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“The projected yearly costs of plantar fascia treatment could range from 192 to 376 million dollars in the United States, which are huge economic burdens for both the society and individuals.” (1) And almost half of plantar fasciitis sufferers will continue to report symptoms ten years after onset. (2)

Fortunately, well-equipped evidence-based chiropractors can have a significant impact on both of these statistics. This blog will cover five home-based tools that will compliment your in-office care and improve outcomes; including a new therapeutic taping technique that has shown promise.

Like most cumulative trauma disorders, the etiology of plantar fasciitis is multi-factorial. (3) Problems typically arise when repetitive eccentric strain exceeds the tissue’s threshold for injury. Certain factors may increase the likelihood of developing the disorder, particularly pes planus (fallen arch) and hyper-pronation, which increase tension on the plantar fascia, leading to repetitive microtrauma at the band’s vulnerable attachment on the medial calcaneus. (4) 

Evidence-based chiropractors are well-suited to manage plantar fasciitis. Our manual therapy options, including mobilization, myofascial release, stretching, exercise, and modalities are proven tools. (5-8) The best treatment outcomes are achieved by combining multiple techniques- particularly mobilization and exercise. (7,9)

In-office care is a crucial component of treatment. However, successful long-term management of cumulative trauma disorders requires minimization of, well…cumulative trauma. Most of that stress occurs between office visits- at home. So here are five tools that you can prescribe to help plantar fascia patients preserve their arch after they leave your office.

1. Fascia Therapeutic Taping

“Fascia taping is designed to stabilize the plantar ligaments and limit abnormal movements of the plantar fascia by exploiting the arch-raising effects of the foot windlass mechanism.” (1)

Windlass mechanism

At heel strike, the plantar fascia is slack to allow the foot to accommodate uneven surfaces. As the heel lifts and forefoot dorsiflexes toward toe-off, the distal plantar fascia “winds” up and around the first MTP joint pulling the plantar fascia taut, shortening the distance between the heel and forefoot, raising the arch– creating a stiffer lever for propulsion. (10)

While the effectiveness of various plantar fascia taping protocols is contested, a January 2020 study analyzed a novel therapeutic taping protocol and found potential benefit for runners with plantar fasciitis:

“Our prediction showed that, compared with non-taping, fascia taping reduced maximal strains on the fascia band and increased navicular height slightly during the stance phase. The study quantified the loading status of the plantar fascia during running and provided mechanical evidence to support the usage of taping as a mean to reduce fascial strain, thus possibly controlling injury risks for the runners.” (1)

Plantar Fascia Therapeutic Taping

Pre-cut one 5-6 inch strip and two 8-12 inch strips of elastic therapeutic tape. Split one end of each long piece into four equal strips, then trim all corners and split the backing at the base of each cut strip. Position the prone patient’s foot so their metatarsophalangeal joints are forced into dorsiflexion by the table. Anchor the unsplit end of one long piece to the patient’s posterior heel. Apply the four split strips to the undersurface of the plantar fascia with approximately 50% stretch. Apply the second strip to overlap the first in an identical fashion. Apply the final shorter piece as a stirrup on the plantar heel surface, anchored below each malleolus.

2. Tensoplast Arch Wrap

The use of a Tensoplast wrap is an alternative taping technique that may help support arches and fascia. This method provides supplemental support in situations where an insole is impractical, i.e., sleeping, wrestling or ballet shoes, etc. An advantage of this technique is that patients can temporarily remove the support for bathing.

Tensoplast Arch Wrap

Tensoplast arch taping is performed by first applying a strip of tape, adhesive side out, around the patient’s arch with 1′ overlap, then covering the first strip with a second piece – adhesive side facing the foot. Tape should be applied snug but should not cause vascular occlusion. Markings may be made to denote top and bottom so that the patient may remove and reposition the wrap as needed.

Alternately, a commercially available brace, like a PSC Fabrifoam wrap, may be more practical for extended use. *Please note that the wrap is size and side specific.

 PSC Fabrifoam Wrap ®

3. Arch Supports & Orthotics

Patients who hyperpronate and those with fallen arches may benefit from arch supports or orthotics. (11) But choosing which patients NEED orthotics can be challenging. A BMC Musculoskeletal Disorders study found that 89% of patients who demonstrate at least 3 of the following predictors will benefit from custom foot orthotics: (12)

  • Average pain intensity decreased by over 1.5 points with a trial of anti-pronation taping
  • Range of ankle plantarflexion >54 degrees
  • Strength of ankle plantar flexors on the symptomatic side was equal to or stronger than that on the other side
  • Range of hip internal rotation <39 degrees
  • Range of hip external rotation >45 degrees

4. Socks and Boots

Acute heel pain upon arising from bed is a characteristic complaint for plantar fasciitis patients. In part, this occurs because the injured tissue heals at rest while the fascia is in a shortened, non-weight bearing state. The first step of the day then abruptly stretches the new tissue and generates pain – like pulling open a cut first thing each morning.

Chronic plantar fasciitis patients may benefit from a boot or night splint that encourages dorsiflexion and allows the plantar fascia to “heal” in a lengthened state. (13,14) There are several commercially-available options ranging from small and soft to large and rigid.

BraceAbility Night Sock ®

Strassburg Sock®

Rigid Night Splint

5. Home Strengthening

Most essentially, manual therapists should strive to empower the patient so they do not need to rely upon long-term extrinsic support. Strengthening exercises are appropriate for the gastroc, soleus, posterior tibialis, and intrinsic muscles of the foot. (15) Examples include marble and towel gripping exercises. Strengthening exercises for the posterior tibialis should be implemented to help arch support. Strengthening of the flexor digitorum brevis is an essential component of treatment and may be accomplished by performing toe flexion with an exercise band. (16) Eccentric heel raises with the great toe positioned in passive dorsiflexion (i.e., great toe propped up with a towel) have shown benefit for plantar fasciitis patients. (17)

Part of our job as the provider is to rehab dysfunctional tissue…But outside of the 1% of time they’re physically in our office, the other 99% of the time, it’s up to the patient to keep those tissues protected and healthy.

