Plantar Fasciitis

Plantar Fasciitis is a very common injury amongst runners and is often connected with the label of being a over-pronator. The picture above is a typical example of an ankle falling inwards, which puts a huge amount of strain and stretch on the plantar fascia underneath the foot, resulting in pain and inflammation.

A CASE STUDY

A 47 year old client consulted me as ‘her last resort’ to help solve her problem of chronic pain underneath both feet.

She started running 4 years ago, following a gradual program with a reputable coach. The pain only started after 2 years of consistent running and her initial complaint was of painful rock-hard calfs and sore feet shortly after her runs and painful stiff feet in the mornings. When regular stretching did not sort out her calfs, she consulted a sport doctor who diagnosed it as compartment syndrome and referred her to a podiatrist. The podiatrist diagnosed it as plantar fasciitis since most of the pain was under her feet. He also said that her arches had dropped and made her a pair of orthotics that would support her ‘weak’ arches. He also suggested that she only wear casual shoes with built in arch supports.

The orthotics worked immediately and she could continue running for 6 months without any pain.

At the same time she started to do powerlifting 3 times a week and quickly excelled and started to win minor competitions. She now ran 3x per week 8-15km at a time and did powerlifting 3x a week.

After 6 months her calf pain and foot pain suddenly showed up again and soon became so painful that she could hardly run at all.

LYNO ASSESSMENT

As expected her Bunkie Test showed full strength on her lateral and anterior lines (Hip Abductors and Quads) and zero strength on her medial lines (adductors, VMO, Tib Post and plantar fascia) and posterior lines (Glut Max, Hamstrings and calfs).

LATERAL LINE

LATERAL LINE SCORE Left 30 sec, Right 30 sec

MEDIAL LINE

ANTERIOR LINE SCORE Left 30 sec, Right 30 sec

POSTERIOR LINE

POSTERIOR LINE SCORE Left 2 sec, Right 2 sec

MEDIAL LINE

MEDIAL LINE SCORE Left 2 sec, Right 3 sec

On the Range Of Motion Test her hip-flexors and particularly TFL were very shortened as well as her Soleus and Plantar Fascia. The result was flexed and internally rotated hips, lateral rotation of the knees and over-pronation of both feet. Add to this a 160kg weight during her powerlifting and there is no way that her knees or feet will survive the impact.

TEST FOR HIP FLEXORS AND MEDIAL ROTATORS (TFL)

TEST FOR HIP FLEXORS AND MEDIAL ROTATORS (TFL)

RELEASING THE CALFS

RELEASING THE CALFS

On her Functional Assessment she was unable to squat in the neutral position where the Glut Max has to do the work. In order to lift her 160kg weight, she relies entirely on her Quads,  hipflexors and Glut Medius, which results in complete over-pronation of her ankles.

HER DEMANDS

She wants to run the 2 Oceans half marathon in 8 weeks and she is not prepared to stop her powerlifting, since she is training to win a competition in 8 months time.

HER OPTIONS

Her body is clearly locked in a rotation pattern that will most definitely result in serious hip, knee and foot injuries. The orthotics have clearly been an effective crutch to this point, but it has also allowed her stabilising muscles to weaken to an extent that she admits that she can not dare walk barefoot at all due to extreme foot pain.

The extreme imbalance between the antero-lateral  and the postero-medial lines has caused a rotation lock in the hips, knees and ankles, causing loading of her full bodyweight on the overstretched and weakened plantar fascia in both feet. If she was inactive, the ‘solution’ could have been support in the form of footwear, but as an athlete, eager to run and lift heavy weights, she clearly has no other option than to correct the imbalance by unlocking the dysfunctional pattern of movement with fascia release, restoring the normal balanced and functional movement patterns. To achieve all this will take a minimum of 6 months in which she will have to cut back to walking instead of running, relearn the normal squat patterns without any weights and slowly strengthen up towards her end goal which is to run her half marathon and win her power weight competition.

IS THIS POSSIBLE?

If she came in with zero-score Bunkies on all lines, I would have said no. Choose another sport and wear supportive shoes.

However, in her case the 30 Bunkie scores is a clear indication that we are looking at a potentially strong athlete,  in complete misalignment, but who has the ability to release dysfunctional patterns, restore neutral movement, strengthen up in the functional position and achieve her optimum performance. So, a big yes!

OUR ADVICE

If you are struggling with Plantar Fasciitis, find a practitioner who will do a full body assessment to evaluate the function of all the muscles. The body moves as a whole. When we walk or run our left arm moves forward together with our right leg and at the same time the opposites move backwards. If any part of your body becomes locked in a dysfunctional pattern, it affects the whole body all the way down to the feet. The way you land on your feet is determined by the quality of movement of the rest of the body.

Plantar Fasciitis can therefor be caused by immobility of different areas in the body and the only way to find out where the cause is, is by means of a proper holistic assessment. Symptomatic treatments like supportive footwear, rolling on a ball, dry needling etc. might alleviate the pain for a while, but unless you find the cause, you are in for a recurring debilitating problem. The human body is similar to a car. If your wheel alignment is out, one of the tyres will show wear and tear. Patching the tyre might help temporarily, but the only real solution is to correct the alignment.

DISCLAIMER – STRUCTURAL PATHOLOGY

Keep in mind though that the above is only applicable where there is no structural damage or pathology of the structures in the foot. To exclude pathology, contact your medical professional who will refer you for the necessary tests.