The Plantar Fasciitis That Wasn't

Tibialis Posterior- False Plantar Fascial Pain

In the last two weeks, I have seen two clients who present with pain that seemed like plantar fasciitis. The only problem was, it wasn't plantar fasciitis! This probably explains why the treatment being pursued was not working.

In both cases, the pain was worse after prolonged use, not after a period of rest. This does not fit the pattern of plantar fasciitis (PF). PF is often worse after use, but it is always worse after prolonged rest.

Also true in both cases was that the location of the pain was a bit anterior to where the pain of PF often occurs. The typical location is shown at the picture below, with the presenting pain just anterior to the medial calcaneus. Therapists often forget that the tibialis posterior has multiple attachments on the sole of the foot, making it another possible source of foot pain. Tibialis posterior pain would be worse after use and better after some rest; exactly what these two people presented with.

Typical location of Plantar Fasciitis pain

Typical location of Plantar Fasciitis pain

In both cases, two short treatments made an enormous difference in relieving their pain. As we show you in the seminar, line of drive and length-tension alterations can make the difference between treatment failure and success. Like tuning a fine instrument, the smallest turn of the wrist can change everything.

There are two very important lessons in this:

  1. Often times, if something seems close to a familiar condition, health care providers often "round up". Instead of struggling with aspects that do not fit the pattern, they call it what they know, ignoring the parts that conflict with the diagnosis. PNMT teaches you this: "If it doesn't fit, it isn't it!"
  2. A treatment is very much like an answer. Answers, however, are in response to questions. If you have the wrong question, the answer is always going to be incorrect. Spend more time on the question and the answer will present itself.

In both of these cases, a lot of money had been spent on treatment that did not work. We therapists will be successful whenboth clients and health providers know that our work is effective and efficient, saving everyone time and money. That is something we can all feel really good about; truly a wonderful service we provide to the community in which we reside. How lucky are we to be in such a wonderful field!


Douglas Nelson

Transient