this is in regards with stretching plantar fascitis, a given HOME program to the patient…..why is the position for the knee should be in KNEE FLEXION? I was thinking it can be done in Knee extension to further stretch the plantar fascia. Please advice.

Plantar heel pain can originate from many different sources but often involves the plantar fascia notably at its insertion near the medial calcaneal tubercle or in the mid portion proximal to the metatarsal heads.

Plantar fasciitis is considered to be the most common foot condition seen in physical therapy. The average duration of a plantar heel pain episode is 6-10 months and approximately 90% of cases are treated successfully with conservative care within 6 – 12 months of symptom onset.

Mobility-directed treatments such as joint mobilization, soft tissue mobilization, neural mobilization and stretching should be considered as a first line treatment strategy for plantar heel pain if examination findings identify relevant involvement.

With stretching and neural mobilization techniques, a variety of limb and joint positioning can be employed including ankle dorsiflexion, planter flexion as well as both knee extension and flexion. For instance, the knee is kept in extension in order to stretch the gastrocnemius muscle but then is flexed in order to better isolate the soleus muscle.

Additionally, when stretching the plantar fascia itself along with the intrinsic and extrinsic toe flexors (flexor hallicus longus and flexor digitorum longus muscles) in a weight bearing position, knee flexion (however slight) is recommended in order to allow for slight tibial internal rotation and pronation of the foot which enables a deeper stretch.

Ref; Baheti N D. Jamati M K. Physical Therapy: Treatment of Common Orthopedic Conditions. 2016. Jaypee Publishers. Section 3. Lower Extremity. Chapter 15. Plantar heel pain. Table 5. Stretching and neural mobilization. Pgs 382 – 397.