And that’s precisely what ChiroUp’s condition/exercise reports come in. Over 1,000 providers around the world use our report builder to:

✓ Educate patients on their condition & treatment

✓ Give patients access to prescribed exercises & ADLs (print, email, mobile app access)

✓ Track patient compliance (based on email & app activity)

✓ Collect outcomes & satisfaction ratings 

There is no other company, no other software that does what we do. Check it out for yourself and click here to learn more about how simple it is to start prescribing our Condition Reports.

References
  1. Chen TL, Wong DW, Peng Y, Zhang M. Prediction on the plantar fascia strain offload upon Fascia taping and Low-Dye taping during running. Journal of Orthopaedic Translation. 2020 Jan 1;20:113-21. Link
  2. Hansen L, Krogh TP, Ellingsen T, Bolvig L, Fredberg U. Long-term prognosis of plantar fasciitis: a 5-to 15-year follow-up study of 174 patients with ultrasound examination. Orthopaedic journal of sports medicine. 2018 Mar 1;6(3):2325967118757983. Link
  3. Gross MT, Byers JM, Krafft JL, Lackey EJ, Melton KM. The impact of custom semirigid foot orthotics on pain and disability for individuals with plantar fasciitis. Journal of Orthopaedic & Sports Physical Therapy. 2002 Apr;32(4):149-57. Link
  4. Abreu M, Chung C, Mendes L, Mohana-Borges A, Trudell D, Resnick D. Plantar calcaneal enthesophytes: new observations regarding sites of origin based on radiographic, MR imaging, anatomic, and paleopathologic analysis. Skeletal radiology. 2003 Jan 1;32(1):13-21. Link
  5. Buchbinder R. Plantar fasciitis. New England Journal of Medicine. 2004 May 20;350(21):2159-66. Link
  6. Renan-Ordine R, Alburquerque-SendÍn F, Rodrigues De Souza DP, Cleland JA, Fernández-de-las-Peñas C. Effectiveness of myofascial trigger point manual therapy combined with a self-stretching protocol for the management of plantar heel pain: a randomized controlled trial. journal of orthopaedic & sports physical therapy. 2011 Feb;41(2):43-50. Link
  7. Díaz López AM, Guzmán Carrasco P. Efectividad de distintas terapias físicas en el tratamiento conservador de la fascitis plantar: revisión sistemática. Revista Española de Salud Pública. 2014 Feb;88(1):157-78. Link
  8.  Schuitema D, Greve C, Postema K, Dekker R, Hijmans JM. Effectiveness of Mechanical Treatment for Plantar Fasciitis: A Systematic Review. Journal of Sport Rehabilitation. 2019 Jan 1;1(aop):1-35. Link
  9. Sutton DA, Nordin M, Cote P, Randhawa K, Yu H, Wong JJ, Stern P, Varatharajan S, Southerst D, Shearer HM, Stupar M. The effectiveness of multimodal care for soft tissue injuries of the lower extremity: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Journal of manipulative and physiological therapeutics. 2016 Feb 1;39(2):95-109. Link
  10. Michaud TC. Foot Orthoses and Other Forms of Conservative Foot Care, Thomas C. Michaud, Newton, MA. 1997.
  11. Landorf KB, Keenan AM, Herbert RD. Effectiveness of different types of foot orthoses for the treatment of plantar fasciitis. Journal of the American Podiatric Medical Association. 2004 Nov;94(6):542-9. Link
  12. Wu FL, Shih YF, Lee SH, Luo HJ, Wang WT. Can short-term effectiveness of anti-pronation taping predict the long-term outcomes of customized foot orthoses: developing predictors to identify characteristics of patients with plantar heel pain likely to benefit from customized foot orthoses. BMC musculoskeletal disorders. 2019 Dec;20(1):264. Link
  13. Batt ME, Tanji JL, Skattum N. Plantar fasciitis: a prospective randomized clinical trial of the tension night splint. Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine. 1996 Jul;6(3):158-62. Link
  14. Powell M, Post WR, Keener J, Wearden S. Effective treatment of chronic plantar fasciitis with dorsiflexion night splints: a crossover prospective randomized outcome study. Foot & ankle international. 1998 Jan;19(1):10-8. Link
  15. Allen RH, Gross MT. Toe flexors strength and passive extension range of motion of the first metatarsophalangeal joint in individuals with plantar fasciitis. Journal of orthopaedic & sports physical therapy. 2003 Aug;33(8):468-78. Link
  16. Michaud T, New Techniques For Treating Plantar Fasciitis Competitor Group Published Mar. 6, 2014
  17. Rathleff MS, Mølgaard CM, Fredberg U, Kaalund S, Andersen KB, Jensen TT, Aaskov S, Olesen JL. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up. Scandinavian journal of medicine & science in sports. 2015 Jun;25(3):e292-300. Link

About the Author

Dr. Tim Bertelsman

Dr. Tim Bertelsman

DC, CCSP, DACO

Dr. Tim Bertelsman graduated with honors from Logan College of Chiropractic and has been practicing in Belleville, IL since 1992. He has lectured nationally on various clinical and business topics and has been published extensively. He has served in several leadership positions within the Illinois Chiropractic Society and currently serves as past president of the executive board.

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