Plantar Fasciitis: Clinical Perspective Utilizing Functional Dry Needling® (Part 1 of 2)

 

edo_zylstra_head_shot_2_175-1Written by Edo Zylstra, PT, DPT, OCS

Heel pain characterized as Plantar Fasciitis is described as having pain and tenderness at the medial tubercle of the calcaneus upon compression due to weight-bearing, specifically after rest (1). “It is one of the most common foot disorders encountered by foot and ankle specialists that affects about 10% of people in their life, and it is responsible for approximately one million physician visits annually” (2, 3).

Management of this dysfunction and pain ranges from ice, heat, ultrasound, iontophoresis, stretching, taping, exercises, night splinting and other manual techniques for the foot and lower extremity (4, 5). If we are to consider implementing Functional Dry Needling as an adjunctive treatment tool for this diagnosis, we would do well to look at somatic referred pain (see pictures below) as a component to the symptoms reported by patients suffering with this.

In the images below, note key trigger points associated with pain referral by muscle:  Abductor Hallucis, Flexor Digitorum Longus, Gastrocnemius, Quadratus Plantae, Soleus and Tibialis Posterior.

 

 

ah

Abductor Hallucis

fdl

Flexor Dig. Longus

gastrocnemius

Gastrocnemius

qp

Quadratus Plantae

soleus

Soleus

tp

Tibialis Posterior

Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual Volume 1, 2nd Edition

Here we can see the many overlapping referral patterns associated with “myofascial trigger points”.  In a functional approach, we would need to consider the myotomal impact of weakness, tightness and inhibition of these muscles that may contribute to the chronicity often found with this diagnosis.

To be continued:  The continuation will include typical assessment findings and treatment utilizing FDN.


  1. Barrett SJ, O’Malley R. Plantar fasciitis and other causes of heel pain. Am Fam Physician. 1999;59(8):2200–6.
  2. Crawford F. Plantar heel pain and fasciitis. Clin Evid. 2005;(13):1533–45
  3. Eftekharsadat B, Babaei-Ghazani A, Zeinolabedinzadeh V. Dry needling in patients with chronic heel pain due to plantar fasciitis: A single-blinded randomized clinical trial. Med J Islam Repub Iran. 2016;30:401.
  4. McPoil TG, Martin RL, Cornwall MW, Wukich DK, Irrgang JJ, Godges JJ. Heel pain–plantar fasciitis: clinical practice guildelines linked to the international classification of function, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38(4):A1–A18
  5. Crawford F, Thomson C. Interventions for treating plantar heel pain. Cochrane Database Syst Rev 2003(3)