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Paul:

This forum exists so that we can all learn from one another. That is what I would have hoped to achieve from our discussion. Judging by what I have read so far, it sounds like a contest for “who can outsmart the other”. What is preventing you from answering my question? I’m not asking you to explain your technique(s), that would be unfair. However, you should still be to explain what you do and justify why you do it. I am always keen to learn, especially if it is something I have never heard of or applied before. I'm sure what you do has tremendous value, but instead of facts all the time, a little more explaining would be helpful from time to time for all of us reading along, so that I/we can better understand your objectives. Unfortunately, Paul, as much as you continue to promote your workshops, in reality, not all of us have the opportunity to attend them, so as I said before, in future, more elaboration and justification would be appreciated.

Regards,

Daniel

Paul:

Let's be truthful here!

The Achilles tendon does stretch and needs to stretch to optimize energy return in weightbearing activities (Lichtwark GA, Wilson AM. In vivo mechanical properties of the human Achilles tendon during one-legged hopping. J Exper Biol, 208:4715-4725, 2005; Ker RF, Bennett MB, Bibby SR, Kester RC, Alexander RMcN: The spring in the arch of the human foot. Nature, 325: 147-149, 1987).

The amount of energy return into the lower extremity by Achilles tendon stretch and recoil has been estimated to be between 35 - 38 Joules, which is estimated to be not insignificant, as you say, but rather accounts for about 35% of the energy turnover with each footstrike during running (Ker RF, Bennett MB, Bibby SR, Kester RC, Alexander RMcN: The spring in the arch of the human foot. Nature, 325: 147-149, 1987).

If you aren't familiar with the scientific literature regarding the significant influence that Achilles tendon stretching has on energy return during weightbearing activities, then just say so, rather than continually making authoratative claims, with no research to back up your claims.

In addition, I don't remember you ever saying anything positive about podiatrists or about podiatric care, in all your comments here on Podiatry Arena, even though you use a podiatrist's comments as a testimonial about the "amazing" nature of your manipulative techniques on your website. It seems to me, from reading your comments over the years, that you think that podiatrists are always doing the wrong things for their patients, and you are one of the few who can do the right things for patients to make them better.

If you want for us to be impressed by what you claim to be the "truth", then give us some good peer-reviewed scientific articles that support your claims, rather than continually directing us back to your website, where you obviously feel resides the only home of "truth" for foot-health practitioners on the internet.

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Kevin

You must be joking

38 joules.. where will it get you in reality

Please explain

Just because I do not have all the scientific data yet, does not mean I am incorrect.

I spend about 4 hours a day reading from podiatry to tensegrity to cell mutation, cell biology, cellular morphology, genetic mutations etc.. But I certainly use criteria that can I use to see if the data is good.

Unfortunately it is not in may cases.


Lets back track a bit

Every time you are challenged you bring things up that look good.

But: I mentioned you never wrote out side of PF in the last few emails. Nothing said.

I mentioned that muscles were for protecting the Joint thus if the joint had a reduced ROM then the muscle length was less.

You continue to pick on nothings. Pick on what I have said or are they just too bit much for you to comment upon.

Why do the muscles of the lateral cell group in embryological development eccentrically work in walking..

They are there for a reason...

Why in all the discussions we have ever had you have never mentioned a muscle in the foot. There are so many with so many functions.

Hve you ever thought why does the lower limb and the foot have prime numbers of muscles present?

So much to think about.

I have spent years thinking about all of this, not some petty little thing about what your perceived ideas that what i have written that denigrates the profession.


It is so easy to grab onto the negatives about anything, look at you presidential race..........................

This is not what I am on about.

Just stop changing the topic or grabbing onto something that may get you browny points.

Podiatry and the world in general is bigger than both of us.

Regards
Paul

PS on holidays out back in the wet. Best wet since the early 70's where I am going
Looking at primitive frogs and fish.

Wow, you guys rock. I am glad you all are helping me learn how to help treat this condition better in my little corner of the world. And you are making me question what I've been taught and actually turn the biomechanics and research on this issue.

