I see it all too often. The world’s smallest violin begins to play in the background as you tell your physical therapist about your plantar fasciitis. Fascia what??? Fasciitis [iitis (suffix)- forming names of inflammatory diseases]. Plantar fasciitis has always been somewhat of a catchall term for heel pain. Does this really matter to you? Probably not. What should matter? Understanding that you can potentially eliminate this heel pain quicker than you can say “iitis” with the help of trigger point treatment. Can I get a “YEHAW?!” The best part is that you can take care of this trigger point treatment yourself. Starting… now.
The GOAL: to save you that $50 physician co-pay, or that $350 bill if you haven’t met your deductible yet.
Quick Overview of Plantar Fasciitis
I know what you are thinking, “so glad I know –iitis means inflammation. Total game changer when re-evaluating my life’s purpose.”
Lets start by replacing plantar fasciitis with the term heel pain. This is listed as one of the most common foot conditions seen in clinic settings. The Physical Therapy Clinical Practice Guidelines for Plantar Heel Pain was updated in 2014. Little is mentioned of any inflammation when discussing plantar fasciitis. More commonly, we are seeing some degeneration of the fascia.
- Trigger points in the calf and feet
- What tends to be overlooked is the fascia and muscle above the ankle that weaves into the plantar fascia. We totally disregard those big calf muscles as a potential source of heel pain. It starts to make sense that stretching the calves and feet routinely helps to reduce pain with plantar fasciitis. Treat the muscles above and below the foot, eliminate the pain!
The pictures below show the referred pain patterns of your calf and foot musculature. This could be the source of your pain.
(Picture to the the right: Referred pain from Quadratus Plantae (triggerpoints.net))
- Limited ankle motion
- Limited ankle motion is linked to increased complaints of plantar fasciitis. Once again, this often has to do with muscle and fascia flexibility!
- Increased body mass index in a non-athletic population
- Increased body mass index in a non-athletic population is also linked to plantar fasciitis. For those of you with an increased body max index that took up running last week. I’m sorry, this doesn’t put you in the athletic category, yet! If you are reading this dad (which he doesn’t) I am talking to you.
How Do I get this pain to go away?
For some reason people tend to hang on to heel pain for a while before getting it looked at. It’s like they have built a friendship with it. In two studies, that totaled 432 people, heel pain had been present around 14 months on average.
We used to set really low expectations for treatment time with plantar fasciitis. We are starting to find that we can make improvements way quicker than we thought.
In the past, treatment of trigger points was also overlooked with plantar fasciitis like symptoms. Which is strange since stretching has been recommended for years.
Treatment guidelines for plantar fasciitis added treatment of muscle trigger points following a study that compared a stretching group and a group that received both trigger point treatment and stretching.
….So what happened?
You guessed it. The combined trigger point treatment and stretching group saw better outcomes in physical function and pain relief.
Even more interesting was a systematic review that looked at treatment of trigger points with a dry needle. This systematic review, as it implies, reviewed a bunch of dry needling studies for plantar fasciitis.
One of the studies found something pretty remarkable. Try to guess which statement below is true!
It found out how Santa delivers all those toys in one night
It identified a study that saw a drastic improvement in the speed of recovery with trigger point needling of the calf (wink, wink)
Ok, I am awake again after all that systematic review talk.
If you guessed B, DING, DING, DING! In this study comparing a group that received trigger point dry needling and a group that received physical modalities + exercise, the trigger point dry needling group required only 3 weeks of treatment vs. 21 weeks for the other group.
The trigger point dry needling group required only 3 weeks of treatment vs. 21 weeks for the other group.
ARE YOU KIDDING ME? Hidden gems like this are what make’s reading through research fun.
Treatment Strategies to relieve Plantar Fasciitis (heel pain):
Stretch: By all means, continue to stretch… please.
- Gastrocnemius stretch
- Soleus Stretch
- Plantar Fascia Specific stretch
Prescription: 20 second stretch/20 seconds rest. Perform 3 minutes for each stretch.
Renan-Ordine R, et al.
The BIG 3 Trigger Point Treatment Locations (see video):
- Quadratus Plantae (Ok, lets keep it simple. The bottom of the foot… where it hurts!)
Renan-Ordine R, et al.
Plantar fasciitis is a common occurrence that can be treated relatively quick with the right plan. Remember, proper training and weight management can make a huge difference in how you feel. Because of the popularity of this topic we wrote a more detailed article at Tony Gentilcore’s website. Click here to keep gathering more information on plantar fasciitis.
-Dr. Michael Infantino, DPT
Cotchett MP, Landorf KB, Munteanu SE. Effectiveness of dry needling and injections of myofascial trigger points associated with plantar heel pain: a systematic review. J Foot Ankle Res. 2010;3:18. http:// dx.doi.org/10.1186/1757-1146-3-18
Eftekharsadat, B., Babaei-Ghazani, A., & Zeinolabedinzadeh, V. (2016). Dry needling in patients with chronic heel pain due to plantar fasciitis: A single-blinded randomized clinical trial. Medical Journal Of The Islamic Republic Of Iran, 30401.
Martin, R. L., Davenport, T. E., Reischl, S. F., McPoil, T. G., Matheson, J. W., Wukich, D. K., & McDonough, C. M. (2014). Heel pain-plantar fasciitis: revision 2014. The Journal Of Orthopaedic And Sports Physical Therapy, 44(11), A1-A33. doi:10.2519/jospt.2014.0303
Renan-Ordine R, Alburquerque-Sendín F, de Souza DP, Cleland JA, Fernández-de-las-Peñas C. Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial. J Orthop Sports Phys Ther. 2011;41:43-50. http://dx.doi. org/10.2519/jospt.2011.3504