feet issues occur!

QUESTIONS TO THINK ABOUT:

- Where are you feet pointing - inward, straight, or outwards? Does the change at all from lying down face up, sitting, and standing?

- In both sitting and standing, are your arches high, or quite flat?

- Feel the floor under your feet - how much pressure is down the outside of the foot compared to the inside and big toe?

- Are your toes quite flat, or hooked?

- How much pressure is down the front of the foot, such as balls of the feet and toes, compared the heel at the back of the feet?

The ankle absorbs both your body weight, and the forces required with movement. If the foot doesn’t absorb the pressures with balance, be it pronation or supination, the tibia and fibia sit on the calcaneal bone with a kink, meaning the Achilles is no longer moving straight, and the bones of the feet are having to move twisted. Thus, the fascia of the foot becomes twisted and dysfunctional, the ligaments compensating and weakened, and the muscles for the feet in the lower leg become strained and tight as a consequence!

Imagine the feet are the foundations of a building, and the body above is the building. If there is imbalance in the foundations, the building will incur structural issues depending on those individual imbalances, such as the knee and hip. It requires healthy tensegrity which means tension in the integrity.

The arch of the foot is also known as the plantar diaphragm, so with healthy movement it aids circulation of blood, lymph, and water for example. A weakened arch therefore can create reduced circulation for example! Therefore, a healthy arch and feet means quicker recovery, and less prone to injury and cramp.

TOP TIP: Walk pigeon toed without looking down at the feet, you are likely to have straight feet! The more you look down at your feet, the more you flex the torso placing more pressure on the plantar plate again, so it is important to trust yourself walking "pigeon toed" with an aim for straight feet. The more rotated outwards (laterally rotated) the feet are, the more odd this will feel, but the more you practice, the easier it will become, the aim is to remobilise the feet back to function again after all!!!

TOP TIP: Sitting square so pelvis straight (no hip in front of the other for example), and feet parallel and again, one not in front of the other. Lift one heel off the floor as you scrunch the other foot up (like a "towel scrunch"). See what happens to your knees, hips and backs of the ankles - do they stay straight or collapse/twist in or out? The aim is to remain straight, thus knee cap directly in front of the hip, and the big toe with 2nd toe in line and directly in front of the knee cap.

TOP TIP: Lying down with knees at 90⁰ with feet flat against a wall, and toes pointing slightly inward, in line with knees and hips and above. Push one heel softly into the wall at the same time as you life the other heel of the wall. Alternate and repeat. Alike above, the aim is to remain straight and balanced from feet to pelvis.

TOP TIP: Roll the feet with a golf/tennis/hockey/spikey massage ball, keeping toes inward and roll from toes to heel across the whole foot. Thus, mobilise the plantar fascia to reduce pressure and tension, enabling more change back to function again!

TOP TIP: Soak the feet in Epsom Salt water. Epsom salts are Magnesium Sulphate, and the skin is permeable meaning the skin can soak up the Magnesium, which draws water back into the connective tissues, increasing hydration and reducing friction. This consequently relaxes the nerves of the feet, which allows the connective tissues to truly relax. You can purchase medical grade Epsom Salts from most decent pharmacies, sometimes behind the counter, and some supermarkets for example now stock them!

THE HANDS:

The thumb is one thing that makes us human as it is “oposable”, thus allowing us to grip much stronger.

The last 3 fingers (middle-little) are our main grippers that oppose the thumb.

The index finger is usually used the most in regards to grip with the thumb, with less use of the other 3 fingers.

The less we use these last three fingers, the more strain placed on the index finger and thumb, altering the forces through the wrist, and creating issues! This augmented by the more times you internally rotate the wrist (pronation).

QUESTIONS TO THINK ABOUT:

- In standing with arms relaxed down by your side, do your palms face forward, your side, or backwards? Also, does your elbow twist your forearm inwards so your palms are facing backwards more so?

- Are your hands in front of the body? I.e, in front of the hips, or next to you at your side.

- When you grip, do you predominantly use your thumb and index finger, or do you use the last three fingers just as much too?

- When gripping, does your wrist collapse? I.e, tilts the hand/s backward towards the back of the forearm.

- When gripping does your elbow rotate inward more at all, and/or does your shoulder collapse forward? Thus, how much pressure do you place on the front of the hand to shoulder, compared to the back of the hand and shoulder?

The function and balance of the wrist depends on grip and wrist balance, and also the function and balance through the elbow and shoulder.

The arm is very similar to the leg in that it has a capsule joint at the top, a long bone for the upper arm, a hinge joint at the elbow, two bones for the forearm, and the wrist and hand consisting of minimal muscle, many ligaments, and various bones, in which we create and absorb pressures and forces.

- If you use your flexors more than your extensors for example, then you will create tension on the front of the wrist, especially if you "sublux" the wrist, thus collapsing the wrist so the hand tilts backwards

- The more you use your thumb and index finger over the last 3 fingers, the more pressure placed on the radial nerve leading to the brachial plexus, creating dysfunction between the front and back of the hand to shoulder.

-The more you pronate the wrist, the more the radius bone rotates over the ulnar bone, creating increased tension particularly between the connective tissue between the two bones, and supportive connective tissues particularly in grip. This then puts more pressure on the A/C joint which is situated at the front of the shoulder, this rotates the shoulder forward more so, creating weakness and dysfunctional tension patterns throughout the posterior chain (back aspect of the hand to shoulder joint).

Wall Angel example with hands above head.

TOP TIP: Try the "Wall Angel" - Stand with your back against a flat smooth wall, ensuring enough space either side for you to move your arms, noting the closer your feet are to the wall, the more difficult this exercise will be, so it may be best to start with the feet further away from the wall to begin with. You can use this measurement of the feet to the wall as a measure of progress. Face feet slightly inward and hip width apart, and bend the knees slightly. Whilst keeping the head, shoulders with shoulder blades, and bum, flat to the wall, try and flatten your lower back to the wall without moving those 4 body parts away from the wall, or straightening the knees.

Focus on abdominal breathing and feel how this gets easier and your shoulders are able to relax more, whilst also lying flatter to the wall!

Next, with your palms facing forward and arms flat to the wall, move them slowly upwards to above your head, bending the elbow slightly as you go, and try and maintain a flat wrist, thus, try not to sublux the wrist by allowing it to fall forwards. Focusing on rotating the shoulders back and down with the shoulder blades makes this part easier. Once you have your arms as high as you can go before struggling, move them back slowly back down.

And repeat!

TOP TIP: With palm facing up/forward, and wrist straight/flat, extend the fingers and thumb backwards - MAINTAINING A STRAIGHT WRIST. The thumb will be more difficult to extend, and the carpal bones on the outer side of the hand will try and sublux (lift up), this is because of tension in the transverse carpal ligament, so keeping the wrist flat and ensuring the elbow does not compensate by rotating/twisting during this stretch enhances the stretch in this area. SO TRY AND KEEP THE WHOLE HAND AND WRIST FLAT WITH NO ROTATION IN THE ELBOW.

You can further this stretch by using an elastic band for resistance. Using a flat surface to extend the fingers toward can also help measure balance through the movement.

TOP TIP: When gripping, practice just using your last 3 fingers in a neutral or supinated grip.

Further this by using holding a kettle bell at the handle, starting with arms at your side and palms facing your side (neutral)- Then move the kettle bell upwards above your head without letting it fall forward or backward, and without subluxing your wrist forward or backward. MAINTAIN BALANCE BY INCREASING GRIP IN THE LAST 3 FINGERS, ESPECIALLY THE LITTLE FINGER.