Plantar Fasciopathy and the

Pelvic Connection
Dr. Courtney Conley + Lauren Ohayon

1. Welcome

2. What is Plantar Fasciitis / Plantar Fasciopathy?

○ Foot intrinsic weakness, forefoot splay, ankle ROM (range of motion), big toe
ROM
○ Bi lateral symptoms - pelvic floor / low back
○ 3 bands of fascia that insert onto the plantar plates
○ Degenerative condition
○ Repetitive microtrauma, m/c bands affected are central, medial
○ Body repairs microtears, collagen 1 replaced with collagen 3 (3 is less elastic)
○ < 6 months, acute; >6 months chronic
○ 2018 Denmark Study: 44% had symptoms 15 years later

3. True Causes of Plantar Fasciitis, Sullivan et al.

○ Arch height had no connection
○ Weakness of the intrinsic arch muscles and the importance of arch recoil
○ Peroneal weakness was the strongest predictor of the development of plantar
fasciitis
○ Calf inflexibility

4. Supination and Pronation Expression + Plantar Fasciopathy

○ Human movement is driven by these 2 expressions
and plantar fasciopathy as well as core and pelvic
floor issues can be compounded by a lack of
supination / pronation expression in the body.

5. Foot and Core Connection

○ Superficial back line: plantar fascia, achilles tendon,
hamstring, sacrotuberous ligament, sacrolumbar
fascia, epicranial fascia, frontal bone.
○ Good position = good stability through the chain;
Poor position = instability through the chain.
 ○ Brain is hardwired from an early age to put the
body in a position of proximal stability (core) and to
move distally (arms/legs).
○ When the central link is blown, certain muscles unwire themselves from
normal reflexive movement, others fire late, and you lose the ability to
move with precision.
○ If we want the foot muscles to work efficiently, we have to address
proximal stability.

6. Local Tissue Assessments

○ Mobility of big toe: plantar fascia
○ Credit card: flexor digitorum brevis
○ Toe to wall - 5 cm away: calf mobility

7. Global Tissue Assessment

SAGITTAL
■ Breathing: looking for restriction of breath or a definite pattern.
■ Toe touch: rolling the golf ball; reassess (straight legged assessments
tension the entire back line of fascia; knees are bent it disrupts the line
= easier).
■ Bridge assessment: fascia to the back line up the post chain
■ Standing squat over chair, cat / cow: feel feet respond.
■ Airplane lunge: feel the connection from feet, calves, hamstrings, pelvis.
Be sure to LEAD from the pelvis.

FRONTAL
■ At wall on block single leg drops: supination / pronation expression
■ At wall listing: hip raise / drop - leg at wall in ER pressing wall - feeling
feet react, glutes, adduction, abduction, hip rotation
■ Kneeling hip shifts: hands on blocks (inner thigh restriction
assessment).

TRANSVERSE
■ Break down triangle hips: relationship to stance limb in supination How
does this relate to gait?
■ Supine knee drive forward. Progress it with one leg straight and lift hips.
Feet should be pronating and supinating.

8. Treatment: Local Tissue Treatment

 ○ Strengthening the peroneus longus
■ Especially effective when treating plantar fasciopathy because this
muscle creates a downward pull on the first metatarsal, increasing
pressure borne by the inner forefoot thereby offloading the plantar
fascia
1. Single leg calf raise with quarter cueing
2. Banded single leg calf raise

○ Strengthening the intrinsic arch muscles, particularly flexor digitorum brevis

■ Create a compressive force that prevents the plantar fascia from being
stretched excessively
1. Banded toe exercise
2. Forward wall lean- toe wink sign
3. FDB Iso + heel elevated

○ Calf tightness causes chronic plantar fascial injury as it results in a premature

lifting of the heel during push off
■ Transferring an excessive amount of force through the achilles into the
attachment of the plantar fascia
■ Restoring calf flexibility is one of the most important things you can do
to prevent a plantar fascial injury from becoming chronic.
1. Pronation + tibial IR
2. Tri planar calf mobility

○ Tightness in the medial head of the gastrocnemius correlates strongly with

the development of chronic plantar fasciitis
■ A specific high-volume stretching routine has recently been proven to
lengthen the medial gastrocnemius by structurally changing its fibers.
These length gains persist even after a period of detraining
1. Static stretch protocol on slant board

9. Global Treatment: All of the above assessments

10. Footwear
○ Non-negotiable: wide toe box to take advantage of the TIE BAR mechanism
of the foot
○ Individual specific:
■ Orthotics. Time and a place. Research has shown that orthotics can be
beneficial in the acute stages and used for a short period of time. (2
weeks up to 1 year)
 ■ Muscles of the foot need load. When appropriate and tolerated, the
transition to more minimal footwear is recommended as the foot can
gain strength and be more in its functional position.

References
Behling AV, Rainbow MJ, Welte L, Kelly L. Chasing footprints in time - reframing our understanding of
human foot function in the context of current evidence and emerging insights. Biol Rev Camb Philos Soc.
2023 Jul 24. doi: 10.1111/brv.12999. Epub ahead of print. PMID: 37489055.

McClinton S, Weber CF, Heiderscheit B. Low back pain and disability in individuals with plantar heel pain.
Foot (Edinb). 2018 Mar; 34: 18-22. doi: 10.1016/j.foot.2017.09.003. Epub 2017 Sep 28. PMID: 29202429.

Conclusions: Individuals with PHP (plantar heel pain) had a greater prevalence of LBP (low back pain) and
higher low back disability that was correlated to reduced foot and ankle function. Treatment to address
both local and proximal impairments, including impairments related to LBP, may be warranted to improve
the management of PHP.

Michaud, Tom. The latest stretches and exercises to make sure your plantar fascial injury never returns.
access it here

Myers, Thomas W., and Susan K. Hillman. Anatomy trains. Primal Pictures Limited, 2004.

Sullivan J, Burns J, Adams R, Pappas E, Crosbie J. Musculoskeletal and activity-related factors associated
with plantar heel pain. Foot Ankle Int. 2015 Jan; 36(1): 37-45. doi: 10.1177/1071100714551021. Epub 2014 Sep 18.
PMID: 25237175.

Welte L, Holowka NB, Kelly LA, Arndt A, Rainbow MJ. Mobility of the human foot's medial arch helps enable
upright bipedal locomotion. Front Bioeng Biotechnol. 2023 May 30;11:1155439. doi: 10.3389/fbioe.2023.1155439.
PMID: 37324435; PMCID: PMC10264861.