Our clinic often sees Plantar Fasciitis (PF) cases, a widespread issue we thoroughly explored in our 2015 book Resolving Plantar Fasciitis. This condition affects up to 2 million North Americans yearly, including athletes and non-athletes. It's especially prevalent in people who spend a lot of time on hard surfaces, those with muscle imbalances, or those with a history of foot injuries.Â
Tackling Plantar Fasciitis is often a complex task. Patients coming to us have frequently explored numerous treatments without success, from orthotics, instrument-assisted modalities, manual therapy, and exercises to more specialized methods and numerous types of injections. This extensive history of varied treatments can understandably make individuals wary of trying new approaches. Despite this, we usually find practical solutions that commonly lead to a complete resolution of this problem.Â
Article Index:
Introduction
Diagnosis
Treatment
Exercises
Conclusion & References
Symptoms of Plantar Fasciitis
Understanding the symptoms of Plantar Fasciitis (PF) is crucial for its diagnosis and management. PF, a common foot condition, often presents with specific and identifiable symptoms. Individuals suffering from PF typically experience:
Morning Discomfort: Intense pain in the foot and heel upon first standing in the morning, causing some to avoid putting weight on their heels and to walk on their toes instead.
Pain Reduction with Movement: A noticeable decrease in pain as they become more active throughout the day.
Pain with Prolonged Standing: An increase in pain, often centered in the heel, during prolonged standing or weight-bearing activities.
Varied Heel Discomfort: The nature of heel discomfort can range from dull aches to sharp, burning sensations.
Heel Pulling Sensation: A feeling of pulling in the heel area.
Difficulty with Hard Surfaces and Stairs: Challenges in walking or running on hard surfaces, as well as climbing stairs.
Nerve Pathway Symptoms: Numbness, tingling, or pain along the nerve pathways in the lower leg and foot.
Extreme Tenderness: Those with PF often report extreme tenderness when touching the inside of their heel (medial tubercle of the calcaneus).
Altered Walking Patterns: The foot pain can lead to changes in walking patterns, potentially causing related pain in the ankles, knees, hips, and back.
Anatomy & Biomechanics
In exploring the complexities of Plantar Fasciitis, it's essential to understand the structure and function of the plantar fascia itself. This knowledge not only aids in diagnosing and treating the condition but also highlights the interconnectedness of foot mechanics and overall musculoskeletal health.
The plantar fascia is a robust fibrous layer on the foot's underside, connecting the Achilles tendon and heel bone to each toe base. Its central area, the plantar aponeurosis, is notably thick and plays a key role in transmitting force from the Achilles tendon to the forefoot during walking.
This fascia stabilizes the foot's arch, preventing its collapse, and assists in walking and running by acting as a shock absorber, stabilizer, and propulsion aid.
Plantar Fascia - Your Body’s Windlass Mechanism
Usually, when we think of a Windlass Mechanism, we think of a mechanical lifting device that consists of a horizontal cylinder turned by a crank or motor, around which a line or cable is wound.
In the foot, the Plantar Fascia simulates the cable in a Windlass Mechanism, with the foot bones forming the frame around which the fascia or cable is wrapped.
Here is how it works in your foot:
The Plantar Fascia loosens and tightens with each change in the weight-bearing forces of the foot.
As you push off with your foot, the Plantar Fascia winds around the forward bones of the foot (heads of the metatarsals), reducing the distance between the heel bone (calcaneus) and the toes.
3. By doing so, the Plantar Fascia elevates the foot arch (medial longitudinal arch). It prevents the arch from collapsing, allowing for effective shock absorption and powering the propulsion mechanism. The Windlass Mechanism packs the bones of the foot together to create a rigid lever for more effective propulsion during push-off.
Key Point - Shock Absorption!
The Windlass Mechanism (Plantar Fascia Mechanism) is an incredibly important shock absorption apparatus. With conditions such as Plantar Fasciitis, Dancers Tendonitis (medial foot pain), or Cuboid Syndrome (lateral foot pain), restoring a dysfunctional Windlass Mechanism is critical for a complete resolution of the condition. This means releasing restrictions in the Plantar Fascia itself, the adjacent muscles, and the joints of the foot and ankle.
The Kinetic Chain and Plantar Fasciitis
Plantar Fasciitis (PF) arises from individual kinetic chain factors, injuries, and biomechanical issues. For some, it's about local foot structures; for others, broader kinetic chain elements are involved. Key foot muscles like the Flexor Digitorum Brevis, Abductor Hallucis, and Abductor Digiti Minimi play roles here. These muscles, insert into the heel and plantar fascia, often confuse the diagnosis, mingling fascia pain with other structural injuries. The Quadratus Plantae muscle, connected to the Flexor Digitorum Longus under the calf, shows how tension in distant muscles can influence foot movement.
