Plantar Fasciitis: Da Agony of Da Feet!

Why do so many people suffer from it and so few actually get better with traditional therapy? Sadly, it is not well-understood, scientifically or biomechanically.

Most individuals do not know the latest research and are not even aware of the basic program for plantar fasciitis treatment, much less advanced care options for severe and/or atypical cases.

What is plantar fasciitis and why does it develop? Plantar fasciitis is a very common kind of tendinitis, but instead of a tendon, it's the plantar fascia of the foot that's inflamed. The plantar fascia (aka the plantar aponeurosis) is a sheet of connective tissue that stretches from the heel to toes, spanning the arch of the foot. It is basically an inflammation and thickening of the plantar fascia caused by chronic irritation of the arch of the foot due to excessive strain. 

Muscle knots, technically known as myofascial trigger points (MTPs), are a factor in almost all cases. A trigger point is a section of super-contracted and irritated muscle tissue, and it can cause symptoms ranging from mild stiffness to extreme pain. They not only cause pain and problems directly, but also develop in response to other biomechanical problems, particularly with lower crossed syndrome (LCS). LCS is a consequence of poor postural alignment and dynamic postural equilibrium dysfunction of the kinetic chain.1 (See previous articles on my website).  

Laser Therapy

Lasers significantly reduce pain and inflammation, but also stimulate the formation of new collagen matrix in damaged tissues.2 Properly applied laser therapy with optimal dosage is one of the best modalities available for effective treatment. The protocol is two visits per week for a total of 10 laser sessions. This protocol is often used along with Manual Therapy.

Manual Therapy

Trigger points and myofascial adhesions are primary culprits in unresolved plantar fasciitis. Some of these muscles are far-removed from the symptomatic area. So why work them? To remove kinetic chain biomechanical compensation patterns, performing hands-on fascial and muscle therapy to the following areas with soft tissue techniques (Fascial Distortion Model, or FDM and Active Release Technique, or ART) have shown to be very effective in my experience. If affected, these areas will be tender and painful.  Body language, verbal description of the pain and mechanism of injury all are pertinent in proper diagnosis and care.  It usually takes six to 10 sessions for most cases to resolve; come chronic cases could be longer, but, I personally have not seen more than one or two cases go beyond 10. Primary muscles include anything that attaches to the lower back, all the way down to the foot. 

Home Care

Home applications, using tennis balls, lacrosse balls, baseballs, golf balls and biofoam rollers are helpful in expediting treatment time. Primary areas include the plantar surface of the foot, calf and buttock regions.

Joint Fixation

The following areas may be addressed for possible subluxation/fixation (any and all areas may be involved): L1 and L2, L5 and S1, sacrum torque, rotated ilium, anterior femur head, tibiofemoral complex, fibular head, calcaneus, talus, navicular, cuboid and cuneiforms; basically, anything from the lower back to the foot. 

Lifestyle

One's activities of daily living (ADL) must be mentioned here, including proper shoes, exercise, work habits, ergonomics, etc. Despite the best care program, maximum results will not occur if patients continue to irritate the condition. They will need to make genuine effort and certain sacrifices to recover. 

Plantar fasciitis can certainly interrupt your lifestyle and can throw off your body mechanics, leading to ankle, knee, hip or back issues. This will not help you to stay active, thus leading to cardiovascular de-conditioning as well as loss of general flexibility.

If you, or someone you know has been suffering with this condition, please call my office to schedule an appointment.

References

1. Clark MA. Integrated Core Stabilization Training. NASM, Thousand Oaks, Calif., 2001.
2. Blahnick JA, Rindge DW. Laser Therapy. Healing Light Seminars, Melbourne, Fla., 2003.
3. Gunn CC. The Gunn Approach to the Treatment of Chronic Pain. Churchill Livingstone, 1996.

Disclaimer 

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All matters regarding your health should be supervised by your health care provider. All information provided in this site is for the purpose of education, not treatment.

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