Plantar fascitis

change in her gait felt more second

nature to her and that she was no
longer having foot pain.
Treatments were continued with
emphasis on improving her core and
adductor strength. After six total
treatments Pamela had walked 1/4
mile and ran 100 yards without
return of her symptoms. Her
headaches and daily foot pain had
not returned.
It is interesting to note that during
the course of her treatment she had
one significant exacerbation that
was a result of emotional stress. Her
shuffling gait pattern returned as
well as significant cranial
restrictions. To her credit, Pamela
was able to rebound after one
cranial treatment and her own
processing that this author believes
was a result of the tools she had
been given by and work she had
done with the body-mind therapist.
Outcome
Pamelas headaches and foot pain
was relieved after four treatment
sessions with a sedentary activity
level. Her symptoms have not

returned with the progressive return

to a running, walking and swimming
program. At the time of this writing,
one month since her last visit, Pamela
is able to run one mile without
exacerbation of her symptoms.

consider the whole body as well as

holistic influences including the
structural, biochemical, and mental/
emotional factors, so that we can
effectively enhance the self-corrective
nature of that individuals body.

Conclusion

REFERENCES

Foot or ankle dysfunction may

obviously precipitate disturbances
in the knee, hip, pelvis, low back.
Conversely, low back, hip, knee,
even cranial dysfunction can be
shown to have the potential to
precipitate disturbances in the gait.
From a clinical standpoint, either
structural/kinematic possibility
could be an etiological factor. In
addition, there exist a variety of
complimentary treatment
approaches of a particular condition
such as plantar fascitis, that produce
similar, beneficial, results.
The structural and kinematic
relationships that occur during gait
are complex and each client presents
with their individual set of
symptoms and dysfunctions. It is
our job as clinicians to openly

Basmajian JV, DeLuca CJ 1985 Muscles

Alive. Their Functions Revealed by
Electromyography. Williams and
Wilkins, Baltimore
Dykyj D 1988 Anatomy of Motion. Clinical
Podiatric Medicine and Surgery. July 5
477490 (Abstract)
Hollinshead WH 1974 Textbook of Anatomy.
Harper and Row, Hagerstown
Janda V 1983 Muscle Function Testing.
Butterworths, London
Magoun HI 1976 Osteopathy in the
Cranial Field. Sutherland Cranial
Teaching Foundation. Fort Worth,
Texas.
Websters New Collegiate Dictionary 1979
G&C Merriam Company, Springfield
Simon SR, Mann RA, Hagy JL, Larsen LJ
1978 Role of the Posterior Calf Muscles
in Normal Gait. Journal of Bone and
Joint Surgery; 60 465472 (Abstract)
Simons DG, Travell JG 1992 Myofascial Pain
and Dysfunction. The Trigger Point
Manual. Volume 2. Williams and
Wilkins, Baltimore

A chiropractic perspective
Terry Hambrick
This article contains parallel threads
of clinical information based both
Terry Hambrick DC
116 West Havard Street
Suite 2,
Fort Collins, CO 80525, USA
Correspondence to: T. Hambrick
Tel: +1 970 282 1173; Fax: +1970 2821175
E-mail: hambrick@peakpeak.com
Received August 2000
Revised September 2000
Accepted October 2000
...........................................
Journal of Bodywork and Movement Therapies (2001)
5(1), 49^55
# 2001 Harcourt Publishers Ltd
doi: 10.1054/jbmt.2000.0203, available online at
http://www.idealibrary.com on

on the general collective impressions

of the practitioners and the actual
impressions gleaned from evaluating
and treating (or recommending
treatment for) the same patient who
has served as a model for the project.
Fascia, both superficial and deep,
originates from mesenchymal tissue
and differentiates into forms suited
to their location and function in the
body. The fascia on the plantar
surface of the foot would be
considered a deep fascial sheet of
fibrous tissue that aids in supporting
the longitudinal arch. On the
calcaneus, the plantar fascia
attaches to the anterior margin
of the medial and lateral processes

