About the Plantar Fascia
The plantar fascia is a thin band of fibrous connective tissue that runs from the calcaneus (heel bone) to the base of the toes, and acts to support the arch of the foot. It acts a tie-rod, one that tightens as the foot bears weight. Some studies estimate that it carries 14% of the total load of the foot.
Interestingly, the actual plantar fascia is rarely tender to palpation and touch. Instead, it is the deeper soft-tissue structures that show signs of injury, and which cause the pain felt by patients.
Effects of the Inflammation Process
The inflammation process causes the body to lay down additional restrictive scar tissue across injured or already inflamed soft-tissue structures, and with Plantar Fasciitis, results in a shortening of the plantar flexors.
These restrictive fibres also bind the layers of adjacent soft tissues together, and prevent these tissue layers from translating or moving freely across each other. The entrapment of these tissue layers causes further friction and inflammation.
Ultrasound measurements of tissues of symptomatic and non-symptomatic patients shows the symptomatic tissue to have increased thickening as the various soft-tissue layers adhered together. This includes structures in both the feet, and further up the kinetic chain, such as:
- Calf muscle restrictions in the gastrocnemius and soleus.
- Hamstring restrictions in the biceps femoris, semitendinosus, and semimembranosus muscles.
- Quadratus plantae, flexor digitorum brevis, flexor digiti minimi
brevis, abductor hallucis, and flexor hallucis brevis.
Treating the Kinetic Chain
From research, and through our own clinical experience, we have learned that Plantar Fasciitis is caused by more than just inflammation of the plantar aponeurosis in one area of the foot.
We have discovered that, in addition to treating the plantar aponeurosis, we must also address:
- The altered biomechanics caused by soft-tissue restrictions that have developed in other parts of the feet, legs, and hips.
- The layers of tissue deep within the foot that have lost their ability to translate or move freely across one another due to restrictive adhesions that have formed between the adjacent structures.
- The stresses on the body caused by altered motio- patterns as the body compensates for these injuries.
Further up the kinetic chain, structures such as the internal and external rotators of the hip can also cause problems with the biomechanics of the lower extremities.
All of these need to be addressed in order for full recovery from Plantar Fasciitis.
Treating Plantar Fasciitis with ART
To ensure complete resolution of Plantar Fasciitis, practitioners should always look beyond the immediate symptomatic area of the foot, and consider structures throughout the body that may also have been affected.
By treating these additional soft-tissue structures, the practitioner is then able to address the original biomechanical dysfunctions that may have caused Plantar Fasciitis, and thereby prevent a reoccurrence of the problem.
ART is used to find the specific tissues that are restricted and to physically work them back to their normal texture, tension, and length, using various hand positioning and soft-tissue manipulation methods.
The actual sequence of treatments, and the sites that are addressed, vary depending on the individual, and the actual cause of the problem. Most importantly, all restrictions, along the entire kinetic chain, must be released to resolve the problem.