Written By: Steve Leary, PT
If you are new to the diagnosis of plantar fasciitis the above title may or may not apply to you. Most of you who have suffered from this diagnosis for 6 months or more, can relate to the spreading nature of this all too common diagnosis. The question that needs to be determined and addressed when it comes to plantar fasciitis is: does the problem come from the plantar fascia or does it come from the knee, hip, buttocks, back….?
It is estimated that plantar fasciitis affects about 10% of the world’s population. Clinically, we see durations that may be as new as several weeks old to as long as 25 or 30 years. As a Clinic Director of Hands On Physical Therapy here in Bend, Oregon (HandsOnPTBend.com), not a week goes by that we don’t treat at least several patient’s with a plantar fasciitis diagnosis. Often times these patient’s are frustrated because they have tried all the traditional approaches to get their plantar fasciitis better, yet they are still struggling with the problem.
I can not over-emphasize the importance of those traditional approaches: appropriate foot stretching and soft tissue work; rest from the offending activity; anti-inflammatory approaches like ice; good foot wear (we will touch on this a little more in this blog, as this is one area where treatment sometimes goes awry). For those of you who have done these things and are now more than 3 months into your foot pain, it is likely that there is a problem higher up the biomechanical chain (more often than not in the buttocks and hip area). Weakness and/or impaired flexibility higher up the leg or back can lead to repeatedly placing the foot on the ground in the wrong orientation. This will negate the incredible spring mechanics of the foot and place increased stress into the plantar fascia.
Plantar fasciitis is the “what”. To resolve plantar fasciitis you must address the “why”. No matter how we look at the problem there is a tissue mobility and inflammation problem in the plantar fascia. Clinically, we typically treat this by trying to calm down the irritation in the plantar fascia through taping the foot into a more biomechanically correct posture. This can be assisted through supportive foot wear; initially stiffer to allow the inflammatory process to recede, then gradually moving towards a more flexible shoe to allow improved mobility and stretching of the plantar fascia. The end goal ideally being comfort in barefoot walking. As the foot pain decreases, the flexibility or stretching component will increase.
To address the “why”, you must look at the whole biomechanical chain. After assessing the range of motion, coordination, strength and flexibility of the muscles and joints of the leg and back, you can determine what additional areas need mobility/strength/flexibility. An exercise plan can be put into place which returns the foot, ankle, knee, hip, pelvis and back to normal coordinated function and ultimately puts the foot into a place where it articulates with the ground properly and the plantar fascia is no longer under undo stress.
To learn more about this thought process on Plantar Fasciitis, please join me, Stephen Leary, PT for the Plantar Fasciitis Clinic at the FootZone on May 15, 2013 at 7 p.m.
Steve Leary, PT graduated from California State University at Long Beach in 1992 with degrees in Physical Therapy and Psychology. Steve excels in the biomechanical analysis of movement patterns. This ability allows him to get to the root of the dysfunction and problem. As an accomplished collegiate distance runner, he has a special interest in the running population. He volunteers his time monthly to answer questions and give recommendations at FootZone as well as for various running groups. Utilizing his experience in Manual Physical Therapy and knowledge of biomechanics he can tailor a flexibility and strength program specific to each patient’s needs.