Rehabbing the Plantar Fascia: To Stretch or Not to Stretch?

Rehabbing the Plantar Fascia: To Stretch or Not to Stretch? Blog

Plantar fasciitis is an overuse injury that causes pain that normally begins in the heel and gradually worsens to affect the entire arch tendon of the foot. Runners, athletes and fitness enthusiasts are all vulnerable to plantar fasciitis, as is anyone required to spend long hours standing. Wearing certain types of shoes like flip-flops and high heels may also lead to inflammation of the plantar fascia.

Plantar fasciitis symptoms include heel pain that feels its worst first thing in the morning, before the foot becomes warm and loosens up. The pain may diminish but remain a constant ache, once you begin walking around on the injured foot.

Treatment for Plantar Fasciitis

The plantar fascia is a tough band of tissue that connects your heel to your toes. The plantar fascia plays an important role in supporting your foot arch, and serving as a sort of elastic band that allows the arch to recoil during walking, running and jumping.

There are a number of common treatments suggested by health care providers for plantar fasciitis:

  • Icing and NSAIDS to reduce pain and inflammation
  • Orthotics to reduce stress on the plantar fascia
  • Reduced training
  • Massage and athletic taping
  • Steroid injections
  • Surgery
  • Foam rolling and massage
  • Stretching of the plantar fascia

While most treatments are geared to alleviating heel pain, they often neglect to get at the true source of pain.

Plantar fasciitis can stem from another injury like a calf strain, causing an athlete to place excessive force on the foot, thereby over-stretching the plantar fascia. Feet with exceptionally high or low arches may be particularly susceptible to plantar fasciitis. Overuse of the plantar fascia can result from tight hamstring muscles or Achilles tendons that cause the plantar tissue to become over-stretched.

While treatment should address pain, it should not stop there. Gait should be analyzed to assess for motor deficiencies. Range of motion of the leg joints and muscles should also be assessed and flexibility training should be prescribed to address tightness in the hamstrings, calf and plantar muscles. Foot strengthening exercises may be in order to increase muscle support of the plantar fascia. Extracorporeal Shock Wave Therapy (ESWT) has proven highly effective in treating plantar fasciitis.

The Role of Stretching in Treatment of Plantar Fasciitis

Stretching of the plantar fascia is often prescribed as first-line treatment for plantar fasciitis. Yet some argue that, since over-stretching caused the condition in the first place, additional stretching may not be particularly helpful, and may even make the condition worse. Others argue that the plantar fascia is so tough, its capacity to stretch is limited to less that one percent.

Recent research by Rathleff et al. (2015) suggests that high load strength training may speed up recovery from plantar fasciitis more quickly than stretching alone.

Heel Pain Treatment at NYDNR

At NYDNRehab, we take a holistic and multimodal approach to treating plantar fasciitis. We combine our functional foot physical therapy with ESWT. In addition, we use diagnostic ultrasonography, and gait and pressure analysis to assess forces acting on the foot, along with joint mechanics and motor control.

We use Computer Assisted Rehabilitation Environment (C.A.R.E.N) dual force plate analysis and feedback to assess and correct asymmetrical weight bearing and hip and pelvic misalignment.

At NYDNRehab, we are dedicated to getting to the source of your pain, to eliminate it for good.

Source

Rathleff, Michael Skovdal, et al. “High‐load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12‐month follow‐up.” Scandinavian journal of medicine & science in sports 25.3 (2015).

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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)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

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

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