Article

Assessment and Tx of Plantar Fasciitis

The coming of spring means rebirth and rejuvenation. This also means it's time for many of us to come out of our long winter hibernation. Spring is that time of year when exercise starts to take front and center stage, because most of our clients, at this point, are concerned about their lack of exercise though the winter and their bulging waist line. With that come some common mistakes by our overzealous clients. A few universal traits to look for with your clients:

• Are they pushing themselves too hard?
• Are they stretching?
• Are they balancing their exercise so not to over-strengthen one particular area while ignoring others?

If they fall under any of these criteria, then they may be setting themselves up for an injury that will hamper their desire for exercise / weight loss. As bodyworkers, in many instances we step in before the injury occurs, and there is no ballyhoo for the preventive side of bodywork. Does the client know we saved them from a possible debilitating hamstring injury in June, or that nasty piriformis syndrome in September? Nope, that side of the work goes unnoticed until the client stops using our services and limps back into the office six months later saying, "fix me, I'm broken". And we just shake our heads and say "No Duhh, you should have, at minimum, been here for maintence on a semiannual basis". Well, we really don't say "No Duhh" to our clients, but my inside voice sure is screaming it. Whew, thank goodness for my filter that prevents those lil' things from bursting forth out of my lips.

One of the common injuries associated with new activities is plantar fasciitis.

Let's review the anatomy of the plantar fascia (PF). The plantar fascia is located on the bottom of the foot deep to the skin and adipose layer of the plantar surface of the foot. The PF attaches onto the anterior calcaneus on one end and the five metatarsal heads and phalanges on the distal end.

In the picture to the above, the plantar fascia is the superficial layer and is AKA the plantar aponeurosis.

One of the functions of the PF is to help maintain the integrity of all the aches, but its main focus of arch support is on the integrity of the medial longitudinal arch. The MLA is the long arch associated with the inside of the foot.

Another extremely important function of the PF is with walking, when the push-off phase of walking is taking place, the PF is pulled taught acting like a spring, the toes go into extension during push-off. This helps to create kinetic energy to propel the body forward. (Kinetic energy is energy of motion. The kinetic energy of an object is the energy it possesses because of its motion.) Think of a rubber band running from the heel to the toes, and the rubberband is being stretched every time you move the toes to the nose (extension). Well, the rubberband is creating energy to pull the toes back down into neutral position, and with push-off during walking the plantar fascia is helping to thrust you forward... energy in motion = kinetic energy.

Now that we have an understanding of where and what the plantar fascia is, lets take a look at; "What is plantar fasciitis"?

Plantar fasciitis is an inflammatory condition involving the plantar fascia near the calcaneal attachment. There is controversy about the "inflammatory" part of plantar fasciitis. It is now being looked at in the same context as tendonitis and tendinosis conditions. The inflammatory response is a reaction to injury or a repetitive stress injury (RSI). The "itis" part of this condition may last up to a month and is typically near the calcaneal attachment, which is much smaller and a more focused attachment then the distal attachment of the five tendons that run up to the toes. The tensile forces coming from all five toes tend to pull heavily on one central point, the calcaneous. Lets also remember our anatomy, the tendons do not actually attach to the osseous tissue. Right? The tendons attach to the periosteum which is loaded with pain receptors, so this injury tends to be extremely painful. The pulling on the periosteum also creates stress loads on the bone which is a signal for bone growth. If this new growth occurs, it maybe in the form of a bone spur because of the localized pulling of the plantar fascias attachment on the calcaneus.

Plantar fasciitis can often be the result of pronation of the foot, AKA flat foot (eversion). Pronation results in the plantar fascia becoming over-stretched and creating a constant tension in the fascia. This pronation is a biomechanical dysfunction which results in the medial arch lowering to the ground. One of the functions of the arch is to act as