Plantar Fasciosis (not plantarfasciitis) is tendinosis that is located in the plantar aponeurosis usually located in the medial plantar heel. It affects >2 million people. It is also recurring. A hallmark symptom is a pain worse when standing immediately after a prolonged period of rest or prolonged standing.
Plantar fasciosis is not an inflammatory condition. It is the condition when this connective tissue structure is degenerated due to multiple repetitive microtraumas that disrupt the internal structure creating dense fibroblasts concentration and disorganized collagen, vascular hyperplasia which causes ischemic pain and poor healing, and innervation changes.
This condition is created by a cycle of poor management of the injury: the initial injury occurs, inflammation is created which when left untreated it creates adhesions or scar tissue. In turn, this creates weakness and tightness. Increased tightness and weakness increase friction, pressure, and tension which leads to more re-injury. The cycle re-starts further aggravating the condition.
The goal of Physical Therapy is to stimulate the growth of new tissue. As therapists, we stimulate growth with progressive resisted exercises starting with eccentric loading. At BreakingThrough San Diego Physical Therapy, we enhance it with blood flow restriction training which protects the tissue from using too much weight and allows for increased
production of platelets. In PT, we also use manual therapy anywhere from 3 weeks to 12 months to breakdown scar tissue and stimulate fibroblast production. This is well achieved with the use of instrument-assisted soft tissue mobilization (Graston, cupping, kraft gun, tapping, etc). We also modify all of the extrinsic factors: multifactorial activities, limited posterior chain mobility, decreased muscular strength and endurance, obesity, and work-related weight-bearing.
We are a family-friendly practice that focuses on one-on-one treatments to get to know each patient. The more details we have, the better the plan of care is.
Picture from the London Foot and Ankle Clinic
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