Overview:� Plantar fasciitis is one of the most common foot ailments.� Physicians treat plantar fasciitis through many available means including stretching, physical therapy, night splints, taping, proper shoes, orthotics, anti-inflammatory medicines, cortisone injections, immobilization and surgery.� Procedures include both non-invasive (shock wave therapy) and invasive (endoscopic vs. open fasciotomy).� The products available through catalogues, online stores, drug stores etc. are numerous and available directly to the consumer, whether or not they have been properly diagnosed.� The consumer direct products are similar to those that me be used or recommended by physicians and therapists treating the disorder.� As can be readily seen by the length of options available, there does not seem to be one truly exceptional treatment available.
Etiology of Plantar Fasciitis:� Increased tension at the origin of the plantar fascia at the calcaneal tuberosity can cause an inflammation within the fascia as it attaches to the bone.� Should the tension be present over the course of many years, and/or the tension is excessive, a heel spur can develop.� The spur is a projection of bone seen on an X ray that extends from the Calcaneus (heel bone) within the line of tension along the plantar fascia.� This bone represents a finding that is seen and described on an X-ray, but is not necessarily a part of the symptom, and therefore, rarely needs to be addressed. �
Treatment failures:� Though all of the above treatments described in the overview have shown value to people, and will work in many situations, they do not necessarily treat the underlying cause (increased tension at the origin of the plantar fascia).� Each of the treatments can reduce inflammation, but none will work toward the resolution of the true cause of plantar fasciitis: increase in tension of the plantar fascia at the heel bone.� Surgery will relieve tension, but at the expense of creating imbalance within the foot.�� Properly casted and fabricated foot orthoses can be effective by controlling heel stability, and thus foot stability, but will only partially work at reducing the tension at the plantar fascia.� Night splints and heel stretching devices will actually increase tension at the attachment point of the fascia.� This can be helpful for post-static pain (pain with the first steps after periods of rest), but do not address the causes of the fasciitis.
Breakthrough:� To decrease tension at the plantar fascial origin, one must look beyond the foot and into the biomechanical chain that creates movement.� There are 7 major muscles that originate in the back of the leg that traverse the ankle joint and insert into the bottom or side of the foot.� There are 3 more major muscles on the front of the leg that traverse the front of the ankle inserting onto the top of the foot.� As movement occurs, the muscles will activate in a coordinated pattern that allow the foot to lift, swing through the air, land, rotate to absorb shock, rotate to create stability, and then lift again.� That is termed the gait cycle.� As the body rotates forward, each muscle contracts in a learned pattern that repeats itself millions of times throughout a lifetime.� Thus, if there are imbalances, weak muscles, tight muscles, problems with bones or joints, then the repetition will create further imbalance which will lead to compensation, and possibly pain anywhere along the biomechanical chain.� In the discussion of plantar fasciitis, if there is tightness within the muscles of the back of the leg, then there will be a limitation of the tibia (leg bone) to move forward at the ankle joint and the heel will lift early.�� The heel will raise when the leg is internally rotated and the foot in a destabilized, shock absorbing position, rather than being in a position of stability, able to withstand the force applied to the heel.� As such, the early heel rise on an unstable foot will increase tension in the plantar fascia.� Through deep tissue manipulation, the muscles in the back of the leg can be relaxed and relatively lengthened.� This will allow the forward movement of the tibia to be less restricted over the foot.� The ankle can bend, and the tension at the plantar fascia can be reduced.� Thus, by focusing on the muscles that control foot function, rather than the just within the foot, the tension to the heel can be reduced to the point, where relief can be felt almost immediately after a treatment that can take as little as 2 minutes.
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Dr. Feldman specializes in reconstructive foot surgery and diabetic foot care, with a special interest and expertise in Sports medicine. He is an accomplished marathoner, 3-time Ironman Triathlon finisher and 2004 honorable mention all-american triathlete.
Visit Centreal Massachusets Podiatry’s web site: worcesterfootcare.com
