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Fascia, flexibility and fasciitis – some basic information regarding plantar fasciitis

heel-spur-plantar-info
Photo: aidmyplantar.com

by Janine Bryant for The Dance Journal

Almost one million Americans are affected by plantar faciitis (PF), which is the most common cause of chronic heel pain. {1} You could think of the plantar fascia as a strap that attaches the base of the toes to the heel base. {2} One can feel this strap tighten/lengthen upon dorsiflexion (toes up) and shorten upon plantar flexion (toes pointed).  Plantar fasciitis is an inflammation of this strap, or, plantar fascia, which is thick connective tissue, superficial to the intrinsic (deep) muscles of the foot.  The site of pain is frequently located at the medial calcaneal border (inside of the heel of the foot), where the fascia originates. {3} Inflammation is usually the body’s attempt at healing.  In this case, small avulsions (microscopic tears) occur from overuse such as in excessive jumping in dance or forcing turnout from the knees, which results in incorrect weight placement and pronation.

For dancers, if you have a really high arch or really low arch, or if you are not stretching enough, you can develop PF, tears and pain in the bottom of your foot from the inflammation. {2}

Clinical Presentation/Diagnosis:  Patients with PF will complain of plantar heel pain, exacerbated with the first step after a period of non-weightbearing, typically in the morning. {1} Diagnosis can be made by firm palpation at the medial (inside) aspect of the heel, just where the arch starts and the pain is pronounced if palpation is done with the toes forced back into dorsiflexion to tighten the PF, and lessened if palpation is done with the toes in neutral or slight plantarflexion, which relaxes the PF. {3} Imaging can also be done and may rule out other causes of plantar heel pain. {1}

Dancers should see their physicians if pain is persistent because the pain, although likely a result of PF, could also be a stress fracture of the heel.  In addition, dancers who persist in dancing through PF could develop a heel spur, which is a tiny spike of bone which has pulled out from where the plantar fascia inserts into the heel. {2}

Treatment:  Exercises to strengthen the arch and stretch the calf muscles are effective as well as stretching the Achilles tendon, which is an extension of the plantar fascia – foot flexibility is increased by paying attention to the flexibility of the entire lower leg and calf. {2} Physical therapy modalities, such as ice, ultrasound, electrical stimulation, and deep friction massage, can be useful in reducing the inflammation, while cortisone injections should be avoided, if possible, as they are excruciatingly painful and can cause atrophy of the heel fat pad, and have been associated with PF ruptures. {3} Patients with severe pain when arising from bed can achieve benefits from the use of a night splint or boot, which can provide a stretch lasting for many hours, while surgical treatment is a last line to be considered only after 6-12 months of conservative therapy. {1}

Inadequate treatment could result in a recurrence of the injury.  Therefore, dancers who experience this pain should seek help early on.  Stretch, stretch, stretch!  Pull your toes up throughout the day and stretch your Achilles tendon and calf muscles.

Until next time, friends, dance healthy and strong!

Janine Bryant
Co-Director of Dance
Eastern University
St. Davids, Pa.
Jbryant3@eastern.edu

  1. Martinelli, N, Bonifacini, C, Romeo, G, Current therapeutic approaches for plantar fasciitis, Orthopedic research and reviews, Dovepress, 2014.
  2. Peterson, Judith R., Dance medicine head to toe, a dancer’s guide to health, Princeton Book Co., 2011, pp. 129-132.
  3. Solomon, J, and R, Minton, SC, Preventing dance injuries, second edition, Human Kinetics, 2005, pp. 49-50.

 

- Janine Bryant

Janine Bryant, Director of the Eastern University Dance Program, or 'Prof B.', as her students call her, teaches courses for Dance, Kinesiology and the Loeb School of Education, as well as the Campolo College of Graduate Studies. She has been teaching technique and choreographing classical and contemporary ballets for more than thirty years.

Janine received her B.F.A. in Modern Dance from the University of the Arts in 1986 where she studied with Pat Thomas, Judith Jamison, Milton Meyers, and Ruth Andrien to name a few. In the early 1980's, Janine was a scholarship student at the Martha Graham School under Martha Graham, Diane Gray, Kevin Keenan, Yuriko, Pearl Lang, Peggy Lyman, Ethel Winter, Jacqueline Bulglisi, Don Foreman, Marianne Bachmann, and Armgard Von Barteleben. While in New York, Janine danced with the Pearl Lang Dance Company and appeared in the cast of Ms. Lang's "The Beloved", filmed at Brooklyn College. Janine also worked with Lynne Lesniak and Dancers, an offshoot of the Alwin Nikolai Company.

In addition to her studies at the Graham School in New York, Janine received a scholarship to the Peridance Center where she studied with Igal Perry, Miguel Moore and Zvi Gottheiner. Independently, Janine studied under Finis Jhung, David Howard and Madame Gabriella Darvash (Kirov technique). She also worked with Kathy Grant in New York to learn the Pilates method. During this time, and as a member of Philadelphia Dance Theatre, Janine was chosen to dance the solo role of Doris Humphrey's, "The Call and Breath of Fire", and was personally coached by Ernestine Stodelle for the role.

In the fall of 1990, Janine was one of two Americans accepted to The Royal Academy of Dancing, London, where she earned her Elementary Executant Certification and her Pre-Elementary Teaching Certification. Both of these prestigious certifications are recognized in 52 countries worldwide. In 1991, Janine founded The Professional School (TPS) in Turnersville, NJ, and directed the school through 2002. TPS was a technique-based studio training many of high school seniors to win college scholarships. Several TPS graduates won the University of the Arts' Presidential Merit Scholarship worth $20,000. Janine has been a frequent guest lecturer at The University of the Arts and also received their prestigious Silver Star Alumni Award in 1996. The Silver Star Alumni award has been bestowed upon nearly 100 graduates of the University's College of Art and Design and College of Performing Arts. The honorees are selected because they are role models and represent educational and artistic excellence that the University's faculty works hard to achieve.

Janine was a visiting guest artist for the Black Rock Dance Company in Reno, Nevada, where she created new works and taught master classes. In addition to her regular instructional post at Eastern University, Janine was recently added to the Summer Intensive faculty of DeSales University.

Janine is an active member of the International Association of Dance Medicine and Science and was recently added to their Peer Review Board, Poster Judging Committee and Education Committee. Janine also is a member of PAMA (Performing Arts Medicine Association) and is currently earning her PhD (ABD) in Dance Medicine and Science from The University of Wolverhampton in the United Kingdom. Janine is excited to be a syndicated writer for The Dance Journal. The column aims to focus on training protocols, injury prevention and general information on dancer wellness. In addition, the column will provide a resource page for dancers who wish to seek medical care, specialty training or somatic therapies from local physicians and practitioners. Janine is passionate about teaching solid technique grounded in sound anatomic and biomechanical principles at a university level.

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