and it (the fascia) extends into

a band that attaches at the base of
the metatarsals (Hamilton 1976).
It is of value in assessing the
plantar fascia to consider the
muscles that originate on the
calcaneus and assist in supporting
the longitudinal arch. The abductor
hallucis, flexor digitorum brevis and
the abductor digitus minimus all have
such attachments and provide
support, with the abductor digitus
minimus supporting the lateral
portion of the arch while the other
two form part of the medial arch
(Hamilton 1976).
Often, shortening of the
gastrocnemius and soleus is viewed

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as the cause of plantar fascitis

because of their posterior and
superior pull on the calcaneus. The
question must be obvious: What is
making the gastrocnemius and
soleus hypertonic? Two additional
considerations are crucial in
evaluating this condition and
answering the question that begs to
be answered. One would be the
relative weakness of those muscles
that are antagonistic to the plantar
flexors if the anterior tibialis and
the peroneal muscles provide
inadequate opposition to the
gastrocnemius/soleus complex, this
allows for over-contraction or
hypertonicity to develop in the
plantar flexors. Proprioceptively
speaking, the antagonist weakness
could be considered more primary
and, thereby, more causative as a
contributor to plantar fascitis. Since
the function of a muscle is to
contract, hypertonicity is frequently
the result of hypotonicity or
atonicity of an antagonist
(Goodheart 1998; Walther 1981).
Secondly, the muscles of the calf
that insert into and support the
medial arch must also maintain their
integrity to prevent excess strain,
and thus, pain and inflammation, on
this portion of the foot.
Additionally, the tibialis posterior
muscle, having no direct attachment
to the calcaneus, may, incorrectly,
be viewed as inconsequential in the
plantar fascitis patient. However,
the proximal attachment is of as
much importance as its distal one in
providing ample support of the foot
mechanics. The pennate fibers of
this muscle, with their attachments
to the fibula and tibia as well as the
intermuscular septum, maintain the
approximation of the tibia and
fibula. Unlike the forearm with its
pronator quadratus muscle that
pulls the radius and ulna together on
their distal end, there is no similar
band of muscle spanning the distal
tibia and fibula. The approximation
of the two bones of the foreleg is

reliant upon a muscle that also

provides critical support for the
medial longitudinal arch by way of
its attachment to the tarsals (except
the talus) and lateral four
metatarsals, namely the posterior
tibialis. Hypotonicity of the
posterior tibialis not only produces a
dropping of the longitudinal arch of
the foot, it also allows for separation
of the distal fibula and tibia in such
a way that the talus is jammed into
the ankle mortise, limiting
dorsiflexion and thereby altering
gait (Walther 1981).
Cailliet (1988) defines plantar
fascitis as a tendofascioperiosteal
irritation. Thus, the condition is an
inflammation of the insertion point
of tendons and the plantar fascial
sheath into the medial tubercle of
the calcaneus. Occasionally, as a
result of the presence of the
tendonous attachments, an
adventitious bursa will develop
along with the irritation of the
insertion points, compounding the
symptoms as the bursa itself
becomes inflamed.
In the context of this article,
plantar fascitis is defined as
inflammation of the insertion of the
plantar fascia on the medial tubercle
of the calcaneus and the portion of
the fascia that extends into the
medial longitudinal arch. Further,
it is defined by the presenting
symptoms of pain, edema, redness
and difficulty in ambulation
resulting from the pain with heel
strike and, often, pain increased in
the morning or after periods of the
foot resting in a plantar-flexed
position.
Our consideration of this
condition will take into account the
biochemical, the emotional and the
all-important structural components
to be addressed with the
presentation of plantar fascitis.
Clinically speaking, the condition is
commonly viewed to be the result of
either repetitive micro-trauma from
new or excessive weightbearing

activity or excessive foot pronation

and loss of arch integrity. We intend
to look behind and beyond and
obvious observations that describe
the consequences of the weakness so
that we provide a more revealing
look at the predisposing factors
which create the condition.

