Houston Methodist. Leading Medicine

Foot FAQ

Question:

Can you explain something to me? I've been doing leg stretches for years for my chronic plantar fasciitis. Then I saw a physical therapist who put her hands on my calf in several places for a few minutes and all of a sudden, no more pain. I still do the stretches (I'm afraid not to!) but it definitely feels different even stretching. Can you offer an explanation for this miracle cure?

Answer:

Heel pain as a result of plantar fasciitis affects an estimated two million adults in the United States every year. And over time, at least one in 10 Americans will report this common foot pain problem. The problem may be more aptly named by calling it "plantar heel pain" because studies show there is no active inflammatory component. The tissue quit trying to self-repair long ago. Sharp pain without swelling, heat, or other signs of inflammation is the only symptom. But that pain can be very disabling affecting quality of life. As you already know, the standard treatment for plantar fasciitis includes actively stretching the gastrocnemius and soleus (calf) muscles and passively stretching the plantar fascia (connective tissue along the bottom of the foot). Other conservative measures often used include medications and steroid injections. In severe cases that don't respond to nonoperative treatment, surgery may be an option. It sounds like you have benefitted from the added treatment of manual therapy. Manual therapy refers several different techniques used to release tension or trigger points in the calf. This technique is done by the therapist's hands directly over the calf muscles. Trigger points are irritable areas in the muscle. The area becomes tight and stiff keeping the muscle from moving (and stretching) normally. It's that stiffness that researchers think might be responding to manual therapy along with stretching. Stretching alone doesn't always stop the pain or alleviate the problem. In theory, until the trigger point has been released, the heel pain will continue (or come back as soon as the stretching stops). There's no problem with continuing to stretch your calf and plantar fascia -- it will do no harm and may benefit you in the long-run. At the present time, we don't have any long-term studies to show what would happen to patients with chronic heel pain if the trigger point is released but they don't continue stretching. Rômulo Renan-Ordine, PT, DO, et al. Effectiveness of Myofascial Trigger Point Manual Therapy Combined with a Self-Stretching Protocol for the Management of Plantar Heel Pain: A Randomized Controlled Trial. In Journal of Orthopaedic & Sports Physical Therapy. February 2011. Vol. 41. No. 2. Pp.43-51.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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