Top 5 Fridays! 5 Patterns of Plantarfasciitis | Modern Manual Therapy Blog

Top 5 Fridays! 5 Patterns of Plantarfasciitis

It's been a foot centric week here at The Manual Therapist! Be sure to check out Monday's post on foot orthotics Q&A and Adam Kelly's Post on his toe orthoses and dynamic balance if you haven't already!

This was a request from my facebook page, so without further ado, here are 5 Patterns of Plantarfasciitis

1) Loss of Ankle Dorsiflexion

  • duh! - actually, the df loss is specifically with "straight" ankle df
  • the foot often compensates with a lateral posterior talar glide, causing forefoot eversion, often leading to more pronation than normal
  • the foot still dorsiflexes, but not with the knee going over the 2nd metatarsal as it is supposed to
  • other than the half kneel ankle df test, I make sure to measure it passively with knee bent and straight, with the forefoot in neutral, controlling for eversion
    • this often makes a firm end feel (eversion), into a hard end feel, indicating manual therapy
another runner with unilateral lower quarter issues, guess which side?

2) Loss of Tibial IR
  • this is just a chain effect of the forefoot everting with each step, often worse with more dynamic activities such as running, jumping, or squatting
  • so this is chicken or the egg, but either way, improving tibial IR by working on lateral lower leg patterns with IASTM and functional mobilization of the tibia, you can rapidly get dorsiflexion and tibial IR back in almost 90% of cases
she has knee pain and runs, are you surprised?
3) Loss of dynamic balance
  • I am a fan of the single leg step down/squat test to check for dynamic balance
  • I also use motor control theory when prescribing exercises, a tip I got from my friend Charlie Weingroff
    • if someone is not rock solid on SLS activities, do you throw them on a dyna disc?
    • how are they supposed to get rock solid on normal ground if they are on an unstable surface?
    • I have them practice the SLS with anti-rotation (therband chest press) - pulling toward leg side up, statically holding a kettlebell, or pushing a dowel into the ground
    • when they're rock solid without assistance and through resistance, THEN put them on unstable surface
  • this tweak tape is a favorite trick of mine as well, easy enough to apply, and stayed on a few of my patients who were marathoners the entire race!
does the path of this nerve look incriminating for plantarfasciitis?

4) Neurodynamic saphenous nerve dysfunction
  • neurodynamic dysfunction may mimic or contribute to the pain state of plantarfasciitis due to the path of this nerve
  • to review: biasing the saphenous nerve involves
    • hip flexion, IR, adduction
    • knee extension
    • ankle dorsiflexion and eversion
  • I demonstrate this toward the end of this video
  • if this is positive, I tend not to do the saphenous mobilization, as it may be provocative
  • instead, I do light IASTM along the path of the nerve, or wrap the lower leg (circumferential) or ankle in an EDGE Mobility Band (figure eight around ankle) to modulate the neurodynamic tensioner

5) subtalar mobility dysfunction
  • an OMPT mainstay, often forgotten by myself in the days of MDT and SFMA until recently in a plantarfaciiitis case
  • all of the above was working, but she had transient relief until I assessed her subtalar mobility with calcaneal rocks
  • to review: cup a hand on the calcaneus and another stabilizing the distal tibia
    • rock the calcaneus in three planes to check for limitations
      • IR/ER - axis of rotation superior/inferior
      • pf/df - axis of rotation medial/lateral
      • valgus/varus - axis of rotation anterior/posterior
  • the case mentioned above was limited in calaneal IR, and after some mobilizations and IASTM around the calaneal bony contours, she was walking much better
  • I taught her how to self distract and added a little wiggle to improve IR as well
Remember to use a Strassburg sock as well, which really helps cut down on visits for plantarfasciitis. It was invented by a fellowship mentee of mine and fellow Buffalonian!

Keeping it Eclectic despite a general lack of quality sleep....


  1. Erson, thanks for a 6 am post and sacrificing some sleep for us. A couple questions/comments.
    1. a: I agree that it is very important to look for forefoot eversion compensations during DF testing/stretching! But if you factor in the multi-planar sub-talar joint, mid-tarsal joint, and even the forefoot abduction components, forefoot eversion is a small part of the equation when attempting to get straight ankle dorsiflexion as you term it without compensation. Just curious why you prioritize this?
    1. b: What did you mean by a "lateral posterior talar glide", notably when you discuss forefoot eversion being related to it? I'm just not familiar with the terms perhaps.
    2. I like the thought about looking for tibial IR, I need to get that in my pattern recognition brain. I typically look for a loss of femoral ER and of course, this may be related to tibial IR dysfunction. Perhaps the hip ER mobility deficit is the more common pattern? However, I can't say that for sure and I need to start breaking down the tibial IR/ER position in isolation, thanks for the tip!
    4. I don't look much for the saphenous nerve, thanks for the tip here too! However, I would point out that the "tibial nerve", notably it's branches (Baxter's nerve- 1st branch of lateral plantar nerve, medial calcaneal nerve, and even the main branches of lateral and medial plantar nerve in the arch) are much more likely to cause plantar heel pain and plantar arch pain.

    I love building the brain map and pattern recognition, thanks for the noodle session!

  2. Kris, no problem! I auto post at 6 am! I don't post live! Although I was probably up! I prioritize it because it's the most common pattern of loss that you will see in many LQ cases regardless of their pain location. I am not saying there are not more arthrokinematically because there are.

    By "Lateral posterior talar glide" I mean the talus is rotating laterally along a superior to inferior axis, as in the lateral side will be moving posteriorly and the medial side anteriorly, so I focus the posterior glide not with my webspace on the entire anterior talus, just the medial portion, which can be uncomfortable. Does that make sense? I have it in a video somewhere

  3. Dr. E,

    Congrats on the new edition!

    With the SLS, what side do they have the dowel or kb on? I would think contralateral, but would just like confirmation i suppose.


  4. Thanks Bill! For KB, they can just hold it to their chest to provide feedback through the foot/extra weight. If they are doing RDL, it's the contralateral hand. For the dowel, it's contralateral to the leg that is down, like a tripod.

  5. Thank you for the extraordinarily fast reply!