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Research-Based Massage for Plantar Fasciitis (2 Continuing Education Hours)

This course is approved for 2 hours of Continuing Education for Massage Therapists by the Texas Department of State Health Services: Approved Provider: MARK SCOTT URIDEL CE0009 and by the NCBTMB for Nationally Certified Massage Therapists.

Learning Objectives: After reading this course, you will...

  1. be able to list anatomical structures involved in the development of plantar fasciitis
  2. be able to list the prevalence, etiology & risk factors associated with plantar fasciitis
  3. be able to describe the clinical signs and symptoms of someone who has plantar fasciitis
  4. be able to list the different interventions proven effective in treating plantar fasciitis
  5. be able to describe massage techniques for plantar fasciitis


Introduction to Research-Based Massage for Plantar Fasciitis
Plantar Fasciitis (PF), also known as plantar fascial fibromatosis (ICD-9 code 728.71; ICD-10 code M72.2), is defined as a degenerative syndrome of the plantar aponeurosis at its insertion on the medial calcaneal tubercle.(1,2)  PF occurs when the plantar fascia along the bottom of the foot experiences repeated mechanical stress, which results in inflammation.(1)  The word “fasciitis” assumes that inflammation is an inherent component of this condition.  However, recent research suggests that some presentations of PF manifest as non-inflammatory, degenerative processes and may more aptly be termed plantar fasciosis.(4)  The plantar fascia is a thickened fibrous sheet of connective tissue that originates from the medial tubercle on the undersurface of the calcaneus, fans out and attaches to the plantar plates of the metatarsophalangeal (MTP) joints to form the medial longitudinal arch of the foot.  The plantar fascia loosens and tightens with changes in weight-bearing forces.  The purpose of the plantar fascia is twofold - to provide support of the longitudinal arch and to serve as a dynamic shock absorber for the foot and the entire leg.  It absorbs significant weight and pressure during standing, walking and running and provides key functions in gait, particularly the windlass mechanism.  When the toes are extended, the dorsal gliding of the phalanx relative to the metatarsals pulls the plantar aponeurosis forward, around the heads of the metatarsals, creating tension on the plantar aponeurosis.  This action causes an arch-raising effect similar to that of a windlass mechanical device.(11)  Repetitive stress on the plantar fascia associated with this windlass mechanism can cause microscopic tears, which can lead to inflammation of the aponeurosis and PF.

Please, click here to read this article as part of the content for this course.


Prevalence, Etiology and Risk Factors According to the Research
In the United States, more than two million individuals are treated for PF on an annual basis, accounting for 11-15 percent of physician visits related to foot pain and it is estimated that 10 percent of the U.S. population will experience plantar heel pain during the course of a lifetime.(5)  In a national survey conducted in 2000, 117 physical therapists unanimously reported PF to be the most common foot condition seen in their clinic.(2)  PF affects individuals regardless of sex, age, ethnicity, or activity level.  It is seen in physically active individuals such as runners and dancers, but is also prevalent in the general population, particularly in women ages 40-60.(6) 

Although PF is the most common cause of inferior heel pain in adults, its etiology is unknown in approximately 85% of cases.(3)  Among the most common suspected causes of PF is an overload of physical activity or exercise.  Athletes are particularly prone to plantar fasciitis and commonly suffer from it.  In athletes, PF appears to be associated with overuse, training errors, training on unyielding surfaces, and improper or excessively worn footwear.  Sudden increases in weight-bearing activity, particularly those involving running and jumping, can cause micro-trauma to the plantar fascia at a rate that exceeds the body’s ability to recover.  PF is also influenced by the mechanics of the foot.  Patients with conditions such as pes planus (flat feet), pes cavus (high arches) or having an abnormal gait can put increased mechanical stresses on the plantar fascia.(6)  Reports state that 81-86 percent of individuals with symptoms consistent with PF have excessive pronation.(1)  A foot that overpronates, or remains pronated into terminal stance, puts excessive stress on the medial plantar fascia.(7)  Recent case-controlled studies have identified obesity or sudden weight gain, reduced ankle dorsiflexion, pes planus, and occupations that require prolonged weight-bearing as the greatest risk factors associated with PF.(6)  One study observed that individuals with a body mass index (BMI) > 30 kg/m² (the cutoff for grade-II obesity) had an odds ratio of 5.6 for PF compared to those with a BMI ≤ 25 kg/m².   The same study observed that risk of PF increases as the range of ankle dorsiflexion decreases.  Individuals with <10° of ankle dorsiflexion had an odds ratio of at least 2.1 for PF.  The ratio increased dramatically as the range of motion in dorsiflexion decreased.(6)  Heel spurs have commonly been implicated as a risk factor for PF.  A heel spur is a pointed bony fragment that stems anteriorly from the calcaneal tubercle into the sensitive tissue and nerves of the arch.  These pointed growths of bone develop when the plantar fascia is excessively and repetitively pulled away from the heel bone.  In many cases, a heel spur can develop along with plantar fasciitis. One study reviewing the radiographs of 1,000 PF patients found that 13.2 percent had heel spurs.(1)  Certain types of arthritis, like rheumatoid arthritis or systemic lupus erythematosus can cause inflammation to develop in tendons, resulting in PF.(9)  Diabetes is also a factor that can contribute to further heel pain and damage, particularly among the elderly.(10)

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