Shins and calves are crucial in PF. Their strength and flexibility impact foot and ankle movements. Imbalances or limited motion range here can lead to abnormal gait patterns, contributing to PF. Surprisingly, the hamstrings and quadriceps are also key. Their interaction influences the whole kinetic chain, with dysfunctions potentially affecting the plantar fascia.
Tight hip flexors, especially the iliopsoas, often result from prolonged sitting and significantly affect PF. They can inhibit gluteal muscles neurologically, alter posture, and destabilize the lower limbs. Weak glutes, a consequence of sedentary lifestyles, add to this instability, leading to PF. These muscles encourage internal leg rotation, knee valgus, and foot pronation, which stress the plantar fascia.
Physical Examination
The videos below showcase commonly used orthopedic, neurological, and vascular procedures during the assessment of Plantar Fasciitis.
Effective Ankle and Foot Examination
This instructional video employs orthopedic tests to thoroughly evaluate prevalent conditions affecting the ankle and foot in clinical settings. Conditions covered in the video include Ankle Sprains (specifically, inversion sprains), Cuboid Syndrome, Talar Dome Lesions, 5th Metatarsal Fractures, Syndesmosis Damage, Morton's Neuroma, 2nd Metatarsal Stress Fractures, Plantar Fasciitis, and Bunions.
Lower Limb Neuro Examination
The lower limb neurological examination is vital to the broader neurological assessment process. This examination aims to scrutinize the motor and sensory neurons supplying the lower limbs, thereby identifying any nervous system impairments. Utilized both as a screening and diagnostic instrument, the lower limb neurological examination can offer invaluable insights into the neuromuscular integrity of the affected area, thereby informing more targeted treatment strategies.
Peripheral Vascular Examination - Key Points
The peripheral vascular examination is an indispensable diagnostic tool for identifying vascular-related pathologies and is critical in everyday clinical practice. Its ability to detect and help treat Peripheral Vascular Disease (PVD) can be instrumental in minimizing cardiovascular and cerebrovascular risks.
Differential Diagnosis of Plantar Fasciitis
Diagnosing Plantar Fasciitis (PF) involves ruling out other conditions with similar symptoms. Tarsal Tunnel Syndrome is a key differential diagnosis. It causes foot pain and tingling, similar to PF, but stems from posterior tibial nerve compression and demands different treatment strategies. Another condition to consider is Achilles Tendinopathy. It causes pain and stiffness in the Achilles tendon area, sometimes mimicking PF symptoms. However, Achilles Tendinopathy primarily affects the tendon connecting the calf muscles to the heel, unlike PF, which focuses on the heel and foot arch.
Stress fractures in the metatarsal bones or calcaneus mimic PF symptoms, especially localized pain during weight-bearing. These fractures usually have a sudden onset and are often linked to increased physical activity or trauma. Fat Pad Atrophy, which is common in older adults, is another consideration. This condition, where the heel's natural padding diminishes, causes pain that can be mistaken for PF. Accurately diagnosing and treating each condition underscores the necessity of a thorough evaluation to differentiate PF from other possible foot issues.
Motion Specific Release
Manual therapy is key in treating Plantar Fasciitis (PF), aiming to reduce pain, enhance foot mechanics, and restore function. Treatment starts with gentle foot and ankle manipulation to improve joint mobility and lessen stiffness, focusing on myofascial release to ease the tight structures contributing to PF. This method addresses both immediate discomfort and the biomechanical issues underlying PF.
The therapy also includes the calf, hamstring, and gluteal muscles, crucial in the kinetic chain affecting foot health. It involves releasing myofascial tension and improving muscle function to align the leg and foot, reducing strain on the plantar fascia.
Our goal is a complete PF resolution. Up next, I'll provide MSR (Motion Specific Release) demonstration videos for the feet, calves, hamstrings, and glutes, illustrating manual therapy's role in effectively managing PF.
Resolve Plantar Fasciitis - MSR Procedures
In this informative video, Dr. Brian Abelson, the Motion Specific Release (MSR) creator, showcases several protocols used to resolve plantar fasciitis.
Eliminate Calf Pain - Release Tom, Dick, and Harry
In this video, Dr. Brian Abelson will demonstrate some highly effective MSR procedures to restore relative motion between tissue layers, which can eliminate calf pain and improve overall function.
Hamstring Muscle Release - Motion-Specific Release
In this video, Dr. Abelson demonstrates Motion Specific Release (MSR) procedures for releasing the hamstring muscles. These muscles are not merely anatomical structures; they serve as functional pillars that influence a wide range of movements and activities, from athletic performance to injury prevention.
Gluteus Maximus & Medius - Motion Specific Release
In this video, Dr. Abelson demonstrates Motion Specific Release (MSR) procedures for releasing the Gluteus Maximus and Medius muscles.
