Plantar fascitis and physical therapy

Plantar fascitis treatments and physical therapy

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plantar-fasciitis_physiotherapy

Above is the xray of a heel spur on the calcaneal tuberosity area from boneandspine.com.

My plantar fascitis is not getting better…now what?

July 27, 2016

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Jon Keller MPT, OCS physical therapist

So the bottom of my feet hurt and they just don’t seem to get better. I have been to the podiatrist, the physical therapist, tried some orthotics in my shoes, gotten some very supportive shoes, I used the night splint, I stretch my calves and my plantar fascia …. and it still isn’t better. After I sleep and wake up and put my barefeet on the ground they hurt, after I walk on cement with supportive shoes they hurt. It hurts right at my inside heel area and on the bottom of the feet.  I’ve tried cortisone shots from the podiatrist too and it still isn’t better. I even had the shock therapy on my feet and even tried surgery.  I have worked for 15 years as a physical therapist and I have had this happen to some patients.  I went to a seminar a physical therapist from Canada a renowned manual therapist of it must be 30 years plus.  He got me starting to think along with him that what if the pain in the heel is not from a tight plantar fascia- what if it is inflammation of the medial calcaneal tuberosity?

Texasfootdoctor.com shows excess pronation of the foot and thus there would be more pressure on the heel spur or calcaneal tuberosity area.  Wolfs law states that bone will build up with excess pressure. So when a person continually pronates their foot or has their arch drop bone will build up and likely cause the heel spur.  So why not as treatment correct the pronation to help reduce pressure on the heel spur area and the calcaneal tuberosity.

So what is a possible quick answer. I have 2 ways that are different to help…. 1. A boot for 4-6 weeks to reduce inflammation on the plantar fascia origin area on the inflammed spur and calcaneal tuberosity area.

Journal of American Podiatry… Positano and his fellow researchers looked back at the patient files of 143 people who came to the hospital’s Joe Dimaggio Sports Foot and Ankle Center from 2006 to 2007, complaining of foot and heel pain in a total of 175 feet. The patients had all either been previously diagnosed with plantar fasciitis, or were clinically diagnosed with it after an examination at the center. Then their feet were examined with an ultrasound machine. Positano found that while the ultrasound confirmed plantar fasciitis in 73 percent of the feet, it also revealed ligament tears in 34 percent. The ultrasounds also found at least one plantar fibroma, or benign growth, in 15 percent of the feet.The treatment for all three conditions can be very different, and in some cases even interfere with each other if a foot condition is misdiagnosed. Alternately, Positano explained, a person could have all three conditions in their foot but not know it because of the lack of an ultrasound examination.“Sometimes I get a patient who has had heel pain for a year, and they were told to go stretch it,” said Positano. “So not only have they been treating it incorrectly, they’ve also now made it worse.”

2. AFter the inflammation is down with icing with ice cup 5 minutes if no contraindications 2 x a day and anti inflammatories if your Dr says it is ok and using boot 4 to 6 weeks as per medical doctor recommends…. then…

Try strengthening posterior tibalis muscle which helps support the position of your foot NOT excessively pronating.  It is called subtalor neutral.  You also strengthen your gluteus medius and maximus.  The simple way to do all 3 muscles at once for strengthening is to stand up and have your feet at shoulder length. Squeeze your buttocks cheeks together and roll your feet out a little so that you are standing partially on the outside of your feet. Don’t get ridiculous and stand completely on the outside of your feet into supination as listed above. Just stand so your feet are a little on the outside and the inside is just raised some- see the picture above for standing in normal position and supination. Your feet should be basically in between the 2 positions.  To restate you squeeze your buttock cheeks together and you stand partially on the outside of your feet. Once this becomes easy you can hold on with your fingertips to a chair or the sink and try to hold this while standing on one foot at a time for 30 seconds.

 Use theraband – push against band out and in with resistance 3 sets of 10 2 x a day 5 x a day for 6 weeks to help create an arch. THis picture is from sportsinjuryclinic.com

peerj.com picture.

Squeeze buttocks together 10 x hold 3 seconds. Perform 2 x a day 5 x a week for 6 weeks.

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3 thoughts on “Plantar fascitis and physical therapy

    1. A few more ideas for this may be Spenco orthotic inserts, rolling your foot on a frozen bottle of water for pain relief, possibly a cortisone shot from your Doctor if it is not getting better, Extremely supportive tennis shoes- ie Brooks ghost or beast shoes, no barefeet!, possibly a night splint.

      Liked by 1 person

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