I have questions (of course)-

1) For stretching the GSAT- does the calcaneus have to be in neutral for these stretches to be effective? This is why I have a hard time prescribing them because I don't think they are doing it properly.

2) Ball rolling techniques on the bottom of the foot- does this help stretch the aponeurosis as much as it does increase the blood flow?

3) Are we saying joint mobilizations to increase dorsiflexion will help or won't help?

4) "Ankle ROM mobs/manip can increase hamstring length from the usual 40 (athlete) to an easy 80+ degrees." (Paul)
How are you measuring the HS length to increase 120 degrees? 90/90 test?

5) Do podiatrists learn joint mobilizations while pursuing their degree?

6) What about Anodyne therapy? Will the infrared light treatments help the problem since they increase circulation? Is it worth a shot? (insurances here don't cover Anodyne anyway, so where I work provides it free of charge for those with diabetes anyway)

In regards to the study on stretching recommendations, my personal experience has been that stretches didn't hurt in a bad way, more like the "good" kind of hurt. I even added in the cross friction massage with the tennis ball on the origin of the fascia.

On a side note, I definitely had the "compressive proximal PF". I developed it when I was pregnant and had bad heartburn the last trimester- I would sleep in the recliner with my heel of my foot resting on the edge of the footrest. I didn't realize the compressive forces would cause this condition. Thus began my almost 6 month journey to a pain free foot condition. Who would have thought?

The subtalar joint does not need to be in neutral to get an effective GSAT stretch, but it certainly would help. To eliminate some of the arch flattening tendency with GSAT stretching exercises, I will instruct my patients to point their back foot (i.e. the leg they are stretching) straight ahead during the stretch. My office handout for stretching is located in this thread .

2. Ball rolling probably locally stretches/massages the plantar fascia.
3. Joint mobilizations may or may not help dorsiflexion, the jury is still out on this one.
5. I didn't learn any of these, but some podiatrists, such as Drs. Howard Dananberg and Bruce Williams, routinely use mobilizations quite effectively in their practices.
6. I don't know enough about "Anodyne therapy" to either recommend it or recommend against it.

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Dear Kevin

Methinks the jury you mention is the one that gave the verdict in the OJ Simpson case.

Back from the bush.


Paul C

What a great thread!

That is probably the most sensible thing i seen written about PF for a long time!!

As Kevin points out there can be several precipitant factors involved in PF. I also suspect a good deal of what is diagnosed as PF is in fact no such thing.

If there is a treatment which some podiatrists seem to be using to good effect and some are not there would seem to be two possibilities. Either one group is mistaken as to the effectiveness of the technique, or the two groups are in fact using a DIFFERENT technique (or the same technique on different patients.)

The Evidence supplied by CP would seem to indicate that, at least in some circumstances, stretches can be benificial...

That would seem to suggest that either we are talking about different types of stretches OR that the perception that they are ineffective is flawed.

Please remember, musmed, that if you are basing your observations on people who come to you AFTER seeing another professional and being prescribed stretches your subject group is grossly skewed. That would be like saying 100% of skis cause broken legs because all the people who attend the fracture clinic with ski's have broken legs. Its a gunslinger fallacy. People who get better don't seek further opinion.

On a very slightly divergant note has anyone tried stretching using the strassburg sock


Seems to be some kind of night splint. There was apparently a small study done with it in JFAS but for the life of me i can't track it down.

Regards
Robert

A Retrospective Study of Standing Gastrocnemius-soleus Stretching Versus Night Splinting In The Treatment Of Plantar Fasciitis.

Plantar fasciitis is the most common cause of heel pain, yet the conservative treatment of plantar fasciitis is not standardized. This open retrospective study compared the effects of standing gastrocnemius-soleus stretching to a prefabricated night splint. One hundred and sixty patients with unilateral or bilateral plantar fasciitis were evaluated and treated according to the standard regimen in addition to either night splints or stretching. Seventy-one patients performed standing stretching of the gastrocnemius-soleus complex. Eighty-nine patients utilized the prefabricated night splint without standing stretching. The night splint treatment group had a significantly shorter recovery time (p<.001), fewer follow-up visits to recovery (p<.001), and fewer total additional interventions (p=.034) compared to the stretching group. Absolute body weight, body mass index, and age did not have a statistically significant effect on the time to recovery or additional interventions needed. The duration of pain prior to our treatment was a predictive factor and was associated with increased time to recovery and increased number of treatment interventions. It was concluded that early treatment in a standardized four tiered treatment approach including the night splint without standing stretching of the gastrocnemius soleus complex, speeds time to recovery. (The Journal of Foot & Ankle Surgery 41(4):221-227, 2002)

It was on their website...