Treatment Frequency Recommendations
When performing manual therapy for Plantar Fasciitis, some patients may experience initial relief or improvement within the first few sessions, especially in terms of pain and flexibility. However, structural and functional changes, such as the realignment of the foot, can take longer and may require consistent therapy combined with exercises and possibly orthotic interventions. The exact timeline for results can vary based on the severity of the condition, patient adherence to home exercises, and individual differences in healing. Regular assessments and feedback are essential to gauge progress and adjust the treatment plan as needed.
Initial Treatment Phase:
MSR Manual Therapy: 2 sessions per week for two to three weeks.
Home Exercises: Daily functional exercise programs as prescribed by the MSR practitioner.
Response Assessment:
Evaluate the patient's response to therapy during follow-up appointments, typically after two to three weeks of treatment.
Positive Response:
A positive response to manual therapy for the treatment of Plantar Fasciitis would be a noticeable reduction in pain and discomfort, coupled with improved toe alignment and enhanced functional mobility during walking and other activities.
MSR Manual Therapy: Reduce to 1 session per week.
Home Exercises: Continue daily routines; adjust as necessary based on professional advice.
Persistent Symptoms:
MSR Manual Therapy: Maintain frequency of two weekly sessions, reassessing the treatment approach weekly.
Home Exercises: Re-evaluate and modify exercises under professional guidance, ensuring correct technique and adherence.
When performing manual therapy for Plantar Fasciitis, treatment should continue as long as there's an improvement in symptoms and function. Ongoing therapy can be beneficial if progress is noted and functional goals aren't yet met. If there are no noticeable results, only marginal improvements or progress plateaus, treatment should be reconsidered or halted.
You should transition to maintenance care once the patient has achieved consistent symptom relief and optimal functional levels, ensuring that progress is sustained and potential recurrences are minimized. All decisions should be based on regular assessments and patient feedback.
Maintenance Phase:
MSR Manual Therapy: Monthly sessions or as needed.
Home Exercises: Daily routines to maintain benefits and prevent symptom recurrence, with periodic reviews by healthcare professionals.
Exercises
A phased exercise regimen is key to resolving plantar fasciitis (PF). Starting with mobility exercises to alleviate tightness and enhance foot and ankle motion is critical. These prepare the body for strength-focused exercises that target muscles supporting the foot arch and calf, which are crucial for proper foot mechanics and reducing plantar fascia strain. The regimen concludes with balance and proprioceptive exercises to improve the body's spatial awareness, preventing re-injury. This comprehensive approach relieves PF symptoms and fortifies lower extremity health to prevent future issues.
Below, we outline several exercises that might be recommended, tailored to the individual's specific needs and condition.
Foot Pain Relief - Self Myofascial Release
Foot mobility is paramount in preventing injuries, enhancing sports performance, and managing various foot conditions, such as plantar fasciitis and bunions.
Calf Muscle Release - Lacrosse Ball & Foam Roller
The gastrocnemius with the soleus, your calf muscles are the main plantar flexors of the ankle joint. In addition, the calf muscles are also powerful flexors of the knee joint.
Effective Foot and Toe Strengthening
Strong ankles, feet, and toes are essential for injury prevention and optimal sports performance. The anatomy and biomechanics of the foot and ankle complex play a vital role in maintaining the body's stability, balance, and movement.
Improve Your Balance - Exercises for Beginners
Balancing exercises are crucial components in Rehabilitation and Sports Performance training. They should not be overlooked, as they can bolster one's capacity to stabilize the body during functional movements. You can enhance balance and avert injuries by incorporating straightforward balance exercises into a progressive training program.
Conclusion
In summary, Plantar Fasciitis (PF) is a complex condition commonly encountered in our clinic and affects a diverse population. Our approach, detailed in the book "Resolving Plantar Fasciitis" and this blog, emphasizes a multifaceted treatment strategy. We recognize the importance of addressing various factors contributing to PF, including standing on hard surfaces, muscle imbalances, or past injuries.
Our treatment philosophy integrates understanding the plantar fascia's anatomy and biomechanics, considering the kinetic chain, and differentiating PF from similar conditions. Central to our approach is manual therapy complemented by exercises that progress from mobility to strengthening and balance. This holistic path aims not just for symptom relief but for the complete resolution of PF, combining manual therapy, as demonstrated in our MSR videos, with tailored exercise programs. Our goal is to provide comprehensive care that leads to lasting relief and optimal musculoskeletal health.
DR. BRIAN ABELSON DC. - The Author
Dr. Abelson's approach in musculoskeletal health care reflects a deep commitment to evidence-based practices and continuous learning. In his work at Kinetic Health in Calgary, Alberta, he focuses on integrating the latest research with a compassionate understanding of each patient's unique needs. As the Motion Specific Release (MSR) Treatment Systems developer, he views his role as both a practitioner and an educator, dedicated to sharing knowledge and techniques that can benefit the wider healthcare community. His ongoing efforts in teaching and practice aim to contribute positively to the field of musculoskeletal health, with a constant emphasis on patient-centered care and the collective advancement of treatment methods.