Biochemical components
In essence, any -itis anywhere in
the body will have a biochemical
component wherein the natural
mechanisms that inhibit
inflammation have, themselves, been
inhibited. By definition, this leads us
to an evaluation of both fatty acid
metabolism and adrenal function.
The adrenals must operate efficiently
in order for the body to produce its
own natural cortisone in the form of
cortisol (Guyton 1996). The
production of anti-inflammatory
hormones and pain mediating
hormones is dependent upon
adequate and appropriate essential
fatty acids to feed the prostaglandin
pathways (Murray 1996; Schmitt
1990).
Doctors of chiropractic who
specialize in applied kinesiology
(AK) have been addressing the
adrenal component as a critical
element in ligament integrity since
the late Dr Jerry Deutsch (1975)
identified what we call the ligament
stretch reaction. In this case, an
intact muscle will be inhibited and
test weak when the ligaments of its
associated articulation are stressed
by a quick, firm stretch applied by
the practitioner. This inhibitory
proprioceptive feedback from the
nervous system reflects, according
to AK methodology, either an
under-functioning adrenal system
or the type A individual who is
over-stressing the adrenal
mechanism. Treatment is to provide
both nutritional support in the form
of herbals, glandular extracts,
vitamins and minerals and to
counsel the patient in life-style

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Plantar fascitis

modifications to diminish the insult

to the glands. Specific nutrients that
are supportive of the adrenal
endocrine axis are (Schmitt 1990)
pantothenic acid, Vitamin C,
choline, tyrosine, B-vitamins,
potassium, naturally occurring
sodium and other alkaline minerals.
Herbalists suggest that licorice and
ginsing are common herbal
preparations that are believed to
reinforce adrenal action (Kelly
1999). Whole glandular extracts,
while controversial in some circles,
have been found by the author to be
clinically effective as evidenced by
changes in standard examination
findings after their administration.
In the authors personal clinical
experience, reversal of postural
hypotension and paradoxical
pupillary constriction are commonly
seen with the judicious use of
glandular preparations (bovine or
porcine).
A brief review of the
prostaglandin pathways mentioned
above leads us to the fact (Schmitt
1990) that the dietary intake of fats
in most developed countries has
shifted from fats high in omega-3
fatty acids to more of the omega-6
and arachidonic acid laden fats and
oils as well as high intake of
hydrogenated (trans) fats. In
addition, the consumption of high
density, low nutrient value (high
glycemic) carbohydrates has
increased substantially in the last
two decades (Sears & Lawren 1995;
Wittenberg 1995). The significance
of these facts in relation to any
inflammatory condition is that the
body naturally produces both proinflammatory and antiinflammatory hormones from
essential fatty acid precursors. In the
presence of elevated insulin from
excess carbohydrate (empty calories)
intake, the omega-6 fatty acids are
converted into pro-inflammatory
hormones of the arachidonic acid
pathway; hormones such as the
leukotrienes, thrombaxanes and

