The Fallacy of Plantar Fasciitis

August 29, 2017 Bare Physical Therapy bunion, Cortizone Injections, foot pain, Manual Physical Therapy, metatarsalgia, Orthotics, plantar fasciitis, Podiatrist laramie arch supports, laramie cranial therapy, laramie foot pain, laramie knee pain, laramie manual physical therapy, laramie manual therapist, laramie myofascial release, laramie myofascial therapy, laramie orthotics, laramie physical therapist, laramie physical therapy, laramie podiatrist, physical therapist tony bare

Plantar fasciitis is such a problem that you can hardly conduct an image search for plantar fascia without returning mostly images of the plantar fascia with a big angry red splotch on the plantar fascia near the heel.

I recently watched a video on Facebook posted by one of my Physical Therapy peers on the topic of plantar fasciitis. I privately messaged him to let him know that I thought his presentation had missed some key points and his reply cited the Clinical Practice Guidelines for plantar fasciitis. There are some issues with that response from my standpoint:
1. The Clinical Practice Guidelines for plantar fasciitis are fairly useless in regards to “what to do” to treat plantar fasciitis and of some limited value in “what not to do”. They very accurately reflect current available research which is of little clinical value in this instance.
2. I’m concerned that my profession is so entranced by Evidence Based Practice (EBP) that they have stopped seeking information or guidance outside of what research has generated, and as a result their patients often suffer through suboptimal care and (pun intended) limp down the clinical plank of failed conservative care, injection and ill-advised surgery. I know this not what the developers of EBP-theory intended, but I’ve seen it just about daily on social media.
3. The research available on this topic is doing very little to help clinicians truly heal their patients of their foot pain. I would dearly love to pitch research ideas for anyone who has faculty connections.
Now off the Soap Box and on to clinical guidance…
– Plantar fasciitis is a misnomer, most of these patients don’t use their plantar fascia at all. A more appropriate term would be “Mechanical Heel Pain”. Typically, the origin of Mechanical Heel Pain is a poor initial contact in stance phase in which the contact is too medial in magnitude and/or duration. The medial aspect of the midtarsal joint, subtalar joint and calcaneus are very neural dense and do not tolerate this increased pressure well and eventually leads to heel/foot pain.

– Unfortunately, a bad initial contact (as described above), has consequences throughout the foot and lower extremity that further perpetuate an inefficient gait cycle. Here are some examples: hallux abductovalgus (painful bunion), metatarsalgia, achilles tendinitis, medial knee pain (pes anserine, plica, etc), lateral hip pain (trochanteric bursitis, piriformis syndrome, etc) and SI dysfunction.
– The good news is that when you treat the cause (improve foot mechanics) and treat the tissue (manual therapy), the patients’ symptoms resolve very quickly…1-4 visits.
If you are a clinician reading this blog and you didn’t delete it from your feed after reading #2 above, you have practiced long enough to be frustrated at heel and foot pain patients’ poor prognoses. Please consider attending a lower extremity biomechanical course, it will completely change your practice. I teach a 2 day course called Thinking on Your Feet. Of course, I’m biased and think mine is best, but there are some other good courses out there. Give one of them a chance and it will elevate your practice above the limitations of the current Clinical Practice Guidelines.
If you are a patient reading this blog, you may have had “mainstream” care for your foot pain which probably included: activity modification, exercises (strengthening/stretching), modalities (heat, ice, ultrasound), massage, shoe inserts, dry needling, injections or surgery. You have probably been nodding your head the whole time, because you know your foot pain isn’t completely (or any) better. Find a clinician with biomechanical training in this topic or contact me directly for advice at Tony@BarePT.com or find out more about my unique practice and skill set at Barephysicaltherapy.com

LTC Tony Bare (ret) DPT, ATC, OCS

Laramie, WY

6 Week Follow Up After Cranial Treatment for Non-Sleeping Toddler

June 24, 2015May 23, 2017 Bare Physical Therapy Cranial Therapy, Cranial Therapy for Toddlers arch supports colorado springs, cranial sacral therapy colorado springs, cranial sacral therapy laramie, cranial therapy colorado springs, cranial therapy for toddlers, cranial therapy tony bare, custom orthotics colorado springs, laramie cranial therapy, laramie manual therapist, laramie myofascial release, laramie myofascial therapy, laramie physical therapist, laramie physical therapy, manual phyiscal therapy colorado springs

Cranial Therapy Success!

