By Nick Mazzone, PT, DPT, CSCS
What is the plantar fascia?
The plantar fascia is a thick band of connective tissue that runs from the lower surface of the heel to the beginning of the toes. This fibrous band of tissue is placed under tension during walking and other activities in which you place weight onto the feet. This tension creates support and stabilization of the arch of foot, which will help stabilize the entire lower extremity during these types of activities.
What causes this structure to become inflamed?
While the exact mechanisms behind the causes of plantar fasciitis are not completely understood, the condition has been correlated with some mechanical issues at the foot and ankle. One of the more common impairments associated with this condition is inadequate dorsiflexion of the foot. Dorsiflexion is the movement performed when the top surface of the foot comes closer to the front of the leg.
Another impairment that is commonly associated with plantar fasciitis is weakness of the posterior tibialis muscle. This muscle helps to increase arch height during activities in which weight is placed on the feet.
This condition can also be considered an overuse injury. For instance, a running athlete may progress their running program too quickly without allowing their body to adapt. This can cause inflammation and pain in the plantar fascia.
What can PT do to help?
Your physical therapist will create a specific treatment plan tailored to your needs and impairments. Most commonly, the treatment will consist of mobility drills and functional stabilization techniques to help support the arch of the foot. These exercises are more effective when performed with weight on the legs in a standing position, as this is more closely related to the way in which these structures actually function in the real world. Your program may start more conservatively depending on your pain and activity tolerance.
The ultimate goal of the treatment is to progressively load these structures so that they become adapted to increased stress. This will ensure that the plantar fascia can handle the demands placed on it during our daily endeavors, whatever they may be. In some cases, a physical therapist will recommend orthotics to help provide support to the arch of the foot.
Check out this video depicting 3 simple exercises that can be performed to help improve your plantar fasciitis:
Nick Mazzone received his Doctorate in Physical Therapy from Stony Brook University. He has a strong background in strength and conditioning and aims to bridge the gap between strength training and physical therapy. Nick believes that a lifestyle centered around physical fitness and mental well-being are vital to one’s successes and happiness. For this reason, he educates his patients on pain science and helps empower them and motivate them to reach their goals every day. You can find him at Evolve Physical Therapy in Mill Basin, Brooklyn. To view some of his other content, visit drnickmazzonedpt.wordpress.com.
Picture of painful foot retrieved from https://www.tcpaindoctor.com/can-prp-help-treat-plantar-fasciitis/
Picture of plantar fascia function during weight bearing retrieved from https://painphysiotherapist.com/2016/05/25/plantar-fascia-rupture/
Picture depicting dorsiflexion of ankle retrieved from http://www.militarydisabilitymadeeasy.com/
Picture of posterior tibialis retrieved from https://www.fixpodiatry.com.au/podiatry-conditions/tibialis-posterior-tendinopathy/
Picture of collapsed arch retrieved from https://www.epainassist.com/sports-injuries/foot-and-heel-injuries/flat-feet-or-pes-planus-or-fallen-arches
Photo of orthotic placement retrieved from https://bestwalkingfeet.com/good-shoes-for-flat-feet/insoles-and-inserts/
Wheeless' Textbook of Orthopaedics. (n.d.). Retrieved from http://www.wheelessonline.com/ortho/Plantar_fascia