By Patrick A. DeHeer, DPM, FACFAS, FASPS
The thing about evidence-based medicine is well, it is evidence-based, and ultimately with substantial evidence the question becomes no longer debatable. Practicing evidence-based medicine leads to consistent and better outcomes. The evidence for the relationship between equinus and plantar fasciitis is no longer debatable. The only question becomes, do you practice evidence-based medicine for the treatment of plantar fasciitis?
What is the evidence for an equinus component to plantar fasciitis? How about at least 36 peer-reviewed published articles? For a list of the evidence-based research on equinus and plantar fasciitis visit http://fixequinus.com/pages/related-pathologies
Patel and DiGiovanni in Foot and Ankle International 2011 evaluated 254 patients with either acute or chronic plantar fasciitis and noted that 83% of these patients had an equinus deformity (1). This result was similar for the acute group (129/155 83%) and chronic group (82/99 82%)
Additionally, Cheung et al. in Clinical Biomechanics 2006 concluded, “The plantar fascia was found to be an important arch-supporting structure, which sustained high tensions during weight-bearing. An increase in Achilles tendon load resulted in reductions of arch height and increases in plantar fascia tensions. The Achilles tendon load was found to have about two-times the straining effect on the plantar fascia than the body weight on the foot.” “Lengthening or tension relieve of the Achilles tendon especially in subjects with tight calf muscles and Achilles tendon may be beneficial in terms of plantar fascia stress relief.” (2)
The research is very clear on this topic, most of the time plantar fasciitis has an underlying equinus component, and the comprehensive treatment for plantar fasciitis mandates treatment of the equinus deformity.
- Patel, Amar, and Benedict DiGiovanni. "Association between plantar fasciitis and isolated contracture of the gastrocnemius." Foot & ankle International1 (2011): 5-8.
- Cheung, Jason Tak-Man, Ming Zhang, and Kai-Nan An. "Effect of Achilles tendon loading on plantar fascia tension in the standing foot." Clinical Biomechanics2 (2006): 194-203.