Dear Robert

The numbers are not skewed. It shows that many are told to stretch and those I saw came from word of mouth and one article in a sydney magazine.

This article generated more queries to the magazine than any of the other articles over 10 years it had published. That includes all forms of cancer etc.

Interesting eh?

Regards
Paul C

Fascinating. But still statistically suspect.

And the rothbart / glazer threads are probably the ones which generated the most "queries" on this forum. That is not necessarily to say that the theories are accurate!

I contend that your sample group WAS skewed. You said
Your sample was 120 patients. All of them had previously seen another professional. All of them (by virtue of the fact that they presented to the program) were unresolved. If 115 of them had beest prescribed stretches that shows only that stretches don't ALWAYS work.

If i saw 1000 patients with PF and treated them all with orthotics a proportion of them will (sadly) for whatever reason, not reslove. If 20 of those turn up at your door and constitute a sample group then you would draw the conclusion that orthotics do not work on PF.

Please show me the flaw in this logic cos i'm struggling to see how a sample based on those who have not resolved on "standard" treatments can be considered representative of the whole.

Regards
Robert

Hey all,
It has been great to read through the posts about this painful condition. I work with your scripts as an allied medical team member to the patients treatment plan. There are many conservative modalities that will help the patient in any given case. I have seen a combination of many such modalities used successfully. The main one is to provide support to the foot if the patient needs to get around.The support will help keep a pronated foot from torquing the plantar fascia and the PTT as well as keeping the arc the palntaqr fascia helps to keep in the windlast mechanism it is to accomplish. This can be in a combination of a good supportive shoe that is not worn out. A worn heel on a shoe will cause more invertion at heel strike. This will cause the moments of gait to be exagerated causing other pressures.
Orthotic support either OTC, custom functional or supportive accommodative device is in order. I have had great success with the birkobalance orthotic. These can be modified post fitting by heating up the cork on the prominent areas or gluing posts to the cork to change the pitch of the orthotic some what more.
I also talk to the patients about a night splint if needed and to see their doctor about that device. this will help to hold the foot in a positon to allow the plantar fascia to not be strained as much at weight bearing the first thing in the morning.
I have also seen patients who get this painful malady back again becaus ethey feel they are over the problem and don't need to be compliant to the support of the shoe and orthotic therapy. I have seen great success in cortozone shots given by doctors coupled with orthotic therapy and shoes that support midial and lateral displacement and torsion. It is a continual battle to find the one modality that works all of the time. The closest I have seen is the birkobalance with a good strong shoe. R.I.C.E.couldn't hurt. Mothers of three just laugh at me when I say rest is important.
It looks like a study needs to be done empiracally on the wife's tales and the sound scientific understanding that is out in the scholarly circles.This should cover the known OTC orthotics and the other modalities of stretching the achilles to have less pressure on the calcaneous so the plantar fascia will not be pulled on because of the tight Gastroc.
Rick Woodland
Cped0810

I'm a bit out of touch in my foot-care, but i was under the impression that Plantarfasciitis is inflammation of the plantar fascia - usually due to it being stretched around the calcaneus.... so if you reduce the tension in the plantar fascia, the pain will subside.
I recommend people to gradually stretch the plantar fascia before they get out of bed in a morning to sort of 'warms up' the plantar fascia so its not as easily damaged

Are Heel Raises / FFO's / Night Splints still the orthotic recommendation still?????

Its not an inflammation.

__________________
Craig Payne
__________________________________________________ ___________________________________
Follow me on Twitter | Run Junkie
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.