Revolutionize Your Practice with Motion Specific Release (MSR)!
MSR, a cutting-edge treatment system, uniquely fuses varied therapeutic perspectives to resolve musculoskeletal conditions effectively.
Attend our courses to equip yourself with innovative soft-tissue and osseous techniques that seamlessly integrate into your clinical practice and empower your patients by relieving their pain and restoring function. Our curriculum marries medical science with creative therapeutic approaches and provides a comprehensive understanding of musculoskeletal diagnosis and treatment methods.
Our system offers a blend of orthopedic and neurological assessments, myofascial interventions, osseous manipulations, acupressure techniques, kinetic chain explorations, and functional exercise plans.
With MSR, your practice will flourish, you will achieve remarkable clinical outcomes, and patient referrals will skyrocket. Step into the future of treatment with MSR courses and membership!
References
Abelson, B., Abelson, K., & Mylonas, E. (2018, February). A Practitioner's Guide to Motion Specific Release, Functional, Successful, Easy to Implement Techniques for Musculoskeletal Injuries (1st edition). Rowan Tree Books.
Buchbinder, R. (2004). Plantar Fasciitis. *The New England Journal of Medicine*, 350(21), 2159-2166. doi:10.1056/NEJMcp032745.
Chaitow, L., & DeLany, J. (2011). Clinical Application of Neuromuscular Techniques: The Lower Body (Vol. 2). Churchill Livingstone. [Specific sections on Plantar Fasciitis and Manual Therapy].
Cleland, J. A., Abbott, J. H., Kidd, M. O., Stockwell, S., Cheney, S., Gerrard, D. F., & Flynn, T. W. (2012). Manual physical therapy and exercise versus electrophysical agents and exercise in the management of plantar heel pain: a multicenter randomized clinical trial. *Journal of Orthopaedic & Sports Physical Therapy*, 42(8), 672-685. doi:10.2519/jospt.2012.4110.
Crawford, F., & Atkins, D. (2006). Interventions for treating plantar heel pain. *The Cochrane Database of Systematic Reviews*, (3), CD000416. doi:10.1002/14651858.CD000416.pub2.
DiGiovanna, E. L., Schiowitz, S., & Dowling, D. J. (2005). An Osteopathic Approach to Diagnosis and Treatment (3rd ed.). Lippincott Williams & Wilkins. [Chapter on Plantar Fasciitis and Manual Therapy Techniques].
Irving, D. B., Cook, J. L., & Menz, H. B. (2006). Factors associated with chronic plantar heel pain: A systematic review. *Journal of Science and Medicine in Sport*, 9(1-2), 11-22; discussion 23-24. doi:10.1016/j.jsams.2006.02.004.
Landorf, K. B., & Menz, H. B. (2008). Plantar heel pain and fasciitis. *BMJ Clinical Evidence*, 2008, 1111.
Martin, R. L., Davenport, T. E., Reischl, S. F., McPoil, T. G., Matheson, J. W., Wukich, D. K., ... & McDonough, C. M. (2014). Heel Pain—Plantar Fasciitis: Revision 2014. *Journal of Orthopaedic & Sports Physical Therapy*, 44(11), A1-A33. doi:10.2519/jospt.2014.0303.
McMillan, A. M., Landorf, K. B., Barrett, J. T., Menz, H. B., & Bird, A. R. (2009). Diagnostic imaging for chronic plantar heel pain: A systematic review and meta-analysis. *Journal of Foot and Ankle Research*, 2, 32. doi:10.1186/1757-1146-2-32.
Orchard, J. (2012). Plantar fasciitis. *BMJ*, 345, e6603. doi:10.1136/bmj.e6603.
Renan-Ordine, R., Alburquerque-SendÃn, F., de Souza, D. P. R., Cleland, J. A., & Fernández-de-Las-Peñas, C. (2011). Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial. *Journal of Orthopaedic & Sports Physical Therapy*, 41(2), 43-50. doi:10.2519/jospt.2011.3504.
Riddle, D. L., Pulisic, M., Pidcoe, P., & Johnson, R. E. (2003). Risk factors for Plantar Fasciitis: a matched case-control study. *Journal of Bone and Joint Surgery*, 85(5), 872-877. doi:10.2106/00004623-200305000-00015.
Sullivan, J., Pappas, E., & Burns, J. (2015). The role of exercise and physical activity in the management of plantar heel pain: A systematic review. *Foot & Ankle International*, 36(1), 105-112. doi:10.1177/1071100714551026.
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