Resolving Plantar Fasciitis

Of all the conditions that we treat Plantar Fasciitis (PF), is one of the most common. In fact, between the running community and the general public I see new cases of Plantar Fasciitis almost every day. This can be a very frustrating condition for a lot of people who previously have achieved only minimal or no results.

When going over patient case histories it quite common to see that they have tried: orthotics, ultrasound, stretching, ice, heat, manipulation, acupuncture, electrical stimulation, steroid injections and a plethora of ointments and creams. Not surprisingly, most of these patients are very sceptical when I tell them that plantar fasciitis is often easily resolved.

The key to a complete resolution is to find what structures are involved, treat them and re-establish normal movement patterns. Sounds simple enough, but to do this you have to consider the entire kinetic chain and not just the area in which the person is experiencing pain.

 


Biomechanical Analysis

 

 

One of the first things we do with our patients is a gait analysis and a few balance/strength tests; this gives us an overall picture of the stability, symmetry and muscle firing patterns.

 

 

 

Common things we look for are:

  • Abnormal motion of the feet or ankles.
    • Abnormal toe motion: This would refer to a lack of toe push off (plantar flexion) or landing, or abnormal toe deviation (in or out).
    • Excessive pronation: Refers to excessive inward roll of the foot after contacting the ground. With excessive pronation the foot continues to roll in when it should be pushing off. This twists the foot, knee, leg and even the hip.
    • Excessive supination: Refers to inadequate inward roll of the foot after contacting the ground. This also causes strain on the foot, knee, leg and even the hip.
  • Abnormal deviation of the knees. (Gait and single leg tests)
    • Restricted flexion or extension of the knees.
    • Medial or lateral deviation of normal knee motion during a single leg squat.
  • Abnormal Leg alignment (femoral alignment)
    • Restrictions in internal or external leg motion (Femoral rotation).
  • Abnormal hip or pelvic motion

Common Factors

On of the most common things I will see during gait analysis, is a lack of control as the individual brings their foot down (eccentric contraction). This motion is controlled by muscle called your dorsi flexors (tibialis anterior, extensor hallucis longus, extensor digitorum longus, peroneus longus). A person who has restrictions in these muscles is easy to hear when you are running. They will be the one slapping the ground as they run beside you. This is a significant finding, because it also means the person is not dissipating the shock of a normal stride. Instead they are directing the force into their muscles, which causes micro tears, inflammation and the formation of scar tissue. In fact, any deviation from a normal gait will have a similar effect somewhere in the kinetic chain, which is why all restrictions must be addressed for a complete resolution of this condition. These restrictions could be restrictions far from the feet themselves.


Treatment Strategies

Once the practitioner has determined (hypothesized) which areas are involved, they need to get into the restricted tissue to confirm where the adhesions are and release them. This will require that the practitioner use a considerable amount of tactile sensitivity. It is not just a matter of finding a tight spot and releasing it. The practitioner must literally feel what is going on in one layer of soft tissue over the adjacent layer.

 


Concurrent Exercise and Lifestyle Recommendations

 

Exercise and lifestyle recommendations can be implemented before, during, and after treatment. Besides restoring the quality of the tissue by breaking up any restrictions it is important to become stronger and more flexible, and to build more power. This will help insure that the Plantar Fasciitis does not return.

 

Note: Most importantly once the adhesions have been removed it is exercise that will restore normal motion patterns and complete the process of tissue repair. With out the right exercises even if the adhesions are removed the probability of a re occurrence in very high.


Read Dr. Abelson’s Blog on Plantar Fasciitis

Resolving Plantar Fasciitis

Of all the conditions that we treat Plantar Fasciitis (PF), is one of the most common. In fact, between the running community and the general public I see new cases of Plantar Fasciitis almost every day. This can be a very frustrating condition for a lot of people who previously have achieved only minimal or no results.

Need more information…check out these great resources

Sport Injury Clinic

Sports massage – Sports massage is essential for optimum treatment of certain injuries and is excellent for helping prevent sports injuries. See Plantar Fascia Strain for more information.

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ACTIVERELEASE.CA

Kinetic Health
Soft Tissue Mgt. Systems
10–34 Edgedale Drive NW
Calgary, AB T3A 2R4, Canada
p | 403-241–3772
f | 403-241–3846
e | reception@kinetichealth.ca

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