Craig:

There are studies that do show evidence of inflammation on biopsy http://www.bcm.edu/medpeds/articles_..._fasciitis.pdf,

edema in the bone of the plantar calcaneus http://radiology.rsnajnls.org/cgi/co...l/2341031653v1

and peri fascial edema. http://www.podiatry-arena.com/podiat...ad.php?t=12403

If it's "not an inflammation" of either the plantar fascia or the tissues that surround the plantar fascia, then what causes the pain of plantar fasciitis and the positive response of plantar fasciitis to oral anti-inflammatories and cortisone injections?

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Hi Everyone

Reading these discussions with great interest.

I'm certainly not an expert on biomechanics or plantar fasciitis - however I still have dozens of patients with these types of symptoms walk in the door. Not being an expert doesn't mean I don't get to treat them apparently.

I think one thing that we seem to overlook with stretches is how all the different professions prescribe them. I don't know about anyone else but when I'm prescribing stretches for the gastroc, soleus and plantar fascia/aponeurosis (which I do for every case) I emphasise and emphasise again to the patient to stretch to comfort only - NO PAIN or DISCOMFORT. I explain it in terms that the plantar fascia has some micro tears and as a result the ligament tightens up like most people do across the shoulder blades when they feel stressed. It's not necessarily that the muscle/ligament/tendon is too short but rather it is stressed and needs to relearn how to relax rather than stretch. A lot of these patients have already been seeing other health practitioners and have been doing stretches for months with no noticeable improvement in muscle flexibility or "feeling" of muscle flexibility or symptoms.

I also initially prescribe ice/massage (ie frozen coke bottle) and ppt heel padding if the patient is on their feet on a hard surface all day.

Clinically (and please remember this is my own experience not a study of any type) I have found that the patients who "stretch" to discomfort or pain come back in four weeks with the same level of symptoms or worse (ie in my mind they tore those micro tears further) whereas about 90% of the patients who stretch to comfort report a significant improvement or complete resolution of symptoms. Those that have an improvement but not complete resolution always have another biomechanical issue at play (such as excessive pronation or 1st ray instability for example).

I've also found that patients have a much higher compliance rate with stretches when they know the treatment is not going to hurt.

Anyway this is just my experience - I'm not disagreeing with anybody else but I have a lot of patients who are initially sceptical because it almost feels like they are doing nothing (ie no pain no gain mentality) - few are sceptical when the pain goes away. I also follow up every patient with a phone call that doesn't turn up for their review - I don't like having unhappy, sore patients.

Do other people think we need to be more consistent with how we prescribe stretches to get maximum benefit?

Cheers
RStone

I think we been around this trap many times, I just can't find the previous discussion:

__________________
Craig Payne
__________________________________________________ ___________________________________
Follow me on Twitter | Run Junkie
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.

Round and round the stump we goes.....where we stop....nobody knows....

__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************

Paul

You wrote

Paul

I'm not sure how long term stretching works and admit to being a little baffled at times when I think of the mechanics and physiology of it, but work it does.

Not just medics and therapists believe this but sportsmen and entertainers, yoga and pilates, martial arts and ordinary people who just naturaly stretch when their muscles are stiff and hurt. And they have been doing it for eons because it works.

People like contorsionists and matrial artists don't become more flexible than average by accident. They work on it for year and years. Some get so good at it that their joints are hypermobile (in the traditional sense) and suffer pathology due to this. I believe that a large part of it is that stretching allows more range of motion rather than manufacturing or forcing extra RoM. IE it allows the CNS to realise that the extra angular displacement will be ok and there will not be injury because of it in future. I also believe that joint mobilsation also physically allows greater RoM and that stretching after mobs allows the RoM to be preserved long term more effectively than stretching alone.

I do not understand why you say that
Muscle and joint are synergistic and one is useless and pointless without the other. Joints allow angular displacement and muscles control acceleration of angular displacement and to some extent control the range of angular displacement . The control implies protection but not solely protection.
Clearly muscles can become shortened eg spastic hypertonia and not allow wide RoM so the opposite should also be true.

