Fight that Plantar Fasciitis!

One of the most common complaints of the foot is plantar fasciitis. It affects as high as 25% of amateur and professional runners. Plantar Fasciitis is essentially inflammation of the thick band of tissue that connects the calcaneus or heel bone to the base of the toes. It is a fairly prevalent condition in runners and casual joggers and can lead to perceived pain at the bottom of the foot and heel. The most common symptoms of plantar fasciitis include pin-point heel pain and pain in the foot while running, particularly while running up-hill. But what causes it and how can we prevent it? 

Plantar fasciitis symptoms typically develop due to poor motor control and strengthening of the intrinsic foot muscles. During the early phases of life, poor foot muscle control can lead to a decrease in the arch of our foot, while decreasing the function of the plantar fascia in our foot as a shock absorber as we run. This causes increased stress around the foot leading to plantar fascia-like symptoms at the heel. In addition, one muscle in particular, flexor digitorum brevis, has been shown to play a major role in the function of the plantar fascia. The flexor digitorum brevis plays a dynamic role in sharing the forces that move through the plantar fascia while running. In fact, current research now shows that the best predictor for the development of plantar fasciitis is not the arch of the foot but in fact strength of this particular muscle. 

A great way to determine the strength of your flexor digitorum brevis is the paper grip test. Take a business card or smaller piece of paper (business cards or denser paper works better for this test) and place the base of your second through fifth toes over it. Have a partner try to pull the card out from under the base of the toes. If the person can grip the card well enough with the toes, the test is negative and the person does not have weakness at the flexor digitorum brevis. Some runners will be surprised by how little force it takes to pull the card from their toes though!

So what can you do when you think you have plantar fasciitis? There are 33 joints in each foot. Manipulative therapy, or adjustments, aim to increase the mobility of joints with decreased or altered motion. Increased foot mobility at the joints leads to decreased tension at the plantar fascia and increased ROM during gait. Studies show that chiropractic manipulative therapy with a stretching protocol was shown to be more effective than bracing after one month of care. 

DNS or Dynamic Neuromuscular Stabilization utilizes stable positions found naturally in developmental kinesiology. To increase arch of the foot, patients are put in these developmental stage positions to activate the intrinsic muscles of the foot and the deep stabilizing muscles up the rest of the lower kinetic chain. 

Dry needling has been shown to alter the biochemical environment surrounding a myofascial trigger point and reduce spontaneous electrical activity within the trigger point region of muscle and fascia. This method is one of the most popular treatments with minimal side effects used for treating chronic pains. A single-blinded randomized controlled study showed decreased heel pain with use of dry needling and it can be used as an effective long-term treatment option before more invasive procedures. 

Soft tissue work with Active Release Technique by hand or with soft tissue tools such as Graston have been shown to be very effective in treating plantar fasciitis symptoms. It gives a neurologic window to make changes within the tissues of the foot to then support with a good strengthening / rehabilitation program. 

Dr. Alec Domjan, DC

Do you have foot or heel pain and think you may have plantar fasciitis? Set up an appointment with one of our Indy Muscle and Joint providers!