How to Fix Plantarfasciitis in 6 Visits or Less | Modern Manual Therapy Blog

How to Fix Plantarfasciitis in 6 Visits or Less

Last summer I started getting regular referrals from a local podiatrist. It was a refreshing change from my regular caseload of chronic craniofacial, headache, cervical and lumbar pain. I have treated plantarfasciitis before with good outcomes, but not since I regularly started using the fascialator for TASTM. Here are the common dysfunctions you should look for

Soft Tissue Restrictions
1) tenderness and restriction along the plantarfascia in a distal to proximal or proximal to distal direction.
This often feels like rice crispies and more so than other areas of the body (except thoracolumbar fascia and/or ITB)

2) along the bony contours of the superior medial and lateral calcaneal borders
this is often tender and restricted, limited calcaneal rocking and tilting

3) the proximal lateral posterior calf - pt's with lower quarter muscle imbalances often have a restriction here, and it can refer distally into the foot, plus limit dorsiflexion

Joint Restrictions
1) the talocrural joint is normally restricted in posterior glide, and more often than not, the medial portion of the talus is not moving posteriorly, but the lateral is. This causes toe out and compensatory overpronation, overstretching the plantarfascia during stance phase

2) the lack of dorsiflexion and the "too many toes sign" then lead to a decrease or complete lack of push off with the first ray, the longer this goes on, the more likely the restrictions in great toe extension, which should be up to 90 degrees passively

3) the subtalar joint may be restricted in medial/lateral tilt, upward rotation (dorsiflexion osteokinematically), or internal/external rotation (vertical axis)

Suggested Treatment
1) Functional Release and TASTM to the plantarfascia

 2) Functional release and TASTM to the posterior calf

3) some finishing touches of TASTM/functional release to the bony contours of the calcaneus to free up calcaneal rock

4) joint distraction and posterior glides to the talocrural joint, thrust as a progression for distraction
also remember to restore great toe extension with 1st MTP distractions and posterior glides if necessary, this will make #6 easier on the pt, thus increasing compliance.

5) home program of runners stretch with an emphasis on heel pushing into the ground and forward facing foot - no too many toes sign allowed!

6) the KEY to the home program is the The Strassburg Sock
If a patient wears this nightly, it will keep them in dorsiflexion and most importantly continue to activate the windlass effect which will keep their plantarfascia on stretch. They have to wear it at least 6 hours!

7) Progress on TASTM and joint mobilization - they should be better within 6 visits no matter how chronic their condition was!


  1. Don't you think the rice krispies you are calling tissue restrictions are really the fat cells that are abundant on the plantar surface of the foot? After dissecting the foot, I was amazed at the corn-like appearance of these cells and can easily see how they would give that feeling while doing a manual technique. I am not saying to not do tissue releases but describe them appropriately.

  2. That is a very valid comment/question. Whatever "they" are, they are usually more prominent on the involved side versus the involved on a bilateral comparison. This leads me to believe there is something dysfunctional about the involved side. Plus whether it is STM or TASTM, they tend to smooth out, but not completely, as is the nature of the plantarfascia to be very gritty. Making the involved side feel more like the uninvolved leads to decrease in pain, and increase in first ray ROM. I will now include in my patient explanations why it is normal for that area to feel so "bumpy" so to speak.

  3. Erson,
    I have felt the same sensation under my hand and come to the same conclusions as you. If I was to be completely honest, I would have to admit that I'm not entirely sure what I am feeling. I have felt the same thing in a dysfunctional forearm. Could it be a connective tissue abnormality? Of course, Take your pick as to which soft tissue/connective tissue. Certainly the plantar foot has plenty of tissue to chose from (not just fat cells). Although the fat cells seem to look like corn to Anonymous, it does not mean that it is fat that we are feeling. How does Anonymous explain the differences in affected and unaffected side, as well as the smoothing out?

  4. Glad someone else posted! Anon never replied, so not sure if they read my reply, as they probably didn't subscribe to comments. Again, it doesn't matter so much as to what we are feeling, or how we are describing it, as it's all models anyway, just that the patients are responding and improving.

  5. Carteret Comprehensive MedicalJanuary 9, 2015 at 11:57 AM

    Very interesting
    article. However still be sure to check in with a local physical
    therapist before trying any treatment.

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