It also seems clear that muscle stretching is never permanent and so stretching regimes must be kept up on a regular basis, but it apppears by my experience that the longer the regime is kept up the longer also it will take for the muscle to shorten when the stretching is stopped and restretching is easier than starting from scratch. This is my experience in over 40yrs of martial arts. I find it takes about 6 months of regular stretching for an average person to achieve a good high kick that can be taken to the head of a similar sized opponent. Over a number of years you can observe people gradually becoming more supple. Some more than others of course.

Just my thoughts and observations

Dave Smith

Hi all. Great thread to read.

In terms of heel pain which is commonly diagnosed as plantar fasciitis I too have been a little confused over the years due mainly to the contradicting views I have read in journal articles since leaving Uni as opposed to those views I was taught. I see from this thread I am not alone.

One aspect I have not seen in this thread is the possible contribution of nerve entrapement, mainly of the 1st branch of the lateral plantar nerve (otherwise known as the calcaneal nerve or sometimes the nerve innovating the abducti digiti minimi). Can such a nerve entrapement eventually be alleviated by stretching of the soft tissue structures around it? Could this be contributing to some people getting better results from the stretching than others? I also feel that this may be contributing to the pain relief felt when trigger points in the Abductor Hallucis & Quadratus Plantae are released. (I think Paul alluded to this in an earlier entry). Perhaps the dynamic stretching of the plantar fascia ie tennis ball, rolling pin etc actually contribte more to masaging the layers of muscles in the foot thus releasing some tension & freeing the entraped nerve.

Some food for thought is the Heel Pain Triad as described by Labib et al (Foot & Ankle International Vol 23, No. 3; march 2002). There are many other articles describing nerve components to heel pain also.

Personally I have found that in heel pain that is unresponsive to what I call traditional treatment (based on my original education not an indication of where I think the different therapies lie) such as orthotics, Gastroc/soleus stretching exercises, plantar fascila stretches, RICE, strapping etc a series of gentle mobilisation techniques (especially talar glide) seems to be very beneficial. Couple this with dry needling for trigger point release & continued orthotic therapy & most seem to resolve. (Daniel & Dawn I hope this is the sort of addition to the discussion you are looking for.)

Cheers
Ben

I have been reading this thread with interest for some time now and would like to add some of my own thoughts.

First I think we should be clear that there is an acute and chronic phase to the care of anyone suffering from PF; fasciitis vs fasciosis. The treatments are not the same so why on earth would the attending strecthes be?

Regardless of the methods different professions were taught in college to address the pain of PF, there is a common and overlapping thread that includes stretching.

Stretching can be further divided into active and passive, weight-bearing and non weight-bearing. There are also active, non-weight bearing stretches against gravity and resistance such as post-isometric relaxation, active release etc.

When a patient has an acute PF complaint and equinus due to a tight GSAT I do not believe that weight-bearing stretches benefit that patient. The increased load on these structures will in all likelihood exacerbate the complaint. Micro-tears and possible full thickness tears in tendons are a common result of permitting patients to bear the full load of weight-bearing in active stretching in acute conditions.

This is the phase of care where passive modalities such as RICE, night splints, ultrasound, electrical muscle stimulation, anti-noninflammatory medication or NSAID's etc. afford a great deal of relief. In this phase of care I find that among the most beneficial treatments is soft-tissue release and passive mobilization of the lower extremity in combination with the above.

With chronic cases typically the patient can begin to add active weight-bearing stretches when indicated. Active strengthening of the muscle intrinsics and GSAT can be introduced comfortably and safely once the patient’s complaint is either resolving significantly, or their complaint is chronic but improving.

Refractory plantar fasciosis, where there is a thickening of the fascia is a condition that frequently does not respond to stretching and physiotherapy.

Differentiating between the phases of care is paramount to success in PF treatment as it is in any soft-tissue injury be it muscle, tendon or ligament or a combination of the above. All of these treatments in the appropriate phase support the successful outcome of any program where the patient’s biomechanical pathology is addressed with orthoses.

I believe that there exists a gap in the overlap between the professions that is as yet unfilled. I know of specialists who favor the old weight-bearing calf stretch for PF, even when the patient is in acute pain.

Also the Achilles tendon can be ‘stretched’ in some people and not in others. Muscles tend to be more complaint, although patients are not always so.

