Why Won’t My Plantar Fasciitis Go Away?

In Hip Pain, Physical Therapy, Uncategorized by Seth Peterson, Physical Therapist Oro ValleyLeave a Comment

Kirstin Weible, PT, ScD

What is the Plantar Fascia?

The Plantar Fascia is a thick band of ligamentous tissue that runs from the calcaneus, the heel bone, to the metatarsal heads, the ball of the foot.  It provides a rigid support to the bottom of the foot and is meant to provide a bit of force absorption.  It can become inflamed and quite painful when it has been repetitively stressed.  Of course, if you’ve been dealing with this for quite some time without relief, you’ve probably already read those details on Dr. Google.  The pain is classically worse in the mornings and felt near the heel.  

What Treatments Work for Plantar Fasciitis?

Additionally, you’ve probably tried all of the treatment options you’ve found on the internet as well, for example, calf stretches (soleus and gastrocnemius muscles), rolling a tennis ball, frozen water bottle, or specialized massage devices on the bottom of your foot, or even sleeping in space boots meant to stretch the fascia in the night.  You have been doing these things for week, months, years, and still no relief.  

Perhaps you’ve even gotten steroid injections in the painful area.  These can sometimes be risky because the recent research has shown that a more chronic fasciitis is in fact more of a fasciosis, meaning there is certainly pain and irritation but not much by way of inflammation.  In that case, you’re increasing the risk of tearing the ligament as these injections can compromise its integrity.  And still, the pain persists.  Why? 

Don’t Look ONLY at the Foot

The foot is the first thing to hit the ground.  No matter how the hip, knee, or pelvis is functioning, the foot must adapt as it contacts the ground in order to keep you upright and on your way.  What I’ve seen in the clinic on many occasions is a person with plantar fasciitis as a secondary problem to a weak hip, specifically weakness in the hip abductors.  These hip muscles are meant to provide stability with each step and maintain a certain mechanical balance to the gait pattern.  They can become weak following surgery, some time away from a sport prior to returning, or any number of reasons.  When this is the case, the plantar fascia pays the price.  With each step, it is stressed at a level and in a direction that it is not meant to handle.  When this occurs over a period of time, the irritation sets in, and no matter how you treat the foot, as long as the hip problem persists, so does the foot problem.  

So what’s the solution?  Strengthen the hip abductor muscles, of course!  The best way to start down that road is to come in for an evaluation, or a telehealth visit for those out of towners, and let us determine which of those muscles may the culprit and why.  It may be simple, or it may be something a bit more curious that needs further evaluation in our clinic.  It is also important that we get a chance to rule out more serious pathologies as well.  Then, we’ll be able to make you a treatment plan and a home program to hopefully kick that plantar fascia pain out of your life for good!

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