PT on the Net Research

Plantar Fasciitis


Question:

What should I do about a client with plantar fasciitis?

Answer:

Plantar fasciitis is the condition where the fascia or connective tissue on the bottom of a persons’ foot is inflamed. This can occur when the person has a problem with pronation. When the ankle pronates, the halicus muscle group located on the medial aspect of the tibia and foot, become stretched. The hallicus group is attached to the fascia on the bottom of the foot. This excessive pulling and stretching causes inflammation and added stress to the fascia. Along with pronation comes a weakened or flattened medial arch of the foot. The flattened arch will also stretch the fascia causing irritation.

So, what should you do? We need to address the cause versus the reaction to the cause. Far too often people will address the symptoms rather than the cause. The trainer should note that there is a pronation-distortion pattern that has developed and should have a training strategy for that particular pattern. This pattern is very systematic and will cause predictable patterns of stress or pain throughout the kinetic chain. These predictable patterns of stress are called serial distortion patterns. If this pattern is not kept in check, it will present itself as shin splints, anterior knee pain and eventually low back pain if it has not gotten there yet. Your client should do as many exercises as possible while holding a medial arch in his/her foot. This is accomplished through a gripping of the toes to the ground. What must be noted is that the individual should never start an exercise session with a trainer if they are in acute pain. Acute means that they hurt before they start and get sharp localized pain when performing normal tasks. These people should seek medical attention. Provided they do not exhibit acute pain, the tight muscles that you should be aware of are the peroneals, the adductors, hamstrings, IT band and the hip flexors. These muscles become tight because of the serial patterns that have developed along with the plantar fascitis. Self-myofascial release with a foam roller will help your client release some of the spasm they are experiencing in those muscles. I hope this advice helps. The serial distortion patterns are present in over 70 percent of the adult population. To my knowledge, Vladimir Janda was the first person to do extensive research in the area of serial distortion.