Any thoughts?

__________________
"If we all worked on the assumption that what is accepted as true is really true, there would be little hope of advance." - Orville Wright

David G. Wedemeyer, D.C., C.Ped.

Hi all,

That's say when a patient fits all the typical signs and symptoms of plantar fasciosis (e.g. pain at insertion to medial calcaneal tubercle and along plantar fascia, first thing in the morning, etc) yet ultrasound scan showed absolute no abnormality with the plantar fascia (e.g. no thickening and no tearing).

Does this mean that this patient might not have plantar fasciosis?

Is ultrasound sensitive enough to pick up tiny damages to the plantar fascia?

cheers
Mike

Dear Mike

The radiology souls state that the PF at the level of the calcaneal tubercle that is thicker than 4.8mm has plantar fasciitis (or what ever it is).
In one study we did where the history of morning pain etc. was used, only 8 out of 114 had an ultrasound thinkness of greater than 4.8mm
One soul had 9.5 and 10mm thick PFascia but only the 9.5 worried her.
So like many things there are no gold standards.

The results on USonography depend on how skilled the operator is and how sensitive and what frequency the transducer being used is.
An 18Mhertz is a small unit used for looking at the pulleys of the fingers can see Pfascia thickness down to about .05mm in skilled operators. The problem is this transducer called the hockey stick (looks like one) costs $45000 so not everyone has one or use of one.

What you see is a increased thickness over the calcaneal tubercle, looks like a raised hillock at that point.
If there is a defect, it appears as a small black dot. One has to remember that u/sound works by transmitting a signal and getting one back. If there is a small tear, ie there is nothing there (or something with fluid there), so it appears as a black dot up to the size of the top of a biro pen.
All the tears I have seen using U/s and MRI are all on the medial side. Why? Worth having an anatomy think.
Another point, we used colour doppler on every case to see if there is increased blood flow (as used in Achilles Tendinopathy). Not one had any increased blood flow.
I have not seen a paper discussing this point.
Have a good one.
musmed

Hi there ,This isnt so much a clinical query more a 'where do I go from here'!.
My patient came requesting a new set of custom made orthoses(his old ones were like nothing I'd seen before and provided by a un-registered practitoner),so I duly examined casted and issued them with appropriate advice -but 6 months later and 3 refurbs later he still says they are uncomfortable.His symptoms are consistent with PF and I rec. all the evidence based stretches etc which I am sure he hasnt complied with.My question to you all is -Has this patient the 'right'to get his money back?and would this be MY easiest solution as I genuinely dont think no matter what I suggest will 'cure' him-(by the way he is a builder)

Hi Kevin,

This may have been done to death already, but the exact cause of the pain involved with chronic plantar fasciitis/fasciosis is something I'm still trying to understand better myself.

If the plantar fascia itself is not inflamed (but rather degenerative), then do we at least concede that there is localized surrounding soft tissue inflammation that clinically presents as hot, red, swollen and painful??

If yes, then would it be right to say that even though there is no inflammation of the fascia itself, the body mounts a localised "inflammatory response" in the surrounding soft-tissue structures in response to the repetitive micro-trauma and degenerative tissue damage occurring within the PF and it's attachment to the calcaneus??

Is it this localized "inflammatory response" that causes the heel pain that our patients experience, rather than the actual micro-tearing of the fascia?? Or both??

Am I on the right track here?

Thanks,
Berms

Hi All -

I wanted to share an article wrote which may stimulate some thoughts on integrating pelvic influences on causes of plantar fasciitis. My background is Human Movement so it is difficult for me to look at the foot & ankle from an isolated perspective. Any patient with plantar fasciitis and decreased ankle joint ROM should be getting a pelvic mobility assessment - I often find MOST have overactive hip flexors and a anterior pelvic position which lengthens the posterior column (hamstrings and calves into plantar fascia).

Is Isolated Gastroc Stretching Adequate for Plantar Fasciits?

Emily

Dear Emily
Hi, just wondering how the lordotic spinal position irritates the plantar fascia? Also what does the Plantar fascia do?
Thanks
Paul Conneely
www.musmed.com.au