Sunday, June 13, 2010

Preventing plantar fasciitis

A friend of mine asked me about some strategies for preventing plantar fasciitis.

The specifics will depend on the patient, but I think the optimal approach is to think of plantar fasciitis as a kinetic chain issue.

Remembering my 3 rules of the kinetic chain:
1. Forces have to come from somewhere
2. Range of motion has to come from somewhere
3. If you cannot address your forces and range of motion anatomically, then you will do so pathologically

When you use this perspective, you realize that usually plantar fasciitis is not a problem with the plantar fascia itself, but in asking the plantar fascia to more than it was designed to do.

The big issue, in this case, is range of motion.  Most people with plantar fasciitis have tight heel cords (their Achilles tendon), and therefore put too much stress on the plantar fascia.

The solution, then, is to stretch the heel cords.

My personal favorite stretch is the "Downward Facing Dog" position from yoga.

This is a great exercise in that it is a closed-kinetic chain exercise that uses your own body-weight to help load the Achilles tendon.   

I do make this caution, however- if you have back problems or are especially inflexible, this can place unhealthy loads across other joints, and you therefore should have someone (whether a PM&R physician or another clinician) evaluate your form, and perhaps make some modifications.

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