February 2010
Plantar Fascitis & Other Lower Leg Injuries
this article is authored by:
Dr. John Doepper, DC
Capitol Rehab of Winchester
230 Costello Drive, Suite 1
Winchester, VA 22602-4300
phone: 540-665-4444
capitolrehabofwinchester.com
@drjohndoepper
on twitter
1 YOU MUST ADDRESS THE SYMPTOMS OF PAIN AND SWELLING
2 JOINT FUNCTION MUST BE EVALUATED
We see many lower extremity injuries present at our office in Winchester,
Virginia. Whether the injury is plantar fascitis, achilles tendonitis, knee
tendonitis, or any other inflammatory disorder, they all have one thing in
common, the lower kinetic chain. Essentially, the lower kinetic chain is a
stack of joints starting in the foot, and rising through the ankle, knee, hip,
and lower back. The relationship is very important to understand and
address when treating any lower extremity injury. In other words, a
faulty ankle or hip can lead to injuries such as plantar fascitis or patellar
tendonitis.
In order to take care of the cause of the pain rather than the symptoms, it
is imperative to evaluate each component of the kinetic chain.
According to WebMD, "Plantar fasciitis (say "PLAN-ter fash-ee-EYE-tus") is
the most common cause of heel pain. The plantar fascia is the flat band
of tissue that connects your heel bone to your toes. It supports the arch
of your foot. If you strain your plantar fascia, it gets weak, swollen, and
irritated and inflamed. Then your heel or the bottom of your foot hurts
when you stand or walk." The question then is “What is causing the strain
on the fascia and what is the course of action to correct it and keep it from
returning?" This is where I use our 5 step rehabilitation sequence to fully
address the lower kinetic chain.
Most Doctors and Therapist do this well. Anit-inflammatories or NSAIDs
and rest is the treatment of choice from most medical practitioners. This
is an important part of therapy as it addresses the pain and attempts to
get ahead of the inflammatory process. Due to side the side effects of
NSAIDs and the important properties that is part of inflammation, I
prefer more proactive and holistic measures such as ice and stretching
and removal of the activities that may aggravate the condition. It must
be understood that this approach alone does nothing for the cause of
the fascitis. Therefore, most conditions return, or do not get better at all.
The causative factor must be found and corrected.
Chiropractors and some Physical Therapists trained in joint mobilization,
do an excellent job with this portion of the therapy. The motion of each
joint in the kinetic chain must be evaluated and, any flaws, corrected. A
good example of this is fixation (immobility) of the ankle joint or of the
Sacro-iliac joint that may cause an abnormal gait. Mobilization or
manipulation can help correct the fixation and create a more natural and
less stressful environment for the fascia. These joint dysfunctions are
part of the cause of the fascitis, but generally more needs
to be addressed.
 February 2010

Plantar Fascitis &

Other Lower Leg 3 THE INTEGRITY OF THE SOFT TISSUE
This is one of the most important parts of the treatment plan. Over time,
Injuries injury to ligaments,fascia, or muscles can cause scar tissue or adhesions.
According to Webster, "scar tissue is the connective tissue forming a scar
continued and composed chiefly of fibroblasts in recent scars and largely of dense
collagenous fibers in old scars." This is the wound healing process of any
injury, but excessive scaring is less elastic and tender to the touch. These
fibroblasts or dense collagen can become less tender and more flexible
by doing some sort of deep tissue therapy. Our clinic performs myofacial
release technique, Active Release Technique, and Graston Technique. I
have found each of these to be very effective. I have also found that
these techniques must be performed along the whole kinetic chain, not
just in the fascia. I have found deep tissue on the Gastroc and Soleus (Calf
muscles) to help tremendously in the recovery process.

4 EXERCISE AND BALANCE TRAINING ARE AN INTEGRAL PART OF

PREVENTING RE-INJURY
Important areas to address through exercise in the whole kinetic chain.
Most therapy focuses only on the foot and ankle. Upper leg, hip, and low
back are equally important as this stabilizes the whole kinetic chain. The
most important part of preventative exercises is balance training.
Balance training stimulates propriocepton or your bodies sense of
balance. If you have not worked on a balance board or a bosu-ball you
have not done enough.

5 SUPPORTS MAY BE NECESSARY

Many lower extremity injuries, including plantar fascitis, is a function of
over-pronation of our foot in the gait cycle. Over-pronation also can lead
to "fallen arches" and is a major contributor to lower kinetic chain
injuries. I fit my patients with either a custom orthotic or an
over-the-counter insert. Many use a night splint that can help increase
the length of the calf muscle but should not be used as the primary form
of treatment.

Plantar fascitis is a very painful condition. It affects nearly 2 million

Americans a year and keeps many from doing the things they love. In my
14 years of practice I have seen many of these cases. Those that
presented to me after suffering for months or even years have usually
applied some of these principles to their treatment plan with minimal
results. My recommendations to find a Chiropractor or Physical Therapist
who addresses all of these areas to attain full recovery.