Plantar Fasciitis

Plantar Fasciitis, bottom of your foot pain, is very common. It can be very debilitating and for most people chronic with very little answers. The western medicine philosophy is to bace it and immobilize your foot. That is to wear a boot, take a steroid dose pac, get custom shoe orthotics. That might help calm your symptoms but it does not address why you are having your foot pain.
First, plantar fasciitis is commonly over diagnosed. There are multiple reason to have foot pain and most of the time the main cause of the foot pain is due to a dysfunction up the kinetic chain.

The most common reason we see people with plantar foot pain is due to tightness and weakness in the posterior chain of the leg. There is research showing a continuous fascial connection from the tips of your toes, to the back of the calves, into the hamstrings, to the glutes, low back, upper back to the base of your skull. It crosses your muscles and joints and tightness along this posterior chain, most likely in multiple areas will put increased strain on the bottom of your feet, the weak link in the chain. Most people who have chronic foot pain also has a history of low back pain, hamstring and calf tightness, to name a few. It is a much broader issue than just foot pain. Our goal with treating plantar foot pain is to help alleviate the tension of the above areas to take pressure off the posterior fascial chain and this will in turn decreased the inflammation and pain in the foot.

The ankle and foot has 33 joints and 26 bones. The structural makeup is meant to provide support and stability but at the same time flexibility and mobility to walking all types of surfaces. Because of this, there are many joints, muscles and nerves that can cause pain to the plantar surface of your foot.

One of the most common issues of plantar foot pain is Posterior Tibialis Tendinitis ( https://www.physio-pedia.com/Tibialis_Posterior ). This muscle originates in the calf and the tendon will travel behind your ankle bone, medial malleolus, and attaches to multiple points on the bottom of your foot. The main purpose of this muscle is to prove stability to your arch. If the
Posterior Tib is not strong enough and functioning properly then every time you step down you pronate, or lose you arch. This movement puts a strain on the Posterior Tib tendon, kind of like a rope on the side of a rocking boat, it eventually gets frayed and loses its strength. Posterior Tibialis Tendinitis refers pain the the bottom of your foot, just in front of your heel bone. Very
similar location as Plantar Fasciitis. At Pro Motion PT we provide soft tissue work to free up the tendon for proper function and then work on strengthening this muscle along with surrounding muscles to properly stabilize the arch and alleviate tension. Other muscles commonly refer pain to the foot are the plantar quadratus and the Abductor Hallucis and the Quadratus Plantae
muscles.

Another source of foot pain can be joint tightness. The foot needs to be very stable, when we heel strike, but also very mobile, when we step to flat foot. Just like other joints in the body, where there is improper stability and lack of movement the joints can become tight, hypomobile. The two of the most common joints/bones that need to be mobile and cause patients trouble are
the Talocrural joint and the cuboid bone. The Talocrural joint connects your shin to you foot. It is the most common joint sprained in the ankle. The most issue is when the talus bone rests too far forward in the joint. Typically when the ankle bends up, the Talus is suppose too glide backwards to create space for your shin bones, your Tibia and Fibula. When the Talus rests too far forward hit creates a jamming of the shin bones which prevents you from getting proper range of motion. The second bone that commonly causes pain in the foot is the cuboid. This bone rests on the outside of your foot and although often overlooked plays a major role in the cause of foot pain. Mostly when people are walking more on the outside of their feet they are putting increased stress on this bone. This increased stress will cause the bone to slightly rotate and this can refer pain to many areas of the foot. The joint mobilization can be uncomfortable but the results are very positive. Allowing the cuboid to rest in its neutral position is vital to
proper foot biomechanics. There are also other joints that play a big role in proper foot function. The calcaneus, navicular bones as well as mobility of the first toe all contribute to proper walking and pain. During the initial evaluation we will assess all the joints to make sure the foot is moving properly.

Just like anywhere else in the body nerves compression can lead to foot pain. Most commonly, the sciatic nerve. Please see (link to sciatic nerve page). But being more specific right after the medial malleolus there is a branch off the Tibial nerve called the Calcaneal Nerve ( https://www.physio-pedia.com/Baxter's_Nerve_Entrapment ). The Calcaneal nerve has three branches and all of them are sensory only, meaning they don’t innervate any muscles only sends sensory information to the brain. These nerves can get compressed due to tightness on the inside of the ankle and refer pain to the inside or bottom of the heel bone. Doing proper nerve testing will be able to determine and neural dysfunction.

Unlike most medical professionals who want to immobilize and restrict movement in your foot, Pro Motion PT wants to restore proper mobility, stability and function not only in the foot but up the entire posterior kinetic chain. Most other PT clinics will have you do simple band exercises, balance on one foot and do some heel raises but the highly skilled manual PT’s will dive deeper
into the biomechanics of your foot and entire leg.