Plantar Fasciitis, like all repetitive stress injuries, typically develops over a long period of time. The fascia and soft-tissues of the feet can be stressed by:

•Alterations in normal foot biomechanics due to physical activity.

•Soft-tissue restrictions in tissues ranging from the foot to the hamstrings

•Repetitive motions that stress soft-tissues in the feet and legs.

•Standing on hard surfaces for long periods of time.

•Existing muscle imbalances.

•Increased physical activity.

•Shoes that do not provide arch support.

•Acute trauma to the feet.

As a result of these repeated stresses, the fascia and surrounding tissues develop micro-tears. When these tissues lack the time or opportunity to heal properly, they become inflamed and irritated by their continual usage.

The inflammation process causes the body to lay down additional restrictive, adhesive scar tissue across the inflamed structures, and results in a shortening of the plantar aponeurosis.

These restrictive fibers also bind the layers of adjacent soft-tissues together, and prevent them from translating or moving freely across each other. This entrapment causes further friction and inflammation. Ultrasound measurements from tissues of symptomatic and non-symptomatic patients showed the symptomatic tissue to have an increased thickening, as the varioussoft-tissue layers adhered together.

The Traditional Perspective

The medical community has been arguing about the cause and solution for Plantar Fasciitis for over 200 years.   Traditional treatment methods used over the last 200 years have continued to deliver relatively poor symptomatic relief. Unfortunately, many of these treatments leave patients unable to perform their daily activities without continuing to experience some degree of pain.

Typical traditional treatments can take 6 to 12 months before they provide any level of relief from the pain. Unfortunately, this relief is generally temporary in nature, and symptoms typically return within a short time.

These traditional treatment methods fail to resolve Plantar Fasciitis since they:

•Treat only the symptoms rather than the cause of Plantar Fasciitis.

•Do not consider the deeper soft-tissue structures that may also be restricted or inflamed.

•Do not consider the other restrictions that may exist within the foot'

•kinetic chain - from the foot to the hamstrings

•Do not remove or resolve the root cause of plantar fasciitis – the restrictive connective fibers that bind and restrict the inflamed soft-tissues.

A Better Solution

Even though people will continue to argue about which is the most effective treatment for Plantar Fasciitis, we believe that the results that are achieved speak for themselves. The best treatment results will be achieved by the therapy that addressees the true, root cause of the problem.

Standard treatment techniques generally achieve poor results since

practitioners often do not consider the deeper soft-tissue structures which are also involved in causing Plantar Fasciitis.

I view Plantar Fasciitis as a series of soft-tissue restrictions that

inhibit biomechanical motions. These restrictions limit tissue translation and affect the biomechanics of the entire body.

Our clinical experience has shown that Plantar Fasciitis is caused by more than just inflammation of the plantar aponeurosis. We have found that in addition to the inflammation of the plantar aponeurosis, we must also take into account: Several commonly-ignored deep muscles that lie below the plantar aponeurosis – For example the quadratus plantae and the flexor digitorum brevis.

The altered biomechanics caused by soft-tissue restrictions in other partsof the feet and legs.

Layers of tissue deep within the foot that have lost their ability to

translate or move freely across one another due to restrictive adhesions that formed between adjacent structures.

By removing these soft-tissue restrictions, we often achieve a functional resolution of this condition in avery short time period. It is not uncommon to see a significant reduction in symptoms in only 1 to 3 patient visits with resolution within 4 to 8 visits.

Once treatmentt has been used to release the restrictions in these structures, the patient experiences an immediate change as the range of motion increases and the foot becomes less tender. In fact, patients are constantly amazed that, after only one treatment, they are able to stand comfortably on the foot, which only moments before, caused them excruciating pain.

Going the Extra Step -The Kinetic Chain

Research has shown that other structures, other than the plantar fascia and plantar aponeurosis, are involved in most cases of Plantar Fasciitis. Other structures which cause, or are related to, excessive pronation include:

•Calf muscle restrictions in the gastrocnemius and soleus.

•Hamstring restrictions in the biceps femoris, semitendinosus, and semimembranosus muscles.

•Quadratus plantae, flexor digitorum brevis, flexor digiti minimi, abductor hallucis, and flexor hallucis brevis.

•

Further up the kinetic chain, structures such as the internal and external rotators of the hip can also cause problems with the biomechanics of the lower extremities. 

To ensure proper resolution of Plantar Fasciitis, ART practitioners always look beyond the immediate symptomatic area of the foot, and consider structures within the balance of the kinetic chain. By treating these additional soft-tissue structures, the practitioner is able to address the original biomechanical dysfunctions that may have caused the Plantar Fasciitis condition, and thereby prevent a reoccurrence of the problem. Biomechanical analysis is also part of any ART analysis. During a biomechanical analysis, the practitioner:

•Identifies both the primary and antagonistic structures involved in the injury.

•The affected structures can vary greatly from individual to individual, although all patients may manifest the same physical pain symptoms.

•Locates the restrictive adhesions that have formed.

•Determines which other soft-tissue structures are affected along the structure's kinetic chain.

Our individualized way of treating this condition is successful at treating Plantar Fasciitis because it:

•Locates the unique, true, root cause of Plantar Fasciitis for each patient.

•Works along the entire kinetic chain - from the ankle, to the calf, the knee, the hamstrings, and into the hips - since the entire lower extremity may be involved and affected.

•Allows the practitioner to concurrently diagnose and treat.

The best way to locate tissue restrictions is by feeling that restriction.  This is where our practitioners excel - with their superb sense of touch - and also where many other myofascial techniques fail.

Techniques such as Active Release Techniques are used to find the specific tissues that are restricted and to physically work them back to their normal texture, tension, and length,using various hand positioning and soft-tissue manipulation methods.

The actual sequence of treatments, and the sites addressed, vary depending on the individual, and the actual cause of the problem. All restrictions, along the entire kinetic chain, must be released to resolve the problem.

The good news is that over 90% of these cases resolve using this strategy.

All the best in health

Dr. Brian Abelson