You have stretched, braced, iced, rolled, rested, strengthened, changed shoes and prayed to the plantar fascia gods but nothing is helping your chronic plantar fasciitis. You are not alone, it occurs in 10% of the population. Don’t worry your problem is correctable but may be related to more than your foot. Plantar fasciitis causes heel pain in active as well as sedentary adults of all ages. There are many causes that can include overuse, improper foot wear, obesity, sudden increase in duration and frequency of activities. Plantar fasciitis is defined as inflammation of the plantar fascia. With any inflammation, the stress causing the inflammation must be removed to completely treat the problem. In most cases, plantar fasciitis doesn’t resolve or keeps returning because the cause of the problem is not corrected. Common symptoms include, pain in the heel with the first steps in the morning, sharp, localized pain in the heel or arch, and slow decrease in pain with activity. With chronic plantar fasciitis, one must look past the foot and ankle.

     The foot has 33 joints and 20 muscles, with the muscles and fascia attaching to the bones that make up the joints. The plantar fascia has many attachments throughout the foot. A lot can go wrong in such a small space. A joint that doesn’t move properly can cause a host of compensatory reactions in other joints and soft tissues in and around the foot. Joint restrictions can lead to changes in the way your walk, asymmetry in flexibility or limitations in your nerve mobility all the up the kinetic chain. These problems will turn an acute situation, into a chronic problem quickly if not corrected. So it is important to treat all systems to effectively heal the plantar fascia. The biggest problem may actually be in your lower back. The nerves that exit your lower back area are the ones that control the foot and ankle. A joint restriction in your lower back may be the actual cause of your plantar fascia. Restrictions in the lower back cause biomechanical alterations to the joints down the kinetic chain and can limit normal nerve mobility. All this can create abnormal stress to the foot and ankle, especially if combined with an activity like running.

     Manual physical therapists will assess strength, flexibility, joint and soft tissue mobility, and nerve mobility of the entire lower quadrant to include lower back, pelvis, hips, knees and feet. We will correct for any joint restrictions throughout the kinetic chain to ensure a quick return to pain free living. Modalities may be appropriate to treat swelling, pain or inflammation. These can include ultrasound, iontophoresis, electrical stimulation, infrared and/or cold therapy. Exercises will be prescribed to normalize mobility and prevent further issues. Research shows that most cases of plantar fasciitis improve over time with these conservative treatments, and surgery is rarely required. So, if you are still dealing with plantar fasciitis, it is time to see a manual physical therapist at Synergy Manual Physical Therapy. In the meantime, be sure to rest as much as possible, perform stretching of the hips, plantar fascia and calf, massage the bottom of the foot and ice multiple times throughout the day. Hang in there; it will improve with the right care.