How & Why Hands On Physical Therapy Addresses Plantar Fasciitis the Way We Do
(written by: Stephen Leary, PT)
Plantar Fasciitis is a painful inflammation of the thick, broad band of tissue (the plantar fascia) that connects the heel bone (calcaneus) to the toe bones (proximal phalanges). Plantar Fasciitis is one of the most common causes of heel pain. In fact, it is estimated that 10% of the world’s population will suffer from Plantar Fasciitis in their life time. This relatively common foot problem can range from uncomfortable to debilitating and can last anywhere from several weeks to multiple decades.
Since there is inflammation and irritation of the plantar fascia, it is extremely important to address those tissues of the foot. This being said, many patients go through extensive treatment of the foot without resolution of their plantar fasciitis. At Hands On Physical Therapy, we believe that it is extremely important to address the plantar fascia and other tissues of the foot, but also believe a much more comprehensive evaluation and treatment are usually necessary.
In acute cases (less than 3 months) of Plantar Fasciitis, that have been caused by a direct trauma to the plantar fascia, often all that the tissue needs is inflammation management and support to the tissue (via supportive shoes or taping). Of course, the joint mechanics of the foot need to be assessed and treated for issues of calcaneal mobility, lateral arch dysfunction (ie. subluxed cuboid), medial and or transverse arch issues, as well as issues of the big toe (ie. planarflexed 1st ray and hallux valgus/rigidus) and the ankle (talocrural limitations especially into dorsiflexion).
Often times the onset of a person’s Plantar Fasciitis is insidious, and resolution is not as easy as inflammation management and supportive footwear. In these cases even correction of the structural biomechanics of the foot (mentioned above), sometimes does not alleviate the Plantar Fasciitis signs and symptoms. For this reason it is important in all Plantar Fasciitis patients to assess for and treat any biomechanical issues found further up the chain.
In addition to the foot and ankle mechanics mentioned above, assessment of the biomechanical chain should include: knee mechanics (tibia rotation on the femur); hip mechanics, particularly as it relates to internal and external rotation of the hip (and lower extremity) during weight-bearing activities; pelvis and sacral mechanics (among other things these may lead to a relative leg length issue); spinal mechanics (especially as it relates to Type I body mechanics – in short, the balancing of the upper quadrant’s motion with the lower quadrant’s motion). Once a more complete picture of one’s biomechanics is established, a treatment plan can be put into place.
One might ask why this biomechanical picture is so important. The answer to this lies at the heart of why Plantar Fasciitis is typically such a chronic problem. The human body is intended to move through very predictable movement patterns. When these movement patterns are altered, the tissues and joints of the surrounding body parts are put under new and sometimes damaging stresses. When considering biomechanical issues at the hip/pelvis/trunk, it becomes apparent the foot/plantar fascia (which is at the end of a long lever-arm, the leg) that terminates into an unmovable object (the ground), may come under extreme additional stresses. These additional stresses are added to the fact that the feet/plantar fascia are put under significant abnormal stress on a very regular and repetitive basis because we must walk on them. Add to this that often times the pain of the Plantar Fasciitis causes the patient to wear only rigid footwear and change the way they walk, and you have a recipe for even more compensated biomechanics.
Considering all of the above issues, Hands On Physical Therapy’s approach to treating Plantar Fasciitis typically incorporates the following strategies: Correction of faulty joint mechanics of the foot and ankle (through manual therapy and taping techniques); Fascial inflammation management (through manual therapy techniques, modalities, supportive taping & shoes); Fascial elongation techniques (through manual therapy techniques and a calculated tapering from foot taping and supportive shoes – it is important to taper out of your rigid footwear as the foot is a structure designed to move and its movement allows for normal elongation of the plantar fascia. If you fail to allow the foot to return to normal motion, the plantar fascia only becomes tighter and ultimately a much more difficult problem to resolve in the future); treatment of the biomechanical chain (through manual therapy, taping, multi-plane stretches & exercises as well as posture and body mechanics education and training).
It is important to remember that Plantar Fasciitis is not the only cause of heel and foot pain. Other issues such as tarsal tunnel, stress, calcaneal fat pad issues and even nerve impingements in the low back can lead to foot pain. It is therefore important to assess for these issues as well and treat them if present.
Hands On Physical Therapy
147 SW Shevlin Hixon Drive
Bend, Oregon 97702