Plantar fasciitis pain: Treatment

Foot pain, Pain relief / Tuesday, July 7th, 2009


With either true plantar fasciitis (inflammation of the fascia) or an underlying problem with the muscles, I treat pain in the bottom of the feet in basically the same way in my Boston area Neuromuscular Therapy center.

1) Warm-up the feet with manual work to get the blood circulating and soften the connective tissue. Fascia has two basic states, solid and gel. When it is cold, it is hard and stiff. When it is warm, it is soft and stretchable. That’s why the first steps in the morning are so painful. Blood is needed for healing and for the removal of waste products that accumulate both from gravity and from the quiet state of the body during sleep. Blood warms the fascia. Manual work also transmits warmth from the practitioner’s hands. Together they prepare the soft tissue for deeper work.

2) Starting with the hands and progressing to pressure tools, work with sustained pressure on the superficial short muscles of the foot. Focus on the medial or longitudinal arch and in the space between the heel and the toes with special attention to the medial attachment to the heel bone (calcaneus).

3) Treat the quadratus plantae that attaches to the calcaneus and the deeper muscles in the midfoot (lumbricals and short muscles of the great toe). They all have Trigger Points that cause pain that feels like plantar fasciitis.

4) As the body allows and as the superficial muscles soften, go into the deepest places between the metatarsal bones of the foot and across the transverse arch at the ball of the foot with a small pressure bar or rubber tip.

Because the feet are so sensitive from the inflammation and tension, the work needs to be done carefully with plenty of communication with the patient. Pressure is sustained gently at first, increasing as the resistance changes and finally allowing access to the deepest spaces. Treatment should not allow a pain level of more than 7 out of a possible 10. I find the optimal level to be a 6 so the patient isn’t guarding.

5) Tension in the muscles in the lower leg must always be included in treatment. The leg takes an extra load when the foot isn’t working well. There are several long muscles there that participate in foot movements and that have Trigger Points into the heel and foot. Refer to the post on Foot pain from tight calves: Treatment

6) Stretch all muscles using Active Isolated Stretching protocol. (The book is on my Amazon store to the right of the page.)

The goals of treatment are:

a) Soften the connective tissue and reduce the inflammation caused by repeated microtears in the fascia.

b) Reduce tension in all muscles to prevent repetitive stress to the small muscles and their tendinous attachments.

c) Relax the muscle hyperactivity to reduce the pain caused by pressure and tension, by resulting Trigger Points, and by the irritating metabolic waste products produced by the muscles doing constant work.

d) Increase blood and lymph circulation throughout to clear toxins and bring healing cells.

e) Restore muscle balance with stretching to prevent overload on compensating structures. Restore normal muscle function and activity with continued treatment until symptoms have reduced.