Plantar Fasciitis: Manual Therapy

Plantar Fasciitis: Manual Therapy Blog

Plantar fasciitis is a painful condition that can severely restrict the patient’s ability to walk, run and enjoy activities. As the weight of the body is added to the foot, the inflammation can make it impossible to function in a normal manner. This problem has created an industry of professionals who are seeking the root cause of the foot and heel pain with the hopes of relieving the source of the problem. This article provides a brief overview of the process involved in diagnosing the condition and coming up with an effective treatment plan. Patients should also keep in mind that approximately 80 percent of all cases will resolve without any external intervention.


This problem is currently considered to be a degenerative condition. In the past, clinicians treated it as an inflammatory condition, but more recent research revealed micro-tearing at the juncture of the calcaneus bone of the foot on the medial side. This leads clinicians to treat the condition as a non-inflammatory degenerative pathology. The foot can be examined using imaging technology in cases where the patient does not have localized pain. Ultrasonography is a helpful tool, but it is not a reliable method for arriving at a positive diagnosis, according to Huang, et al.

There are many terms for pain in the foot, and these names can be helpful when differentiating one type of inflammation from another.

Examples include:

  • Runner’s heel
  • Sub-calcaneal pain
  • Plantar heel syndrome
  • Calcaneodynia
  • Heel spur syndrome
  • Plantar fasciopathy
  • Plantar fasciosis

These terms are designed to reveal specific characteristics of the pain that can assist in the treatment plan. These terms can also be helpful for other medical professionals who might be involved in the process. Understanding the specific aspects of the condition can help physical therapists and others to address the most pressing symptoms. For example, the collagen tissue in the area may be visibly degenerating, and there may be signs of increased vascular tissues around the medial portion of the calcaneus near the tubercle.

Tendinosis provides a close parallel, which can be helpful for explaining the causes and symptoms to the patient. For example, fibroblasts can be viewed under a microscope, which communicate something entirely different to the clinician than the presence of inflammatory cells. This distinction, although important for accurate diagnosis, does not lead to a clear treatment plan by itself.

Relieving Heel Pain

Different professionals will take an approach that is based on the particular strengths of their respective disciplines. Our clinic focuses on providing patients with access to a variety of treatments that have reduced pain and improved the range of motion in the foot for other people with similar problems.

Plantar fasciitis affects up to 2 million people every year. This is an incredibly dangerous situation for elderly patients who may have other cognitive problems in addition to their heel pain. Any effective treatment plan will reduce pain and discomfort if it addresses the root cause of the problem. Contributing factors must also be taken into consideration. This may include the patient’s body-mass index, or BMI and excessive pronation of the foot are just two examples. Our clinic uses the most advanced methods available to treat the actual root of the plantar fasciitis, and we base the treatment protocol on the evidence discovered during the examination.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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