Plantar fasciitis is a very common foot condition that is treated by physical therapists. The current evidence suggests that this condition is not mainly characterized by inflammation but rather by degenerative changes in the plantar fascia. This may be a reason why your anti-inflammatory medications and ice are not working for your pain!

Symptoms

Daily pain in the morning is usually the major complaint.

The pain is most noticeable when patients begin walking.

Plantar pain during the initial steps after a period of inactivity (such as getting up after sitting at your desk).

Pain can be worse at the beginning of workout (or exercise).

Tender location

Patients usually report pain after palpation of the proximal insertion of the plantar fascia and plantar medial heel.

Most tenderness can be found at the calcaneal tuberosity.

Treatments

Clinician techniques for plantar fasciitis treatment include:

1. Passive joint manipulation of the ankle and foot

2. Myofascial maneuvers of the gastrocnemius, soleus muscles, and plantar fascia. This can include:

   • Tool assisted soft tissue mobilization

   • Dry Needling

   • Cupping

3. Neural mobilization of the tibial nerve

4. Stretching of the plantar fascia and triceps surae.

5. Taping to support the foot during the rehabilitation process

Trigger Points

Muscle trigger points may be involved in the development of plantar heel pain and one specific way we improve your pain. Clinically, a trigger point is considered active when the pain referral elicited during examination reproduces any symptom experienced by the patient and is recognized as a familiar pain. A trigger point is considered latent when the referred pain does not reproduce any symptom experienced by a subject.

As the stiffness of Trigger Point taut bands is 50% greater than that of the surrounding tissue, it is probable that they induce an excessive tension on the calcaneal insertion, thereby contributing to plantar heel pain.

Most trigger points can be in the calf (gastrocnemius), inside of foot (flexor hallucis brevis) and under the foot (quadratus plantae).

The pain referral elicited by active trigger points in the foot and leg muscles can reproduce the pain symptoms experienced by people with plantar heel pain. If this is the case, this is a good sign! This means we have concrete substance to perform techniques to address the trigger points and find strategies to minimize how sensitive they are to prevent future occurrences.

Patient techniques for plantar fasciitis include:

1. Stretching of the plantar fascia and triceps surae

2. Strengthening of the triceps surae

3. Strengthening of the intrinsic muscles of the foot

4. Strengthening of the hip muscles

We usually find that combining manual therapy with exercises (if you feel them where you should!) is the most effective treatment for plantar fasciitis. We look at both muscle strength and flexibility. Motor disturbances, that is, muscle fatigue and accelerated fatigability, can be a factor in the rehabilitation. Additionally, muscle stiffness and tightness can be a major factor in rehabilitation.

Frequency of treatments

Typically, patients receive treatment regimens of 3 weekly sessions over a period of 3 weeks or 4 weekly sessions over 4 weeks.

In our clinic, we usually see someone once a week for this period of time. Reason we have less frequency of visits is that we spend an ENTIRE hour with you personally (no technicians or other patients right next to you). We value your time and commitment away from life to visit us to help you.

We have the ability to offer different treatment options. This is important to suit different patient requirements and to fit around patients. Some patients respond better to different techniques. We strive hard to find your “cocktail” so you can get better faster!

Contact us to learn more or go ahead and book an appointment to get relief!

We offer specialized, personal treatment in our office in Wake Forest, North Carolina.