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Wednesday, March 6, 2013

Strengthening the Plantar Fascia...This Post Makes More Sense!

I think I need to clarify a previous post on my blog.  I kind of went haywire when writing Can You Strengthen the Plantar Fascia??  So right from the beginning, no you can not strengthen the plantar fascia!  The plantar fascia no matter how you look at it is made up of connective tissue and not contractile tissue as is the tissue that our muscle are made up of.  In the prior mentioned post, I treat the plantar fascia as if it is a tendon because of it's properties and characteristics and the way it responds to proper treatment.  But as stated in peer reviewed literature and the medical field, it is considered a ligament.  I do believe there will be a closer look though at it's classification.

What you can do however is to strengthen the specific muscles in the foot and leg that will relieve the abnormal tension on the plantar fascia.   The plantar fascia does respond to forces and stress on it.  This is seen in imaging studies.  The plantar fascia will thicken under heavy loads and abnormal tension.  This is one method that is used to diagnose plantar fasciitis.  When the load on the plantar fascia reduces, the thickness of the plantar fascia reduces as well.  Ligaments do not have such a responsive property but tendons do!

Here in lies a problem though.  The plantar fascia can thicken but it doesn't necessarily mean that the pain in your foot is that of plantar fasciitis.  The problem is that a doctor will look at the thickness alone and use this one diagnostic finding and then automatically assume that a person has plantar fasciitis.

So, let's take for example the connective tissue at your wrist of which often causes symptoms of carpal tunnel syndrome.  The connective tissue or retinaculum that makes up one side of the carpal tunnel thickens.  This then puts pressure on the underlying vessels and nerves going in to the hand.  It's this pressure on the underlying tissue that causes the pain.  It is not the thickening of the retinaculum.  This retinaculum is for the most part nocioceptor free.  But if this retinaculum were a tendon, it would be extremely painful at rest or when active.

In my book, I give specific directions with performing what is called "eccentric" strengthening exercises.  This type of strengthening is great for strength gains but also increases the integrity and strength of the involved tendons.  One particular tendon that responds very well to eccentric strengthening is the patella tendon.  Eccentric strengthening is also used for achilles tendonitis or recovering from a ruptured achilles tendon repair.  Therefore, assuming the plantar fascia is a tendon and even after reading this post you still are hung up on "strengthening the plantar fascia", then these are the exercises for you.

So you see, the pain in your foot can easily be the tibialis posterior tendon or the intrinsic muscles in your foot.  As seen in the image below, the pain that you feel in the heel of your foot is usually from the  periosteum (the outer covering of your bone or the "skin" of your bone.  This skin on our bones is nerve dense with pain receptors).  The periosteum can become quite painful from the pulling and tugging of the tissue attachment that is under abnormal stress, i.e. the plantar fascia.  It's this very reason that when you press on the bottom of your heel when you are experiencing symptoms that your heel is very sore and painful.  The pain is coming from the inflammation at the bone and tissue attachment site on your calcaneus or heel bone.

Image is property of David Wooster Middle School...Thank You!

Again, it takes a methodical and meticulous examination of the leg, ankle, and foot prior to determining exactly what you have - plantar fasciitis, tibialis posterior tendonitis, or some other injury to your foot or leg.

Any questions, feel free to email me!

Happy Bipeding!

Brad Senska, PT, DPT, BS, ASTYM

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