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Posted on 05-03-2016

The plantar fascia or plantar aponeurosis is a long thin fibrous band that extends from the heel to the digits on the plantar or underside of the foot.  The plantar fascia is of great strength and supports the arch.  It is divided into three portions.  The thickest is the central portion which attaches to the medial process of the tuberosity of the calcaneus.  The lateral and medial portions cover the sides of the sole of the foot.  The lateral portion is thick where it radiates from the central portion, then this as it stretches longitudinally toward the first metatarsal or pinky toe.  The medial portion also radiates from the central portion but is thinner and covers the under surface of the abductor hallucis muscle which moves the great toe.  


The image on the right shows the potential referral pain patters commonly associated with plantar fasciitis.      


All of the above information looks great.  Now you know where the structure resides but does that really tell you anything about how to effectively treat the issue?  NO.  ABSOLUTELY NOT.  If you have been following along enough times you will already understand that pain is typically a distraction and when a practitioner ONLY treats the site of pain, they are typically unsuccessful.  You can see from the image on the right that there are many different presentations of plantar fasciitis.  You may be asking yourself “Why?”  It is because their root cause is probably different.  There are many muscles that can be involved in the mechanism.  I’ll speak about the most common, but realize, there are no absolutes in this game.  The most common denominator in a plantar fasciitis mechanism is tight calves.  Now you know from our previous discussions that a tight muscle doesn’t become tight arbitrarily.  There must be some GOOD reason for its tightness.  When testing out the muscles of the posterior chain, we often see tight calf muscles.  What do we always look for?  The WEAK structures.  The weak structures promote other normally functioning (often in the same chain) muscles to work harder.  That extra stress begins to exceed the muscle load capacity causing tightness.  The usually culprit?  Disconnected glutes, and hamstrings.  See that I didn’t use the word weak.  Not the best description.  People usually say, “I work my glutes, I work my hamstrings, I do the exercises I saw in Runners World magazine.  You can do the same exact exercises perfectly and still work around a disconnected muscle.  I can’t stress this enough.  It’s simple.  Don’t guess where the problem may be stemming from.  Get tested by anyone of us and learn where your disconnect may be.  

donna koslowski said:

do you treat sesamoiditis?

2016-05-03 08:40:27

Marc said:

If we look at the mechanisms of sesemoiditis there are some that are treatable with our analysis. If it was from repetitive impact, then the likelihood of seeing relief diminishes. However if there is "tightness" which is causing the inflammation on the sesamoid bones, then yes. Remember, medical you have a diagnosis of sesemoiditis. Essentially it is describing your symptoms which is inflammation on those tiny bones. It doesn't really describe how it came about in the first place. Or best advice always is if two or three treatments doesn't make a profound effect, then we don't expect it to.

2016-05-04 04:55:01

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