others in the prostaglandin-2

category. In the presence of
trans-fats, the body also
preferentially increases conversion
of omega-6 fats to degenerative,
pro-inflammatory hormones.
Add this to the high-saturated fat
intake that is already filling the
arachidonic acid pathway and it
becomes a recipe for inflammation
and degeneration of any stress point
in the body.
The solution is to decrease
omega-6 fatty acid and arachidonic
acid intake, increase omega-3 fatty
acids which inhibit inflammatory
processes and eliminate trans-fats
from the diet. Omega-3 oils are
found in deep water, cold water fish
and flaxseed, for example (Schmitt
1990; Sears & Lawren 1995).
Specifically in reference to the
patient being examined for this
article, she presented with evidence
of functional hypoadrenia by virtue
of postural (orthostatic)
hypotension. (Walther 1988;
Schmitt 1981; Berkow 1992). In the
normal adrenal system, there will be
an elevation of the systolic fraction
of blood pressure when the subject
arises from a supine position and,
often, from a seated position. The
blood pressure (BP) is taken in the
usual fashion with the patient supine
or seated, the pressure cuff is
deflated after the BP is recorded and
then re-inflated to immediately
re-take the reading as soon as the
patient rises to a standing position.
The normal systolic reading will
show an elevation of 810 mm Hg
when tested in this manner. The
patient in question had a systolic
blood pressure of 114 in the supine
position that dropped to 110 upon
standing.
Other biochemical components of
note in her case are a pulse rate of 60
beats per minute and a salivary pH
of 5.5. The slow pulse in the nonathlete is often indicative of
parasympathetic dominance with
consequent low adrenal function.

The highly acidic saliva is indicative

of metabolic imbalance that can
predispose the patient to bursitis
and other inflammatory conditions.
Interestingly, the supplementation
of appropriate forms of essential
fatty acids often normalizes the
acid-alkaline balance in the absence
of pathologies or other
complications (Schmitt 1981).

Emotional component
Notwithstanding Rene Descartes
conflict with Roman Catholic
Church, the mind is connected to the
body. Even a condition as distal to
the brain as plantar fascitis may
have an emotional component.
Practically speaking, this connection
in cases of foot pain can be observed
by noting the general posture of the
patient as they move about during
the examination. While no given
pattern is present in every case, this
author has found it important to
consider whether the patients
general state of mind is causing a
postural tendency which exacerbates
their condition. An example can be
taken from the patient used as a
model in this article. Her posture
and gait reflect a collapsing inward
in such a way as to contribute to the
obvious foot pronation and anterior
head position which parallels the
front foot standing pattern. The
downtrodden appearance suggests
a body-language pattern that may
precisely reflect what is happening to
her feet the arches are falling and
she is treadding down on the
plantar surfaces of her feet. In the
same fashion, some hard-driving
A-type individuals can develop
plantar fascitis from pushing too
hard.

Evaluation
The explanation for the
predisposition toward inflammation
developing in the plantar fascia
rather than in some other region or

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area of the body lies in the

orientation of the structure and its
relationship to the plumb line. In
other words, posture and gait
determine where the stresses are
placed in the system. Patients with
plantar fascitis do not typically
spend their life lying flat on their
back on a therapy/treatment table.
As a result, they must be evaluated
in the weightbearing position and in
gait. Additionally, examination of
the foot in the supine position
should include comparison of active
and passive range of motion with
the non-involved side, with
particular attention to dorsiflexion.
Normal dorsiflexion is 208. In
plantar fascitis, the range of motion
on the involved side is commonly
restricted due to hypertonicity of the
triceps surae (gastrocnemius/soleus
complex). The Achilles tendon
should be plapated on both sides,
comparing for tautness as well
as patient reaction. The tight
triceps surae will often cause
pain/tenderness in the Achilles
tendon. However, the postural
distortions leading to the plantar
fascitis may originate in the pelvis
(or above) and place torsion into the
opposite hamstring with resultant
increased pain on the side opposite
symptoms in the case of unilateral
fascitis.
The information gleaned from
examination of gait is enhanced by
manual muscle testing when the
contralateral arm and leg are tested
simultaneously in the phases of gait.
The phases of gait that are typically
tested in this fashion are abduction,
adduction, extension, flexion, and
two additional ones as follows:
testing the psoas and the pectoralis
muscles simultaneously; testing the
gluteus medius and oblique
abdominals simultaneously.
In AK procedures, the gait
mechanism is evaluated as follows:
. The extension phase of gait
is tested in one of two ways. In

Fig. 1 Testing the extensor (posterior) phase

of gait.

