Plantar fasciitis is....maybe over diagnosed.  Technically speaking, plantar fasciitis is inflamed plantar fascia.  This means that the fascia or connective tissue on the bottom of the foot (plantar aspect) is irritated, there may be some degree of swelling or inflammation, and there is micro breakdown in the tissue.  Plantar fasciitis is however a symptom; generally tissue doesn’t become inflamed without reason.  You don’t just wake up one morning with plantar fasciitis.  And if it truly is a case of plantar fasciitis, it’s usually a quick fix in PT treatment and doesn’t turn into a chronic condition.

With that being said, clinically, plantar fasciitis can be a bear to treat.  It can be stubborn, have limited response to treatment and can be mysterious in nature.  Let’s go back to my statement earlier of it is a symptom within itself, not a source of dysfunction.  Mechanically, when the plantar fascia becomes stressed, it is because of an altered movement pattern or some sort of compensatory gait pattern.  We are able to change our gait pattern in response to pain, weakness, or dysfunctional motor control.  Why would we non-volitionally change our gait pattern?  Something is not mechanically sound in the system.  There may be a small bony spur developing, there may be ankle joint laxity, may be arthritic changes, may be low back pain and stiffness.  The point is, we have to consider other sources of the plantar fascia symptoms.  Deductively, a good clinician would first look at the ankle joint and assess ankle health, then to the knee, hip, low back, core and depending on those findings may or may not consider the upper extremities.

Today I evaluated a patient who presented with heel pain which progressed up to the left side of his low back.  He had a history of L5-S1 disc protrusion for which he had successful PT treatment and he intuitively felt that the heel pain was not stemming from his low back.  After a quick exam it appeared he had one leg shorter than the other and it was determined that his left hip was rotated (very subtle) backwards.  So for this patient, we will focus on his hip mobility and squat mechanics (his squat mechanics weren’t too hot), lengthening his posterior chain and improving his lumbar facet joint mobility.  Of course during the course of this patient’s treatment I will monitor the symptoms in his foot but I am confident we will clear these altered movement patterns up quickly and ensure this doesn’t becoming a revolving door-like issue.

In short, if you are consulting with any type of medical profressional or therapist, ask about what potentially could be the source of the dysfunction and even further, ask about speculations as to how the symptoms progressed.  Something I often encourage is asking questions because the more you know as a patient, the better decision-making skills you will have about your health.