BraceLab Clinical Clues

March 2021 No. 20

Plantar Fasciitis: Complex made Simple

Jerry Ditz, DPT, Dip. Osteopractic, Cert. SMT, Cert. DN

A recent 34-year-old patient with plantar fasciitis who was training for 6.2-mile race experienced symptoms anytime she ran more than 4 miles. Her race was in two weeks, and her schedule permitted only one 30-minute evaluation and one 30-minute treatment prior to the race.

Typical treatment for runners/patients with plantar fasciitis includes stretching, low-dye arch taping(1), strengthening, night splints, foam rolling, dry needling, orthotics, and multiple video sessions to evaluate and modify the running form, all of which typically takes weeks(2). Although I suggested she stop running for a couple weeks until her pain subsided, she informed me that was not an option and I needed to “fix” her before her race.

Because she was unwilling to rest, my only option was to modify her tissue stress caused by the running. Providing extra foot support with low-dye arch taping and examining her running form to determine contributing factors (i.e. low cadence, heel striking, lack of mobility, unrelaxed upper body, or unequal weight distribution) were my two available treatment options.

Low-dye arch taping was applied at the end of her first treatment session (Figure 1) with the goal of limiting/controlling foot pronation and off-loading the plantar fascia(1). I used one-inch-wide zinc oxide tape, rather than traditional athletic tape which is more rigid and adheres tenaciously to the skin. The taping proved helpful, so she wore it during her running form evaluation. She would wear the tape during her upcoming race if her symptoms did not increase after the evaluation.

Figure 1: Steps of applying low-dye arch taping shown from left to right

Next was the challenge of compressing an evaluation that usually takes multiple one-hour sessions into one single half-hour session. Typically, I would use visual feedback from video-taped sessions to explain how the runner’s form differed from other runners and how this impacts their body and running efficiency. Such a short clinic time dictated my trial of one change for this patient as recommended by Zimmermann who modifies a runner’s form/forces by using a simple verbal cue. (3)

Figure 2: Illustration of heel striking gait

During the running evaluation she contacted the ground with her heel (“heel striking” runner). Although this gait is acceptable when walking, experienced and efficient runners typically contact the ground with either their mid-foot (ball of the foot) or forefoot (toes). Based on Zimmerman’s article, I instructed the patient with one cue: “Change to a ball-of-foot strike.” As she continued 10 minutes of running, she maintained the mid-foot strike pattern and her pain did not increase. The patient used the combination of low-dye arch taping and her “ball-of-foot strike” cue to successfully complete her race.

In the past, evaluating and modifying a patient’s running form has been a complex process. After working with this patient I wondered if I have been making things too complicated? Perhaps instead of explaining all we know to a patient, maybe we should offer strategic tissue unloading and a gait cue as the simplest “fix” to this complex problem.

 

1. Radford JA, et al. "The effect of low-dye taping on kinematic, kinetic, and electromyographic variables: a systematic review." J Orthop Sports Phys Ther 36.4 (2006): 232-241.

2. Fraser JJ, Glaviano NR and Hertel J. "Utilization of physical therapy intervention among patients with plantar fasciitis in the United States." J Orthop Sports Phys Ther 47.2 (2017): 49-55.

3. Zimmermann WO and Bakker, EWP. "Reducing vertical ground reaction forces: The relative importance of three gait retraining cues." Clin Biomech 69 (2019): 16-20.

 

 

Download Clinical Clues No.20, Plantar Fasciitis: Complex made Simple; March 2021

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Disclaimer: BraceLab Clinical Clues are intended to be an informal sharing of practical clinical ideas; not formal evidence-based conclusions of fact.

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