Plantar fasciitis often starts because of altered biomechanics with gait or running. This can happen because of various areas of hip to knee and ankle moving improperly resulting in stress to the foot causing pain and inflammation.
The plantar fascia is a fibrous ligament (aponeurosis) that runs from the heel (calcaneus) to the base of the toes (metatarsals) whose function is to provide arch support for the foot. This structure is placed under stress in walking, running, jumping, and general weight bearing.
We often see clients with flat feet (pes planus) more than those with high arches (pes cavus) with plantar fascia pain. A knock knee (genu valgum) appearance can also cause stress to the knees and feet but lead to increased foot flattening (overpronation) of the feet.
In gait analysis, we often can detect altered biomechanics from the trunk to the feet and often find individuals landing with a rearfoot heel strike rather than a forefoot landing. This will increase stress from the foot all the way up the chain to the trunk. A forefoot strike lessens knee (patellofemoral joint) stress distributing more load to the calf (gastrocs) resulting in more inversion and plantar flexion during running. Shortening the person's stride can also have positive effects.
Proper shoe fitting for the individual is also crucial. For rigid high arched individuals, a looser or more flexible shoe is recommended and for those with more mobile or lower-arched (flat-footed) individuals, a more supportive or stiff shoe is recommended. Also you may want to avoid shoes with high arches and posterior or lateral flares.
Muscular weakness is often detected in the calves' (gastrocnemius muscles) ability to work eccentrically (lower slowly) from a heel up (plantar flexed) position. Weakness also may be in the (tibialis posterior) muscle which is responsible for inversion and plantar flexion. Foot intrinsic muscles are almost always a culprit in plantar fasciitis. Weakness of the following foot muscles: abductor digiti minimi, the abductor hallucis longus, flexor hallucis longus, flexor digitorum longus, flexor digitorum brevis, extensor hallucis longus, extensor hallucis brevis, extensor digitorum brevis, lumbricals and quadratus plantae can lead to poor active arch support or foot imbalances. Glutes and hip abductors can also be a contributing factor in foot/ankle pain.
Muscular tension is almost always found in the calf (gastrocnemius), the (soleus), plantar aponeurosis and 1st metatarsal joint. We often give our clients stretching for these hip to knee muscles if found to be tight and causing dysfunction: hamstrings, IT band and iliopsoas.
Joint mobilization is one of the most overlooked and neglected areas of treatment in plantar fasciitis due to the skill involved in treatment and the lack of training among many practitioners. Restoring talocrural joint dorsiflexion (ankle up) mobility and subtalar joint (below the ankle) inversion or eversion (in and out motion of the ankle) is crucial. We must also look at the forefoot and 1st toe for restrictions and correct them accordingly.
Treatment options for Plantar Fasciitis:
- stretching/strengthening exercises
- intramuscular dry needling
- ankle/foot joint mobilization
- massage and IASTM (intrument-assisted soft tissue mobilization)
- corticosteroid injections
- (ESWT) Extracorporeal Shockwave Therapy)
- rolling exercises for plantar fascia
- ice roller or cryotherapy
- orthotics (Short Term) vs. (Long Term)
- foot taping
- night splints
- endoscopic plantar fasciotomy
For more information on proper exercises look to our YouTube video channel for a full treatment video: https://www.youtube.com/watch?v=_DubBdtFaLs and check out or Instagram page
https://www.instagram.com/dr_anthony_pribila/?hl=en for proper exercise performance for plantar fasciitis and other health, rehab and wellness tips.
To schedule an appointment and get your plantar fasciitis treated call (813) 876-8771 for Lakeland and Brandon or (727) 470-6070 for our Pinellas Park Office.