Is it Plantar Fasciitis?

Is it Plantar  Fasciitis?

Many times, pain in the bottom of the foot or heel can be pushed into a blanket diagnosis of “you have plantar fasciitis”. But is it plantar fasciitis? Could it be another condition like tibialis posterior tendonitis, stress fracture in the heel, radiating pain from the low back? While getting a blanket diagnosis of plantar fasciitis based on zero exam with some basic rehab and soft tissue techniques thrown at it may work, there is a good chance it probably will not. You must know what you are aiming at. And in the same boat, what is causing the plantar fasciitis? Just because there is pain and inflammation in the plantar fascia does not mean that the CAUSE of the pain is coming from that area as well. In fact, it rarely does. This is why seeking out help from sports chiropractor or physical therapist is important to get a proper diagnosis and most importantly find out the main cause of the pain.  

For the purposes of this blog, we will assume that we have ruled out all red flags, low back, and other conditions near the foot. We will focus on differentiating between plantar fasciitis and tibialis posterior tendonitis. We will go through anatomy and function, classic signs of each condition, and patient history things to consider. In the next blog we will go through treatment and rehab considerations for each condition.

 

What is the Plantar Fascia?

The plantar fascia is a dense, fibrous connective tissue that is attached to the heal, toes, and many surrounding muscles and structures of the bottom of the foot. The plantar fascia is designed to be a passive (meaning non contracting) transmitter of forces that are put on the foot. It is also a supporter of the medial longitudinal and transverse arches.

  InkedPlantar Fascia LIInkedPlantar side view LI

 

What is the Tibialis Posterior?

The tibialis posterior is the deepest and most central muscle of the lower leg with fibers originating on both shin bones. It wraps around and inserts into the calcaneus, navicular, cuboid, cuneiforms, and the second through fourth toes. With it location, multiple attachment points, and powerful tendon, it is the most important stabilizer of the foot helping to create the medial arch. When injured or weakened, stabilization of the foot can be compromised. The tibialis posterior also helps to flex the ankle down and turn in.

InkedTibialis Posterior LI

 

Plantar Fasciitis Classic Signs:

  • Pain with first steps in the morning or prolonged period of rest.
  • Pain again comes back usually toward the end of the day with increased weight bearing activity.
  • Walking on toes or upstairs can be aggravating
  • Diffuse pain across heal or pinpoint pain on bottom of heal
  • Tenderness along inner side of bottom toward heel

 

Tibialis Posterior Tendonitis Classic Signs:

  • More pain in heel longer you are on it
  • Pain along medial border of foot to behind medial ankle and up medial posterior shin
  • Pinpoint pain and tenderness at the navicular (bone behind the tissue of the bottom arrow in tibialis posterior picture above).

 

Recent History:

  • Any sudden increase in activity like running or explosive movements over last few weeks or months.
    • The increased strain from activity alone could have been too much for the body to adapt and recover from.
  • Any change in footwear whether for work or workouts.
    • Improper footwear can put the toes in relative upward position for longer periods of time causing the fascia to be consistently overstretched over time.
    • Improper footwear can also cause the foot to become stiff from lack of movement. Very stiff and rigid shoes that allow minimal movement in the foot cause this to happen over time. Then when the demand is placed on the foot and it needs to be mobile, it cannot move properly and leads to pain. This is why we refer to some shoes as a “coffin for the feet”. They do not allow the foot to be a strong and mobile base of support leading to the “death” of its very important function.

 

Flat Feet and Pronation

A big misconception we hear is that a patient’s pain is due pronation or their “flat fleet”. The reality is people with high arches can get plantar fasciitis and people with “flat feet” are not doomed to come down with it. It is more about the rate at which you can control pronation and how long you remain in it that it the problem. People who overpronate or cannot control the rate of it, will elongate the fascia like wringing out a dish rag that will cause increased strain on the fascia. This foot is too mobile.

People that cannot move properly through the foot limit their shock absorption and cannot dissipate forces, so the fascia takes a beating. This foot is too rigid.

 

Stayed tuned as we will cover how treatment for people that cannot control pronation vs people that cannot move properly throught the foot can be different, as well as general treatment and rehab considerations for each condition in the next blog! 

 

 

References: Gilroy, A. M., MacPherson, B. R., & Ross, L. M. (2008). Atlas of anatomy. Stuttgart: Thieme.

 

By accepting you will be accessing a service provided by a third-party external to https://www.ictmjc.com/

Have a Question?

Do you have a question about chiropractic care, fitness or nutrition?  We would love to hear from you, and we might even turn your question into our next blog post!

Ask a Question

Blog Topics

GoTime #KneePain Rhomboid Muscles Foot Pain Neurology sports #Wichita Physical Therapy development orthotics Running Tension Healing Latissimus Dorsi WestWichitaChiropractor Heel Pain knee health parenting Squats #somethingsbrewingict race ICTrunning Handout mental health WSU #wholefoods #hipstrength crawling FootExercise How to reduce pain guest blog adjustment ShoeShopping Conditioning healthcare #freemuscletherapy Hip Flexors Health Cupping Therapy Rehabilitation rollingpatterns Chiropractic tag2 Toe DNS Mechanics Glute Muscles lifting PlantarFasciitis health movement screen functional chiropractor pregnancy doula muscletherapy Foam Rolling gaming Seek Chiropractor Pain childbearing toe functionality conditioning Compression Sleeves Functional Core foot complaint home stretches Adductors Self Help bodyweight Mobility Movement Healthcare 2018 rehabilitation weekend sport injuries Performance Low Back Pain squats DryNeedling stability Crossfit #deepsquat Education WichitaChiropractor Dry Needling Shoes treatment options #races bodyawareness squat MRI Mobility Drill Company Announcements Mid-Back Pain wichita Pectoralis Muscles Body Awareness Yoga dairy free WestWichita HamstringStrain Grand Opening FAQ 5K Massage Top 5 Adjustment Core Strength Orthotics test 1MillionCups Information BackPain Recovery patriotic #FootPain membership plan Shoulder Pain knee function Inflammation Wet Needling #1millioncupsict chiropractor Sitting Help RunningShoes Lifting #bellybreathing disc herniation Taping Treatment Options #localfarmers Feet Equipment chiropractors kansas seminar Conservative Care Stop Light plantar fasciitis Understanding Pain ICT #RunningPain Fitness Class physical therapy GroupTraining community Disc Herniation #Running Squat postpartum Acupuncture Gym motorpatterns Insurance SportsInjury stress Soft Tissue Therapy awareness performance SportsRehab Strain #growingwichita Accupuncture Lumbar Roll BeginningExercise Payment allergies Sitting Posture Cost Fitness esports myths Shoulder #localbusiness Myofascial Release Pain Management sara skiles mechanics inflammation SportsChiropractor knee pain Myths Limitation entrepreneur crossfit pain management tummytime Rolling Patterns Home Stretches knee joint Headaches Elbow Pain culture Plateau Membership Plan Wichita Nerve Pain Breathing Inner Thigh foot pain ChiropracticOffice ChiropracticPhysician Sprinting chiropractic Exercise FoamRollingFriday running elbow pain #HipPain rhomboid muscles

Subscribe to Our Blog

Move HEALTHY.               Feel HEALTHY.              Live HEALTHY.