Magazine

Assess & AddressPlantar Fasciitis
by Whitney Lowe
Pathology Assessment & Evaluation Treatment Massage Techniques

Massage techniques
Massage techniques are quite helpful for plantar fasciitis. Longitudinal stripping methods applied to the bottom surface of the foot will help reduce tension in the intrinsic flexor muscles. It will also maintain better tone in those tissues. Some practitioners advocate performing most of the longitudinal stripping methods toward the calcaneus in order not to create additional tensile stress on the plantar fascia.

Deep transverse friction may be used directly on the plantar fascia to stimulate fibroblast activity and tissue healing from chronic overuse. However, caution should be used in applying friction massage near the attachment on the calcaneus because of the possibility of a bone spur. Since the practitioner will not know whether a bone spur is present, it is best to assume that one might be there. The client’s pain will generally be a good guide as to how much pressure may be used with various massage techniques. Pressure that is too painful for the client should not be used.

Working on the lower leg muscles, especially those involved in plantar flexion, is also important in addressing plantar fasciitis. Tightness in these muscles may contribute to excess tension in the fascial continuities running from the leg through the bottom surface of the foot. Massage of the gastrocnemius, soleus and tibialis posterior should be included.

Various broadening and lengthening techniques applied to the posterior calf muscles will be particularly helpful. Compressive effleurage, broad longitudinal stripping, and broadening techniques done with the palm are all beneficial for this purpose. Addressing these muscles will help the effectiveness of a tension night splint as well.

Practitioners should also massage muscles of the entire lower extremity when addressing plantar fasciitis. Biomechanical compensation may be occurring as a result of foot pain, the effects of which may not be limited to the lower extremity. The practitioner is encouraged to watch for soft-tissue effects throughout the rest of the body.

Stretching the gastrocnemius and soleus, as well as all of the other tissues of the plantar flexor "sling," will be important. Stretching is most beneficial when performed several times a day. The morning is especially effective as this is when the plantar fascia has been in a non-weight-bearing position all night. The classic "wall stretch" position (see Figure 2) is a good choice for these tissues. Pulling the toes into hyperextension as the foot is pulled in dorsiflexion works well in stretching these tissues.

Plantar fasciitis is a condition that affects a large percentage of the population; thus, massage therapists are frequently presented with this condition in their practices. Fundamental knowledge of foot biomechanics and the development of this pathological problem are essential for providing appropriate care. Some of the suggested treatment methods, such as orthotics or anti-inflammatory medications, necessitate treatment from other health professionals. Thus, it may require communication with these other professionals. As a massage therapist, you have a special and unique contribution to make in treating this problem. The better informed you are, the greater your session results will be.

References

Pathology Assessment & Evaluation Treatment Massage Techniques
See Issue 105

Other Assess & Address Articles