the supine position, the examiner

contacts the distal arm and leg
proximal to the wrist and ankle in
order to be able to pull upward
on the arm and leg. The patient is
asked to attempt to extend the
hip and shoulder by pressing the
arm and leg toward the table
against the examiners pressure.
. Alternately, the prone patient is
asked to bring the right arm and
left leg into extension and flex the
elbow and knee. The examiner
contacts the thigh and the upper
arm just proximal to the elbow,
directing pressure downward
toward the table as the patient
resists (Fig. 1).
. The anterior or flexion phase
(Fig. 2) is tested with supine
patients right arm and left leg in
forward flexion to approximately
308. Examiner places hands on
distal dorsum of the forearm and
distal anterior calf in order to
direct pressure downward against
both extremities simultaneously.
Patient is asked to resist the
downward pressure. The muscle
pairs should be facilitated as in
gait and the patient able to resist
the examiners pressure.
. The abduction phase (Fig. 3) is
tested as the examiner places the
patients right arm and left leg in
approximately 308 of abduction.
Again, examiner contact is on the
forearm just proximal to the wrist

Fig. 2 Testing the flexion (anterior) phase of

gait.

Fig. 3 Testing the abduction phase of gait.

and the leg proximal to the ankle.

Muscle testing pressure is applied
in the direction to adduct the leg
and arm as the patient resists by
pushing against the examiners
force.
. In AK methodology, a
correlation with gluteus medius
and abdominal contraction has
been identified as a component of
gait and is tested as follows. This
gluteus medius phase (Fig. 4) is
evaluated when the supine patient
is asked to roll the torso up from
the examining table by raising the
right shoulder and torso as if
doing an oblique abdominal
crunch exercise. While the patient
maintains this abdominal
contraction, the examiner tests
abduction of the patients left leg
by directing pressure against the
lateral ankle toward adduction as
the patient attempts to abduct the
straight leg.

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Plantar fascitis

muscle groups tests to be

inhibited, it indicates a primary
gait fault.

TCM connection

Fig. 4 Testing the gluteus medius/abdominal

phase of gait.

. The adduction phase (Fig. 5) is

examined when the patients left
arm and right leg are placed in
the adducted position with the
humerus in internal rotation and
the leg in the neutral position
relative to rotation. The examiner
directs pressure against the
forearm and lower leg to attempt
abduction as the patient resists
by adducting arm and leg
simultaneously.
. The rotational (psoas) phase of
gait (Fig. 6) is tested with the
patients left arm in 908 flexion at
the shoulder joint and the
humerus internally rotated as in
testing the pectoralis major
muscle. Simultaneously the right
leg is in approximately 308 of
flexion and 308 of abduction
similar to the test position for the
psoas major muscle (Walther
1981). The examiner contacts the
forearm just proximal to the wrist
joint and the leg just proximal to
the ankle joint. Pressure is
directed by the examiner to push
the two muscles apart as the
patient resists by drawing the
extremities toward each other.
. Having tested each phase of gait
with the left arm and right leg, the
right arm and left leg are then
tested in the same fashion.
. If any muscle pairs are found to
be inhibited in this manner of
testing, the examiner must

Fig. 5 Testing the adduction phase of gait.

Fig. 6 Testing the rotational (psoas) phase of

gait.

determine if the individual muscle

tests strong when tested without
its gait-related counterpart. For
example, if the right arm and left
leg present diminished resistance
in forward flexion when tested
together, it is important to test
flexion of the arm by itself and
then test the hip flexor group by
itself to assure that these muscles
are intact individually. Providing
that these muscle groups are
intact when tested individually,
they should be facilitated to work
synchronously when tested in the
above fashion. In fact, clinically,
those who practise AK have
noted that these muscle pairs
should test stronger in the
gait position because of the
facilitatory action of the spinal
cord mediated gait mechanism
(Walther 1988). If one or both

