30 seconds Of Therapy: Plantar Fasciitis and Graston Technique

11 minutes ago

5 min read

Illustration showing the anatomy of the foot with emphasis on the plantar fascia. The image highlights the location of plantar fasciitis with a red inflamed area at the heel. The left side shows a skeletal view of the plantar fascia stretching from the heel to the toes, while the right side shows a person holding their painful heel, indicating discomfort commonly associated with plantar fasciitis. — ***Plantar fasciitis*** is the inflammation of the plantar fascia, tissue in the foot used during walking and foot movement. Plantar fasciitis can be caused by a number of factors, including type of shoes, foot structure, overuse and types of walking surfaces. The main symptom of plantar fasciitis is heel pain

START

Treating Plantar Fasciitis (PF ) as a tendinosis, not an inflammation.
1. Understand the pathology of fasciosis
  1. PF involves disorganized collagen, fibroblast overactivity, and vascular hyperplasia, not swelling or redness typical of inflammation.
  2. Histological studies show an absence of inflammatory cells, meaning anti-inflammatory approaches (NSAIDs, ice) have limited long-term benefit.
  3. Use correct language—"plantar fasciosis" or "plantar fasciopathy"—to guide more appropriate loading-based treatment plans.
Using graded loading strategies.
1. Apply controlled and progressive tension to stimulate tissue healing.
  1. Begin with heel raises on flat ground and progress to heel raises with toe extension (which increases plantar fascia load by 40%).
  2. Incorporate eccentric heel drops, progressing to weighted versions as tolerated.
  3. Example progression: Week 1–2: Seated towel scrunches and isometric plantar flexion. - Week 3–4: Standing double-leg heel raises → single-leg raises. - Week 5+: Add resistance or perform on a step to increase stretch.
Integrating Graston Technique or instrument-assisted soft tissue mobilization (IASTM)when appropriate.
1. Integrating Graston Technique or instrument-assisted soft tissue mobilization (IASTM)when appropriate.
  1. Use GT tools over the medial calcaneal tubercle and central plantar fascia to stimulate fibroblast activity and create a rich sensory experience.
  2. Apply GT progressively: - Phase 1: Static unloaded (non-weight bearing) - Phase 2: Dynamic partially loaded (e.g., during active toe flexion) - Phase 3: Dynamic fully loaded (e.g., while performing calf raises)
  3. GT is especially helpful when combined with exercises, as it enhances neuromotor control and tissue extensibility

STOP

Relying on passive modalities alone.
1. Passive tools like ultrasound or phonophoresis should not replace active care.
  1. These modalities received Grade C or D evidence—too weak or conflicting to be relied on as primary treatments.
  2. They may reduce short-term pain but do not improve tissue strength or structure.
  3. Replace with active treatments like strengthening, manual therapy, and mobility training.
Assuming all heel pain = PF.
1. Rule out other conditions with proper testing
  1. Use Tinel’s test for tarsal tunnel syndrome (Sensitivity 0.81–0.92, Specificity 0.99).
  2. Use the Windlass test to help confirm PF (Specificity 0.99, though low sensitivity).
  3. Consider other diagnoses: - Fat pad syndrome (pain when walking on hard surfaces, not first-step pain) - Calcaneal stress fracture (pain worsens with activity, bony tenderness) - Baxter’s nerve entrapment (burning pain, especially at night)
Avoiding proximal and kinetic chain assessment.
1. Limited mobility or strength upstream can overload the plantar fascia.
  1. Assess hip extension—limited mobility here alters gait mechanics and increases heel stress.
  2. Strengthen the posterior chain: glutes, hamstrings, and calves.
  3. Example exercises: - Bridges and deadlifts for glutes - Single-leg squats for control - Planks and bird-dogs for trunk stability to support limb movement.

WHY

Why Graston Technique?
1. GT uses instrument-assisted soft tissue mobilization (IASTM) to stimulate fibroblast activity, enhance tissue alignment, and restore functional movement. It’s more effective than stretching alone for improving ankle dorsiflexion.
Why shift terminology from plantar fasciitis to fasciosis?
1. Because plantar fasciosis is a degenerative condition—not an inflammatory one. When we treat it as “fasciitis,” we often rely on ice, rest, or anti-inflammatories, which don’t target the root issue. Recognizing it as fasciosis focuses treatment on progressive loading, manual therapy, and collagen remodeling—strategies that actually rebuild the fascia and reduce symptoms long-term.

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