By Don McCann, MA, LMT, LMHC, CSETT
In the last several years I have seen an increase in clients with plantar fasciitis ranging from dancers, to pregnant mothers, construction workers, and athletes. The activities of the clients are vastly different, but the symptoms are debilitating and painful.
They are all looking for relief from pain and the ability to resume their normal life activities. The key to this is understanding and identifying the cause of each client’s plantar fasciitis. The following is a case history which shows how understanding the cause of plantar inflammation can lead to recovery.
The Case Study
Mary, a 28-year-old mother who was six months pregnant with her second child, first noticed pain in her left foot at five months, after she danced at her sister’s wedding reception. This was the first time she had worn three-inch heels since becoming pregnant. The next day when she got out of bed she noticed a sharp burning pain in her left foot that continued whenever she was standing or walking. She went to her doctor who injected her left foot with cortisone, but the relief was minimal.
She then went to a podiatrist but refused any additional injections due to her pregnancy and previous lack of success with them. He made her orthotics promising her that they would be her solution. Immediately upon using the orthotics the foot pain became worse so he gave her a boot that would support and immobilize her foot.
However, the pain persisted with no relief. She then went to a chiropractor who adjusted her back and foot which only irritated her foot, but he told her the adjustments and ice should resolve the issue. The ice helped but when she took it off and stood up the pain returned in full intensity.
Her obstetrician told her that she would probably not get better until she delivered because the extra weight she was carrying with her pregnancy was continually straining her plantar fascia. He suggested minimal standing and walking until after delivery. Mary was quite frustrated as she had always been active and felt fine except for her left foot and some discomfort in her low back which she felt was from the additional weight of carrying the baby.
Understanding the Cause
Mary had tried a number of medical solutions with no success. It seemed like everything she did aggravated the condition. She had little control over the weight she gained, and she knew she would gain more with her pregnancy. The pregnancy was definitely a contributing factor. The postural analysis clearly showed that her left ilium was significantly rotated anteriorly and her right ilium posteriorly. More than likely this rotation had been present for years since this is the core distortion that even a normal one-year-old exhibits.
The weight gain with the growing fetus caused it to become more pronounced. Looking at her left leg it was obvious that her knee was rotated medially and hyperextended, her lower leg and foot were rotated laterally, and the arch was everted and much flatter than her right foot.
These were compensations for the longer left leg due to the anterior rotation of the left ilium. This structural pattern was putting significant stress on her medial plantar fascia where she was experiencing her pain and inflammation. Additionally, her anterior transverse arch just behind the ball of her foot was flat to the floor and painfully inflamed.
Dancing in high heeled shoes with this structural collapse pattern strained her plantar fascia in these areas. The continued weight gain with her pregnancy also put more strain on the entire structural pattern from the hip down through the arches, especially the plantar fascia. Therefore, bringing her body back into structural support including the arches would take the pressure off the plantar fascia. This turned out to be structural solution to rehabilitate the condition that was causing her plantar fasciitis.
Mary developed plantar fasciitis while she was in the core distortion with significant structural weaknesses that affected the plantar fascia during weight bearing activities. Her plantar fasciitis in her left foot was associated with the anterior rotation of the left ilium in the core distortion which also created a long left leg, weaknesses, stress and imbalances in the leg and down through the arches affecting the plantar fascia.
Results of the Therapy
A combination of therapies including Cranial/Structural therapy and specific myofascial release techniques were used to bring both iliums into weight bearing support which changed the stress down through the feet and into the plantar fascia. Both functional and applied kinesiology showed significant strengthening throughout the legs when the iliums were moved back into support and balance.
Since Mary’s weakness was in the medial plantar fascia in her left foot, reducing the anterior rotation of the left ilium evened out the leg lengths, reduced the weight bearing collapse that went down into her medial arch, and took the stress off the plantar fascia with the improved structural alignment. This allowed the inflammation of the plantar fascia to heal which relieved the plantar fasciitis pain and discomfort.
Even though Mary’s pregnancy with its increasing weight would continue to create increased stress down through her left foot, the plantar fasciitis was completely alleviated by bringing the body into structural balance and support, and by applying the myofascial soft tissue releases. This case was resolved by looking beyond the symptoms of the plantar fascia and addressing the structural imbalances.
Yochum TR, et al. Essentials of Skeletal Radiology, Volume 1, 2nd Edition. Philadelphia: Lippincott Williams & Wilkins, 1986; pp. 175-76.