Plantar fasciitis is inflammation of the plantar fascia which is located on the bottom of foot. The plantar fascia originates on the inner heel of the foot and attaches to your toes. The inner bottom heel is a common location of pain of this injury and is often tender to touch.
This heel pain is is typically worse on weight bearing after a long period of rest. A classic example would pain on the first few steps when getting up in the morning after sleeping. The pain decreases after a taking a several steps and then returns after a period of weight bearing activity. 1,2,3
Common causes of plantar fasciitis:
- High or flat arch
- Improper or old footwear
- A rapid increase in walking or running distance without inadequate rest
- Poorly designed plyometric program
- Obesity
- Decreased intrinsic foot strength 1
A chiropractor can help determine the cause of your plantar fasciitis. If you are unsure of the cause of your plantar fasciitis, your rehabilitation will not be effective and the recovery will take longer. You cannot adress an injury without addressing the cause.
“My biggest piece of advice for treating plantar fasciitis is to adress the cause of the injury and remove it. In addition, to allow the tissue to heal you should decrease the amount of steps you take in the day and focus on non/low impact exercise (biking, swimming, weight training).”
Plantar fasciitis typically presents with altered biomechanics of the foot:
- Inadequate range of motion dorsiflexion due a tight gastrocnemius and soleus. In addition, he or she may have decreased ability to extend toes. 1,4
- Decreased intrinsic muscle strength. 1
Treatment Strategies
- Stretching the plantar fascia before getting up in the morning may decrease symptoms during the first few steps in the morning. This can be accomplished by using a towel to stretch the plantar fascia before getting out of bed.
- Plantar fascia release with a lacrosse ball.
- Avoid wearing high heel shoes as they place increased tension on the plantar fascia for extended periods of time due to the sustained ankle plantar flexion and toe extension. In addition, high heels don’t allow the foot to dorsiflex which reinforces the hypomobile gastroc-soleus complex associated with plantar fasciitis.
- Custom orthotics for your shoes may help decrease plantar fascia pain if you have a high or flat arch of the foot.
- Big toe mobility into extension is often decreased with plantar fasciitis and must be restored for proper foot biomechanics.
- Restoring intrinsic foot strength must be included in a plantar fasciitis chiropractic rehabilitation program. Towel toe curls are good place to start.
- The achilles tendon attaches to the plantar fascia via fascial connections. Foam rolling the gastrocnemius and soleus may decrease the tension of the plantar fascia and regain dorsiflexion mobility
References
- Martin, RL, et al: heel pain-plantar fasciitis: revision 2014. J Orthop Sport Phys Ther 44(11): A1- 33, 2014
- McPoil, TG, et al: Heel Pain – plantar fasciitis: clinical practical guidelines linked to the international classification of function, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sport Phys Ther 38(4): A1-A18, 2008.
- Thomas, JL, et al: The diangosis and treatment of heel pain: a clinical practise guideline-revision 2010. J Foot Ankle Surg 49(3):S1-S19, 2010
- Fuller, EA: The windlass mechanism of the foot. A mechanical model to explain pathology. J Am Podiatr Med Assoc 90 (1):35-46, 2000
Dr. Brandon Parnham, DC 