Plantar Fasciitis - What is it and How do you treat it



Plantar Fasciitis is an inflammation of the plantar aponeurosis, a thick fascia located underneath the foot than spans from the heel bone (medial and lateral calcaneal tubercles) to the toes (plantar tubercles of the proximal phalanges) (See Figures 1 and 2 below). 


Figure 1 - Plantar Aponeurosis (Long Plantar Ligament).  A thick fascia that runs from the bottom of the heel bone to the toes.



Figure 2 - medial view of the foot demonstrating the insertion of the plantar aponeurosis into the heel bone.

Plantar Fasciitis is characterized by pain across the inside of the ankle (medial malleolus) and under surface of the heel bone (medial calcaneal tubercle) (See Figure 3 below).  Plantar Fasciitis is the most common foot symptom seen in chronic pain patients.


Figure 3 - location of pain associated with Plantar Fasciitis; inside of the ankle and the under surface of the heel bone.
  
In 1971, I published a paper in the Journal American Podiatric Association that challenged the then current thought that Plantar Fasciitis was frequently due to a heel spur irritating the long plantar ligament.  I suggested that Plantar Fasciitis (heel pain syndrome) was the result of excessive foot twist.  My paper was based on my findings that:
  • Many of my patients with heel pain (Plantar Fasciitis) did not have heel spurs
  • Many of my patients with heel spurs did not have heel pain
  • All of my patients with heel pain had foot twist
In this paper, I described the step by step process in which foot twist can culminate in heel pain (Plantar Fasciitis):
  • Foot twist expands the foot (longer and wider)
  • As the foot becomes longer, the long plantar ligament is stretched
  • As the long plantar ligament is stretched, micro tears occur in the attachment of the ligament into the heel bone
  • These micro tears result produce an inflammatory reaction, culminating in heel pain
My research remained controversial for approximately 20 years until the early 1990s when other research teams came to the same conclusions.

However, the question that still needed to be answered was: what causes the foot to twist?

This question was answered in a paper I published in 2002 in the Journal Movement Bodyworks Therapy, in which I linked foot twist to two embryological foot structures, the Rothbarts Foot and the PreClinical Clubfoot Deformity. I theorized that these two foot structures force the foot to twist due to the incomplete osseous development of the calcaneal (heel) and/or talar bones.

Therapy

Traditionally, Plantar Fasciitis is treated with arch supports.  The rationale of this therapy is to reduce the stretch on the long plantar ligament (plantar aponeurosis), thereby allowing the inflammation at its insertion points to heel (See Figure 4 below).  However, a randomized trial published by Landorf et al (2006) concluded that this approach resulted in only “small reductions in pain for people with Plantar Fasciitis”.  In my practice, I have found that arch supports frequently increase the pain in patients suffering from Plantar Fasciitis.

Figure 4 - Therapy using arch supports which actually increase the tension of the plantar aponeurosis, which in turn, predisposes this ligament to further micro tears.


Rothbart Proprioceptive Therapy  

Rothbart Proprioceptive Therapy has proven to be very effective in eliminating heel pain associated with Plantar Fasciitis.  The reason this therapy is so effective is that it treats the underlying cause of foot twist, which in turn, decreases the elongation of the long plantar ligament (and resulting inflammation of its insertion points as it is being torn away from the bone) (See Figure 5 below).


Figure 5 - Proprioceptive Therapy reduces foot twist, which in turn, decreases the tension on the long plantar ligament (plantar aponeurosis).

For more information on Rothbart Proprioceptive Therapy, go to: What is Rothbart Proprioceptive Therapy or Does Rothbart Proprioceptive therapy reduce foot twist? A technical presentation.


References

    Landorf KB, Keenan AM, Herbert RD, 2006.  Effectiveness of Foot Orthoses to Treat Plantar Fasciitis. Archives Internal Medicine, 166:1305-1310.
    Rothbart BA 1971.  Heel spur and heel spur syndrome.  Journal American Podiatric Medical Association (JAPMA), 61(5):186-9.
    Rothbart BA, 2002. Medial Column Foot Systems: An Innovative Tool for Improving Posture. Journal of Bodywork and Movement Therapies (6)1:37-46
   

Professor/Dr. Brian A. Rothbart
Chronic Pain Elimination Specialist
Discovered the Rothbarts Foot and the PreClinical Clubfoot Deformity
Developer of Rothbart Proprioceptive Therapy
Designer of Rothbart Proprioceptive Insoles
Founder of International Academy of Rothbart Proprioceptive Therapy
Author of Forever Free From Chronic Pain

Sign Up Now to get a free chapter from my book, Forever Free From Chronic Pain

Posted by rothbart at 11/18/2009 7:16 PM
Categories: Biomechanics (Technical)
Tags: Long Plantar Ligament Heel Pain Plantar Fasciitis Rothbart Proprioceptive Therapy Plantar Aponeuros
 

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