Are you SURE it’s plantar fasciitis?
Heel pain is multi-factorial. What needs to be determined in physical therapy is whether the origin of the pain is local, referred, or both. As our population becomes heavier, more de-conditioned, and more susceptible to concurrent orthopedic dysfunction, the chance of referred symptoms arising from the low back and/or a pinch along the sciatic nerve is greater. If your symptoms are not significantly improving after 4 visits of localized soft tissue treatment, then referring sources of pain need to be considered. If nerve involvement is suspected, then it is easier to perform manual differentiation testing after the nerve has been sensitized. You may be instructed to return to PT when you are most symptomatic. Neural tension testing of the sciatic nerve may elicit heel pain or a “doorbell” sign may be elicited along the course of the sciatic or tibial nerve. See below.
Our patients may be susceptible to the “double-crush” phenomenon. The “double-crush” means that you are more susceptible to nerve entrapment in one area if you already have an entrapment in an adjacent area. A pinched nerve in your low back due to a herniated disc may make you more vulnerable to a “pinch” along the sciatic nerve as it courses through the lower part of your leg. Active Release Techniques, as performed at OrthoWell/WalkWell, are very effective in resolving these entrapments.