There are acupuncture points on the

foot which have been found in
clinical practice to correspond with
these evoked weaknesses (inhibited
pairs). Conventional treatment in
AK involves stimulating these
points in order to restore integrity to
the gait mechanism. The points are
thought in AK methodology to
correspond to individual pairs of
muscles as follows: Spleen 3 on the
medial aspect of the great toe relates
to the posterior gait demonstrated in
Figure 1; Liver 2 (and sometimes
Liver 3) between first and second toe
on the dorsum of the foot
corresponds to the flexion gait
shown in Figure 2; Stomach 44
(sometimes 43) between second and
third toes corresponds to Abduction
in Figure 3; Gall Bladder 42
(sometimes GB 41) between fourth
and fifth toes relates to the gluteus
medius and oblique abdominal
portion of gait seen in Figure 4;
Bladder 65 (sometimes 64) relates
to Adduction phase of gait and
kidney 1 on the plantar surface of
the foot corresponds to the psoas
and pectoralis major, sternal portion
of the gait test shown in Figure 6.
The patient being examined in this
project had a disturbance of the left
adductor gait and the right posterior
gait mechanism. When a weakness
of the right arm and left leg is found,
the acupuncture point on the left
foot is treated for the corresponding
phase of gait. When the weakness is
of the left arm and right leg, the
related point on the right foot is
treated. Thus, in the case of the
patient involved in this study,
stimulation was applied to BL 65
on the left foot.
Examination of the ambulatory
gait mechanism should include
observation of the entire carriage

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Hambrick

rather than simply looking at the

feet. Often the postural stresses that
are contributing to or causing the
dysfunction and pain are in the
pelvis or torso and can be observed
as the patient/client walks. For
example, in the patient who was the
subject of this study, there was an
obvious imbalance in the adductor
muscles creating a pelvic tilt. The
pattern of left adductor weakness
with resultant right adductor
hypertonicity would be recreated
with each step as long as the gait
imbalance mentioned above
remained uncorrected.
Evaluation of the patient in the
static weightbearing position
should, of course, attend to the
common excessive or extended
pronation and dropped longitudinal
arch, evidenced by Helbings sign
(bowing inward of the Archilles
tendon). Palpation under the arches
in the weightbearing position reveals
increased tenderness on the side of
plantar fascial inflammation if
unilateral.
In examining the patients
posture, they will often be found to
be forward of the plumb line.
Clinically, it is observed that this
front foot standing often originates
in the torso and is the result of weak
abdominal muscles with the
attendant anteriority of the pelvis.
In addition, the implementation of a
bilateral weight scale measurement
might prove helpful in identifying
equality or inequality of weight
distribution. In the normally
developed right-handed individual,
there is approximately 810 pounds
more weight distributed on the right
leg due to the weight of the relatively
dense liver and the muscle mass on
the dominant hand side. In the lefthanded individual meeting the same
criteria, there is approximately 5
pounds more weight on the right leg
(Goodheart 1998). It is not
uncommon in larger patients to
see a 2030 pound imbalance from
side to side. This author has

Fig. 7 Gait related acupuncture treatment points.

observed to universal pattern in

which all patients have more weight
on the side of symptoms, though it is
more common to see this
presentation than to see the excess
distribution on the side opposite
their foot pain.
Manual muscle testing of
individual muscles in the lower
extremities can provide invaluable
data regarding the balance of
strength, tone and proprioception.
In the patient in question, she
presented with a graded weakness of
the right rectus femoris (with a
positive disc sign, indicating nerve
root encroachment at the L34
level), left anterior tibialis, right
posterior tibialis and left peroneus
tertius. Neurologically, she showed
poor balance on the left foot with
eyes closed, further indication of the
proprioceptive disturbance
originating in the lower extremity
(Goodheart 1998; Walther 1981).
The patient evaluated in this
study was a right-handed individual
and her weight distribution was 72
pounds (32.72 kilos) on the left foot
and 70.5 pounds (32.04 kilos) on the

