subsides. Another effective tool to relieve the cramp can be to ask the client to press the sole of the foot into your palm to simulate standing, which can effectively release the cramp. If neither of those is effective, you can ask the client to place the cramping foot onto the floor and put weight Trigger point therapy If you are trained in trigger point therapy, this can also be a very effective method for treating plantar fasciitis when applied to the muscles of the calf discussed previously. It can be even more effective when combined with passive stretching during a manual therapy session and can greatly increase the beneficial effects of stretching. A study published in the Journal of Orthopedic and Sports Physical Therapy in 2011 “reported that trigger point manual therapy can also potentially provide ‘superior short-term outcomes’ when compared to stretching alone. This particular study involved 60 patients with diagnosed plantar heel pain and those who received trigger point therapy indicated Instrument-assisted soft tissue mobilization The Graston technique (more commonly used in the physical therapy setting- see Figure 4) and Gua Sha (more commonly used in the massage therapy setting) can help release the fascia surrounding the calf muscles and reduce their hypertonicity, which can allow for more effective deep tissue work within the muscle belly and more effective stretching. IASTM applied directly to the plantar fascia on the sole of the foot can also be very effective, but only if the client can tolerate it. As with any modality, these techniques should only be used if you have taken the proper training and are aware of any contraindications. Exercises for lower leg strength Therapists can instruct the client to do exercises to strengthen the muscles of the lower leg to create more balance and improve the tension patterns that may be contributing factors. A gait assessment might help the therapist gain more insight as to where the imbalances are, and determine which muscles need to be made stronger and which muscles are working too hard and will likely need to be stretched. The anterior tibialis is the primary Stretching and passive stretching Stretching as a method for treating plantar fasciitis is commonly applied during therapy sessions and suggested to patients as a way to self-treat at home. Passive stretching, in which the client does not actively participate, can also be very effective as part of a therapy treatment. After the soft tissues of the lower leg, ankle, and sole of the foot have been adequately warmed up and worked with the tools discussed previously, stretching can be applied with caution during acute episodes. If your client is currently experiencing a lot of pain from acute inflammation, use Light massage Depending on the severity of the acute inflammation and the comfort level of your client, light massage may be applied directly to the plantar fascia. Remember that the common point of tenderness with plantar fasciitis is at the front and central edge of the heel mound on the sole of the foot, and that the plantar fascia is thickest in this area.
on it, which often relieves the cramp immediately. When the cramp subsides, ease back into the deep tissue work if there is no evidence of further cramping. If the cramping continues to happen, stop the work that is causing it and continue on with the rest of the manual therapy session. experiencing a greater reduction of pain and improvement in function than those assigned to the stretching-only group” (DeBusk, 2018). Releasing the calf muscles first with trigger point therapy or deep tissue massage can allow for better stretching in those muscles as well as the plantar fascia itself. However, you should proceed with caution when applying trigger post therapy to a client with an acute case of plantar fasciitis. As with deep tissue massage, trigger point therapy applied to the calf muscles can also cause cramping in the sole of the foot. If this happens, follow the foregoing guidelines.
Figure 4
mover in dorsiflexion of the ankle, and it can be weakened by inhibited dorsiflexion caused by hypertonicity in the gastrocnemius. Because the calf muscles are larger and stronger than the shin muscles, some degree of reciprocal inhibition will likely always be present, but better balance between the front and back of the lower leg can be beneficial in reducing occurrences of plantar fasciitis. gentle stretching with the intention of slowly lengthening the affected tissues. The goal, in this case, is less about creating more flexibility and more about allowing some small amount of release to take place. As the saying goes, slow and steady wins the race. Be careful about pushing already inflamed tissue too far, and invite feedback from your client about their comfort level while performing passive stretches. Our goal is to aid in the reduction of inflammation, not to add to it. Digging too deeply in this area during episodes of acute inflammation can cause more pain and inflammation and should be avoided until the condition has improved (see subsequent sections for applications for chronic plantar fasciitis). However, light effleurage and gentle cross-fiber friction to the whole of the plantar fascia can provide some
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