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Plantar foot pain can be a debilitating condition that severely impacts a client's quality of life. There are numerous causes of foot pain, and the ideal treatment for each condition varies depending on the nature of the problem. This article is the first in a two-part series looking at plantar foot pain. Here, we'll explore several potential causes of plantar foot pain. In Part 2, we'll look at key treatment strategies based on the ladder of engagement model presented in the November/December 2022 issue of Massage & Bodywork magazine (page 20). PLANTAR FASCIITIS Plantar fasciitis is the most common cause of pain on the bottom surface of the foot. It is prevalent with athletes and others who spend long hours on their feet or have repetitive impact loading. The condition is aggravated by various biomechanical factors such as pes planus (flat foot) or pes cavus (excessively high arch). The plantar fascia attaches proximally to the anterior calcaneus and distally blends into the ligaments surrounding the metatarsophalangeal joints and f lexor tendon sheaths of all five metatarsals (Image 1). It provides the primary soft tissue support for the longitudinal arch. The plantar fascia is crucial for shock absorption in the lower extremity. Reducing these impact forces is particularly important in sporting activities because ground- reaction force can be 2–3 times the body's weight when running. Without tissues such as the plantar fascia mitigating these forces, individuals could develop a host of problems, including stress fractures, joint disorders, shin splints, or other overuse conditions. The plantar fascia functions primarily as a spring to maintain the foot's arch. The shape of the arch can frequently determine how effective the plantar fascia's function is. Pes planus has a poor longitudinal arch, which decreases the shock-absorbing capability of the plantar fascia. Pes cavus may cause chronic overuse to the plantar fascia because tension increases, causing greater stress on its attachment site on the anterior calcaneus. Plantar fasciitis is routinely considered an inf lammatory condition involving the attachment site of the plantar fascia on the calcaneus. However, inf lammation may not always be involved, and the primary tissue irritation could be collagen degeneration in the fascia akin to that experienced in overuse tendinosis. Both processes 22 m a s s a g e & b o d y wo r k j a n u a r y/ fe b r u a r y 2 0 2 3 Exploring Plantar Foot Pain, Part 1 TECHNIQUE By Whitney Lowe CLINICAL EXPLORATIONS 1 KEY POINTS • There are several potential causes of plantar foot pain, including the most common, plantar fasciitis. • Other nerve entrapment syndromes, such as tarsal tunnel syndrome, Morton's neuroma, and Baxter's neuropathy, can also cause plantar foot pain. The plantar fascia. Image courtesy of Complete Anatomy. Plantar fascia

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