Point-Counterpoint: Stretching: Is It Beneficial For Plantar Fasciitis?
Continuing up the kinetic chain, the lower back as well as the thoracolumbar areas may suffer as well due to the abnormal rotational compensations. The excessive internal rotation could produce shearing of the lumbar discs, causing potential bulging or degenerative arthritic changes. Accordingly, clinicians may commonly note a disc bulge incidentally. Often when it ruptures, the patient was not doing any excessive movements and this probably would not have occurred if there were not chronic low-grade rotational compensations occurring at these areas. Lower back postural fatigue is common and we can often remedy this when we look toward the foot for the answer.
When there are frontal, transverse or sagittal plane compensations, rotation of the pelvis will be affected so any or all of the musculature attaching to the pubis and ilium are susceptible to abnormal strain. The affected musculature may include the abdominal musculature, psoas muscles, tensor fascia lata and the hip adductors. Impaired recruitment here may lead to chronic weakness and the gait changes I mentioned above.
Moving proximally, the quadratus lumborum and erector spinae muscles attach to the ribs, illium and lumbar vertebrae. The muscular and aponeurotic diaphragm forms the floor of the thorax and the roof of the abdomen. The diaphragm originates from the superior lumbar vertebrae, its ligaments and the lower ribs. Extensive arteries, the phrenic and intercostal nerves, and lymphatic vessels supply and pass through the diaphragm. When mechanical compensation patterns persist throughout the trunk, due to what is occurring in and around the foot and ankle, could we imagine that vessel, nerve and lymphatic flow are altered or affected?
This list sounds daunting and it is unlikely that all of the scenarios will occur simultaneously. However, we must realize what happens to a foot can affect the whole kinetic chain, not just for treatment of plantar fasciitis, but for a whole host of conditions and diagnoses that we evaluate and treat. Every change we make to the foot — whether it is with a shoe, pad, surgical procedure or orthotic device — will ultimately affect other joints, tissues, tendons and fascia. We know that performing a flatfoot procedure without lengthening the Achilles is unthinkable. Understanding and reviewing the anatomical connections that every muscle, joint and ligament share will make every physician realize the importance and the magnitude of stretching the gastroc and soleus for all of the biomechanical conditions we treat.
We have always been the biomechanical experts in the field of foot pathology but that accomplishment is slowly fading away as we continue down the path of medical parity. We cannot eliminate the essence of who we have been as podiatric physicians. As our surgical prowess continues to grow, we cannot forget the biomechanical teachings and workings of the foot joints as every mechanically-based surgical procedure will fail without this knowledge.
Let us get back to our roots of what distinguishes us from the other practitioners who treat foot conditions. The combination of evolving surgical genius with the reinvigorated research, use and love of biomechanics can catapult us out of the park as the experts in the foot and ankle. This will solidify our status and make us very valuable specialists in the ever changing healthcare marketplace.
Dr. Schoene is a triple board certified sports medicine podiatrist and a certified athletic trainer. She is a Fellow of the American Academy of Podiatric Sports Medicine and the American College of Foot and Ankle Surgeons.
For further reading, see “Plantar Fasciitis: How To Maximize Outcomes With Conservative Therapy” in the May 2006 issue of Podiatry Today.
While stretching can be an early treatment for plantar fasciitis, this author says it is not always appropriate to recommend stretching to heel pain patients and it can cause harm.
By Stephen Pribut, DPM, FACFAS