right foot. Given the criteria

mentioned above, she actually has
an excess of up to 11.5 pounds (5.22
kilos) on her left foot since there
should be 810 pounds (3.634.54
kilos) more on the right than the left.
In addition, she evidenced the classic
forward head posture discussed
above.
Another common finding in
patients with foot pain is what is
known as a shock absorber
disturbance. As is well known, the
weightbearing joints all have a
resilient mechanism that absorbs the
shock of running, jumping, walking,
standing and any impact into the
weightbearing structures. Often
when there are problems in
proprioception and ambulation,
the shock absorber mechanism is
compressed or overstressed. This
disturbance is revealed on an
examination by testing any intact
muscle in the lower extremity, then
striking the bottom of the foot with
a sudden impact from the palm of
the examiners hand and
immediately re-testing the
previously intact muscle. The

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Plantar fascitis

proprioception should allow for this

force to be absorbed without insult
to the nervous system. If the
previously facilitated muscle tests to
now be inhibited or weak, the
indication, according to AK
concepts, is that the shock
absorber is disturbed and requires
treatment. For those practitioners
trained and licensed to manipulate,
the appropriate treatment is firm
and sudden axial traction to the
involved joint or joints; commonly,
each ankle, knee and hip is tested
individually.
The patient in our study had
bilateral shock absorber dysfunction
in the ankles and was treated
accordingly.

Etiology
Posteriority of the calcaneus often
develops with activities which jam
the structure backwards this
author has often seen plantar fascitis
develop with patients who charge at
the net or at the ball in racquet
sports. Patients who plant trees in
their yard in the Spring or do other
gardening chores in which they use a
shovel repetitively, forcing the
calcaneus backwards will produce
the subluxation pattern that results
in plantar fascitis. In addition, there
can be the simple overuse injury
from jogging with poor foot
mechanics, etc. Many joggers have
been encouraged to run with
attention to effecting a heel strike in
their gait. Common sense
observation reveals that such an
action is antagonistic to forward
motion in the runners gait and
should be avoided. While heel strike
is not currently taught by all
running coaches, there are plenty of
weekend warriors who remember
being trained in this fashion from
years ago. These unfortunate souls
go out when the weather warms up
and beat their feet to a pulp, each
step jarring the shock absorber

mechanism and forcing the

calcaneus into posteriority. In the
authors practice, a recent spate of
foot pain patients who are Contra
dancers is interesting there is a
repetitive action of stomping one
foot in the series of dance
movements that seems to be
causative in these cases.

Treatment
Again, for those who are qualified to
do so, manipulation to reduce the
posteriority of the calcaneus is
critical in resolving plantar fascitis.
Additionally, the tarsal bones
should all be evaluated for
misalignment. The distal tibiofibular articulation will often have
separated due to the inhibition of
the posterior tibialis. Attention must
be directed to improving the
strength and removing the trigger
points in the posterior tibialis as well
as to proper adjusting and support
of the tibia and fibula. Taping the
bones to maintain their
approximation is often helpful,
as is taping to maintain the
longitudinal arch and support the
ligaments.
Appropriate acupuncture point
stimulation of the gait related
reflexes is indicated when the tests
are positive. Muscle energy
techniques and other exercises based
on muscle test and orthopedic
findings are well-advised. Some
patients benefit significantly from
wearing a firm support to maintain
the foot in neutral or slight
dorsiflexion while they sleep.
Stretches directed at lengthening the
gastrocnemius and soleus should
always be encouraged with careful
attention to the patients level of
pain as the determinant of
frequency, duration and intensity.
As is mentioned in the body of the
article, attention to the entire
structure and not just the feet, is
critical.

The neuroemotional component

warrants particular focus and the
various treatment modalities are
beyond the scope of this article.
Significant insights, as well as
improvements, are frequently
obtained by employing Dr Scott
Walkers Neuroemotional
Technique (Walker 1995), using
the involved foot as the entry
point.

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