toes much father down than you can lift them), but both are necessary for healthy joint function and range of motion. The normal range for plantar flexion is considered to be between 20 and 50 degrees, while the normal range for dorsiflexion is between 10 and 30 degrees. Anything less than 10 degrees is considered to be decreased or inhibited dorsiflexion, and the reason for that can be skeletal, soft tissue, or both. Our focus will be on the soft tissue causes, as that is what manual therapy can address within the scope of practice. Limited or compromised dorsiflexion causes a chronic shortening and tightening of the plantar fascia, which can trigger episodes of inflammation. When that consistent tightness is compounded by heavy use from the impact of running and other high-impact activities, pain often follows and can be persistent if it does not get adequate rest or the calf muscles are not adequately and frequently stretched. Figure 2
the heel (see Figure 2) on the underside of the foot (at the attachment where you pressed in “Where Is the Plantar Fascia” previously), particularly upon getting up in the morning after the feet have not been bearing weight for many hours. When it occurs in runners, walkers, and hikers, it is considered to be a repetitive strain injury, and the pain typically occurs soon after exercising. Other, less common symptoms can include redness and swelling at the point of tenderness or elsewhere along the plantar fascia, and all of the symptoms can be exacerbated by standing for long periods of time. Episodes of inflammation in the plantar fascia can be acute and only last for a few days, or they can be chronic and recur frequently, as in the case of runners who log a lot of miles and do not allow adequate time for the inflammation to subside. It can become a very nagging problem for anyone who spends any amount of time on their feet. The pain caused by plantar fasciitis becomes hard to ignore, because every step is a reminder. Plantar fasciitis can also be part of a more complex problem, which often happens with runners and other athletes, that also includes the Achilles tendon, the gastrocnemius muscle, and sometimes the soleus and other small muscles in the lower leg. When the calves are chronically tight (hypertonic) from heavy use and inadequate stretching, as they can be from running or other sports that include a lot of running or jumping, the tension pattern causes a decrease in the degree of dorsiflexion that the ankle can achieve. This tension pattern in the lower leg is also fairly common among those whose professions require a lot of time standing on ladders. Dorsiflexion is the movement of the ankle joint that creates upward movement of the top of the foot toward the shin, and is the opposite ankle joint movement to plantar flexion, which is commonly known as “pointing of the toes.” Normal articulation of the ankle joint allows for much more plantar flexion than dorsiflexion (you can typically point your Plantar flexion and dorsiflexion Use your feet again to examine the mechanics of dorsiflexion and plantar flexion of the ankle. Sit barefoot with your knees at 90-degree angles, feet flat on the floor, hip distance apart, toes facing forward. First, press the toes into the floor, lift the heels, and bring the ankle into plantar flexion. Notice the degree of the angle between the sole of the foot and the floor, which should be significant if you do not have an ankle injury. Next, press the heels into the floor and lift the toes up toward the ceiling, bringing the ankle into dorsiflexion. The angle between the sole of the foot and the floor is probably much less than when your ankle was in plantar flexion, which is normal, but is your dorsiflexion limited? Were you able to roll all the way onto the back of your heel surfaces and lift the rest of the soles of the feet off the floor? Did both feet lift an equal distance Risk factors A research article published by the National Institutes of Health in the National Library of Medicine states, Plantar fasciitis is the most common cause of heel pain presenting in the outpatient setting. The exact incidence and prevalence of plantar fasciitis by age are unknown, but estimates show that approximately 1 million patient visits annually are due to plantar fasciitis. This condition accounts for about 10% of runner-related injuries and 11% to 15% of all foot symptoms requiring professional medical care. Plantar fasciitis occurs in about 10% of the general population, with 83% of these patients being active, working adults between 25 and 65 years.” (Buchanan et al., 2024)
away from the floor? Did you notice tightness in one or both of your calves as you did this? Then, stand up and repeat the exercise. (You may want to have something nearby to hold onto if balance is an issue for you). Again, measure your degree of plantar flexion, then measure your degree of dorsiflexion. Notice how much more difficult it is to lift the toes up and back to lengthen the plantar fascia when the feet are weight bearing and the muscles of the calves are engaged. Do you feel more tightness in the calves and soles of the feet when standing as opposed to sitting? To further investigate the relationship between the ability to dorsiflex the ankle and the plantar fascia, repeat the exercise with shoes on, both sitting and standing. Notice how much restriction is placed on the front of the foot and toes when wearing shoes. There are, presumably, many more who suffer with this condition but do not seek medical treatment. Though plantar fasciitis is more common in athletes, anyone can be affected by this affliction. Age is also a factor, as the statistics show that middle-aged people seem to have the highest prevalence of plantar fasciitis. There are risk factors related to both activity and general physical condition, which will be described subsequently.
EliteLearning.com/Massage-Therapists
Book Code: MLA1225
Page 60
Powered by FlippingBook