Extremity Adjusting: A Patient Case of Plantar Fasciitis
The spine has always been the foundation of chiropractic care—it houses and protects the nervous system, supports posture, and serves as the central point of structural and neurological balance for the entire body. But did you know that your chiropractor can also assess and adjust nearly every other joint in the body?
Think feet, knees, hips, shoulders, elbows, hands, jaw, ribs, etc…
The body functions as an integrated system, and when extremity joints lose proper motion or alignment, they can create abnormal stress patterns that influence spinal mechanics and nervous system function. These stress patterns can also contribute to local problems within the extremities.
Misalignment and restricted joint motion = uneven wear/tear = imbalances & injury
In this blog post, we will focus on the lower extremity (foot & leg) and look at a real patient case of plantar fasciitis from our office!
What is Plantar Fasciitis?
Plantar fasciitis is a common condition seen by chiropractors and other healthcare providers. It is typically considered an overuse injury, common among runners and people who work on their feet a lot.
Traditionally, it has been described as inflammation of the plantar fascia, but more recent literature has questioned this model. Beyond the acute phase, there is actually little/no evidence for the presence of inflammation. Rather, scientists have observed degenerative changes in the plantar fascia, associated with altered blood flow to the foot (Lemont et al., 2003).
Both theories acknowledge foot posture and biomechanics as a significant contributor to the problem, but the absence of inflammation could explain the 46% recurrence rate of plantar fasciitis under the inflammatory model (Jacobs et al., 2019).
If it’s not an inflammatory problem, then why would treating inflammation fix it?
Function of the Plantar Fascia
The plantar fascia is an important component of foot biomechanics. It maintains the integrity of the medial longitudinal arch, and contributes to propulsion during gait via what is known as the windlass effect.
This effect describes the fascia as a cable between the heel and the ball of the foot, which tightens during ankle dorsiflexion (toe-off), creating a rigid lever arm (Bolgia et al., 2004).
Normal function of this fascia is dependent upon proper biomechanics of the joints and tissues surrounding it.
Common dysfunctions described in the literature include hyperpronation, excessively high or low arches, instability within the foot, and external factors in the knee or hip (Bolgia et al., 2004).
Inflammatory vs Degenerative Treatment Approach
Plantar fasciitis has commonly been treated as an inflammatory condition, but this model has often been unsuccessful, leaving patients with recurring plantar heel pain.
Traditional methods include rest, orthotic support, and corticosteroid injections — removing stressors and inflammation, without addressing the root cause.
Furthermore, corticosteroid injections have been associated with serious side effects such as rupture of the plantar fascia (Lemont et al., 2003). Without sufficient evidence for the presence of inflammation in the first place, the risk is unnecessary.
Under the more recent theory of degenerative plantar fasciosis, emphasis should be placed on restoration of biomechanical integrity via individualized chiropractic mobilization, strengthening, and footwear alteration.
The Role of Chiropractic Care
Spinal adjustments are the foundation for full-body movement and function. Misaligned vertebrae in the spine can put pressure on nerves and interfere with communication between the brain and body. One of the many ways that this can manifest is altered proprioception and muscle activation in the extremities. This is why we will always begin with adjusting the spine, no matter where the pain is.
Still, joint misalignment and dysfunction can also occur within the extremities. In our office, we perform focused assessments to identify these fixations. Then we apply a specific chiropractic adjustment to restore proper alignment and motion.
In the context of plantar fasciitis, a fixation of the bones in your ankle/foot can alter the load bearing and propulsion mechanics of the foot. If the foot can’t move properly, then two things happen…
The plantar fascia is forced to compensate and take on more load/stretch
Foot posture suffers, and compression of the lateral plantar artery leads to degeneration of the plantar fascia
A specific chiropractic adjustment serves to restore normal joint mechanics, promoting proper load balance, posture, and blood flow in the foot.
Strength and Proper Footwear
Once structural integrity and motion have been restored, maintaining it takes a little extra care.
Strengthening exercises serve to…
Teach your foot to maintain normal arch height
Prevent recurrent joint fixation/misalignment
Train the foot to withstand prolonged load and control its newfound range of motion
Proper footwear should support both motion and strength of the foot. When it comes to foot pain and shoes, there are two popular trends that you might be familiar with…
Orthotics: These have their time and place, but aren’t as beneficial as once thought. They can be helpful temporarily, to support your arches and relieve stress on the plantar fascia. But over time they become a crutch, encouraging the foot to become even stiffer and weaker.
Note - structural flat feet (the minority which cannot be corrected with mobilization or strengthening) may benefit from orthotics, but functional flat feet (the majority which can be corrected) should be approached differently.
Barefoot/Minimalist shoes: These have become very popular in recent years, and rightfully so, but there are some caveats to understand before making the switch.
Shoes are not the solution; they serve to complement and enhance treatment (mobilization & strengthening). Putting stiff, weak, and dysfunctional feet into barefoot shoes is likely to cause more harm than good because you are asking your feet to do more, without giving them the tools to adapt. Instead, give your feet a good foundation first. Then use the shoes to apply and optimize it.
Transition slowly. Barefoot shoes ask a lot of inexperienced feet. Without artificial support, they must learn to control and support themselves — and this can be a lot of work. So first try wearing these shoes just a few hours/day. From there, you can slowly progress to all-day wear.
Look for shoes with minimal cushioning in the sole, and a wide toe box that allows your feet to naturally spread as you walk. Too much cushioning prevents your feet from feeling the ground properly, and interferes with proprioception (the body’s perception of where it is in space). Additionally, narrow toe boxes keep the feet from naturally spreading under load, and instead forces them into a posture that has been shown to decrease plantar artery blood flow (Jacobs et al., 2019).
A Patient Case from Our Office
We have a patient who came to our office for low back pain and sciatic pain. She also noted chronic plantar fasciitis in her left foot, and a meniscus tear in her right knee. Her back pain had been making it difficult to sleep, and she was concerned about needing knee surgery if the meniscus tear continued to progress.
As with every patient, we performed a thorough initial exam including thermography and full spine x-rays. We were also able to review her MRI reports for the knee. With all of the information gathered, we developed a personalized care plan to address her concerns as efficiently and effectively as possible.
As Gonstead chiropractors, we always begin with the foundation of the spine — the pelvis and sacrum. In this case, we started with addressing 11 mm of rotation in the patient’s pelvis. Key adjustments were also performed in the midback region, and eventually the lower lumbars (low back). Within the first few visits, all low back and sciatic pain was gone. The patient also noted that she was getting the best sleep she’d had in years.
To address the plantar fasciitis and alleviate stress on the torn meniscus, chiropractic adjustments were performed on both feet/ankles. With a combination of adjustments and foot strengthening exercises, the patient quickly showed significant improvement in knee pain. She went from struggling to bend the knee slowly, to easily moving it quickly and without pain. She also experienced significant improvements in foot pain and functionality.
We are so grateful for the opportunity to care for her, and look forward to continuing her progress. It brings a smile to our faces every time that she walks in the door, and our practice would not be the same without her. Each patient who comes into our office becomes a part of the Rise family, and we love to celebrate wins like this with them!
References
Bolgia, L., Malone, T. (2004). Plantar Fasciitis and the Windlass Mechanism: A Biomechanical Link to Clinical Practice. Journal of Athletic Training.
Jacobs, J., et al. (2019). Passive hallux adduction decreases lateral plantar artery blood flow: a preliminary study of the potential influence of narrow toe box shoes. Journal of Foot and Ankle Research.
Lemont, H., et al. (2003). Plantar fasciitis: a degenerative process (fasciosis) without inflammation. Journal of the American Podiatric Medical Association.