Plantar Fasciitis is known to be a recalcitrant and difficult to treat condition. Most current treatment approaches focus on treating the pain and inflammation of the foot, doing some stretching, massage, perhaps some foot strengthening, and maybe some taping or orthotics. However, treating only the symptoms or limiting treatment only to the foot is not the most effective way to get this condition resolved.

In order to treat plantar fasciitis effectively, you need to first figure out what factors are contributing to increased load through the tissue. This diagnosis needs to look all the way up the kinetic chain.

The assessment will start with the foot, including assessing the mobility of the mid-foot, ability to load through the first metatarsal head and big toe, and maintain the arch structure through gait. Then ankle mobility needs to be assessed. Is there a dorsiflexion restriction that is causing more stress through the mid-foot and forefoot during gait, resulting in loading and splaying of the longitudinal arch and plantar fascia? Look at calcaneal inversion and eversion. If the heel isn’t moving well, more load is absorbed by the plantar fascia. Check for inhibited muscles. Is the tibialis posterior firing appropriately? How about the peroneals? These are crucial for foot stability and appropriate load distribution. Look at the hip and pelvis. Is the ipsilateral hip extending and pushing off? Is the glute firing appropriately? If the glute isn’t working, the gastroc/soleus will compensate for push-off. This will create tightness and restriction of mobility which can result in more loading of the plantar fascia.

What is the opposite leg doing or not doing? Are those muscles firing? Is that leg participating or is it inhibited for any reason and causing compensation and increased loading through the symptomatic leg. Core function needs to be tested, stability and balance should be assessed. If there are restrictions and inhibitions coming from the core, creating poor neuromuscular coordination and lack of balance control, ankle strategy takes over and the feet are working extra hard to maintain upright posture and ambulate, further placing demand on the plantar fascia.

This assessment outline is by no means complete, and different people will require a different assessment flow based upon their presentation and findings. These are merely suggestions to help facilitate a thorough diagnostic process.

Once the contributing factors are determined, including complete kinetic chain diagnosis, the dysfunctions can be corrected, and the plantar fascia can be relatively off-loaded. Supportive taping or orthotics can further support the injured tissue while healing occurs. Once the pain and inflammation are decreased, high load strengthening can be initiated to improve the strength and load capacity of the plantar fascia, as well as intrinsic and extrinsic muscle strengthening to improve foot strength, endurance, and load carrying capacity. Weaknesses discovered up the chain can also be addressed which will help ensure a lower likelihood of symptom recurrence.

A thorough diagnosis of the entire kinetic chain affords highly specific and effective treatment. This is how I fix plantar fasciitis in just a few visits.