Jill and Mike had their daughter Brooklyn treated 6 weeks ago because she was sleeping so poorly and they were all sleep deprived as a family. You can read their first post HERE

So it has been almost 6 weeks since we had the cranial sacral therapy done by Tony on our daughter Brooklyn (she will be 3 in October), and I have to say life is amazing! I will admit that for the first week I thought every night was a fluke. I kept expecting that this treatment would not last and we would be back to the screaming, thrashing wake ups. That was the life that we had become accustomed to. But here we are 6 weeks later, with a sleeping toddler. We have the occasional night where she wakes up because of a storm or a loud noise, but it no longer is the end of our night. It only takes about 5 minutes to get her back to sleep and she is not inconsolable. She is also napping at least an hour a day, but more like 2-3 on a regular basis.
Besides the sleep I have to say that we have our daughter back. Since the sleep deprivation had become such the norm, we did not realize the changes that had occurred in Brooklyn. Looking back now it is easy to see. She had terrible tantrums that lasted up to an hour, she became a poor eater and she her personality had disappeared.
Once her sleep improved the rest of the problems seemed to vanish. Her tantrums still occur, she is almost 3, but they only last a few minutes and we are able to calmly discuss the issue afterwards. She began eating much better, and has put on healthy weight and above all her personality returned. The first day we heard her laugh again, we realized that it had been at least 6 months since we heard that infectious laughter. She is back to her silly, dancing, singing, laughing self. Brooklyn has also grown leaps and bounds with her confidence. She will now go and explore on playgrounds without holding our hands and she is not afraid to introduce herself to other kids and initiate play.

6 weeks ago if you had told me that cranial therapy could improve all of these aspects of Brooklyn’s life I would have doubted that was possible. But now I know and as a family we feel so blessed to have had this session with Tony!

Mike, Jill and their (sleeping at night!) daughter Brooklyn

Jill is the FIT4MOM Front Range Membership and Special Programs Coordinator as well as the Littleton Stroller Strides and Body Back instructor and running coach. They are expecting baby #2 in September!

Custom Orthotics By Providing Video Gait Analysis

June 1, 2015August 31, 2017 Bare Physical Therapy achilles tendonitis, Arch Support, bunion, foot pain, knee pain, metatarsalgia, Orthotics achillis tendonitis, arch support, arch supports colorado springs, custom orthotics colorado springs, foot pain, hip pain, hip pain colorado springs, iliotibial band syndrome, knee pain, knee pain colorado springs, laramie arch supports, laramie cranial therapy, laramie foot pain, laramie knee pain, laramie manual physical therapy, laramie myofascial release, laramie myofascial therapy, laramie orthotics, laramie physical therapist, laramie physical therapy, laramie podiatrist, matatarsalgia, orthotics colorado springs, physical therapist tony bare, physical therapy colorado springs, shin splints

I’ve had a lot of interest in my Bare Necessities Custom Orthotics (arch supports or shoe inserts) from people across the country and I’ve had good success making them based off the information below. If you’ve read my post on the Fallacy of Arch Supports, you know that one of the components of my exam that makes the orthotic successful is the dynamic gait analysis, so if I’m provided the video footage I’ll have great insight into your biomechanics and if they need any help or correction.

The good news is that I’ll assess your videos FREE!! All I need is 10 second clips of you walking barefoot on the treadmill from behind and from each side. Just do your best to walk on the treadmill at your comfortable walking pace. Take video footage of the following angle/level (including both sides/foot):

I’ll need a tracing of your foot next to a ruler. See picture below (it doesn’t have a ruler but you’ll need a ruler next to your tracing). The tracing will let me know what size of orthotic to make and I’ll have an idea what adaptations your biomechanics have forced your foot to make and that will be even more information helping to guide my orthotic prescription.

The orthotics themselves are only an average cost of $85 plus $10 shipping and handling, so send me your videos and get on the road to pain free walking or running.

Now that we are relocating to Laramie, WY please refer your Colorado Springs friends to this post.

Please email me your video and foot tracing to tony@barept.com

LTC Tony Bare (ret), DPT, ATC, OCS
Physical Therapist
Laramie, WY

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