The Key to Solving Plantar Fasciitis

Introduction

There is no one-size-fits-all answer to resolving plantar fasciitis, as the best treatment plan will vary depending on the individual’s specific symptoms and history. However, there are a few commonalities among the majority of plantar fasciitis-suffering cohort. Most people who have plantar fasciitis experience heel pain upon waking and worsening pain as they exercise or stand on their feet throughout the day. Some may also feel a burning pain in the heel or arch of the foot, often during physical activity or when barefoot. The plantar fascia is a thick band of tissue that connects the heel bone to the toes, its function is to maintain the arch of the foot through propulsion, acts as a shock absorber, and reciprocates energy stored through midstance of the gait cycle. There are three main commonalities among people who have plantar fasciitis: 

1. Weak intrinsic foot muscles
2. Lack of ankle and big toe dorsiflexion
3. Weak peroneal muscles

Weak Intrinsic Foot Muscle

The intrinsic foot muscle that is responsible for controlling toe deceleration through propulsion (push off when walking or running) is the flexor digitorum brevis (FDB). When this muscle is weak, there is more force applied to the plantar fascia. Overuse of this strategy can cause the plantar fascia to become inflamed and painful. One of our favorite exercises to strengthen the FDB is to do banded toe flexions. 

Lack of Ankle and Big Toe Dorsiflexion

Having a lack of ankle and big toe dorsiflexion means that the ankle joint is not moving upward toward the head. The plantar fascia attaches to the big toe, and when the big toe is brought up towards the head, the medial longitudinal arch (arch of the foot) increases by tensioning out the plantar fascia. By increasing this range of motion, the big toe can go through a full excursion without stressing the fascia. If the ankle isn't allowed to go through its proper range of motion, there is more demand placed on the foot to absorb the ground reactive forces created by propulsion. My favorite ankle mobility drill to encourage proper dorsiflexion of the big toe and the ankle is half-kneeling dorsiflexion with a big toe wedge. 

Weak Peroneal Muscles

Peroneal muscle group responsibility is to evert the foot, as well as, allow the first metatarsal-phalangeal joint to glide posterior and dorsally when the big toe is dorsiflexed through propulsion. The mechanism of involvement for the weak peroneal muscles has not been identified yet, however, based on the main function of the peroneal muscles I can only hypothesize that the foot isn't everting and the big toe dorsiflexing adequately. The jury is still out to determine if weak peroneals are due to the plantar fasciitis or is a contributor to its manifestation.

Conclusion

If you're currently working with a provider to treat plantar fasciitis and all you're doing is dry needling, shock wave, or myofascial release; you've got to focus on these underlying issues propagating the pain instead of just alleviating the symptoms. Identifying the root cause of the pain is critical in resolving the problem and preventing it from recurring in the future.

- Dr. Dakota Vaughn