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Plantar Fasciitis

By: Ryan, Mitch, Meghan and Theresa

Ryan Longley

on 7 February 2014

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Transcript of Plantar Fasciitis

Plantar Fasciitis
By: Ryan, Mitch, Meghan and Theresa
Pt 865 - "Grand Rounds" Project
repetitive strain injury
to the plantar surface of the foot
medial tubercle of the
irritation, inflammation and degeneration of the plantar fascia
to the plantar plates of the MTP joints
Overtraining or overuse
Training on unyielding surfaces
Prolonged weight-bearing activities
Aging and tissue degeneration
Weight gain
Occupation-related activity
Worn down footwear
Traumatic event (rare)
Biomechanical Imbalances
Leg length discrepancy
Tightness in gastroc, soleus, achilles
Weakness in intrinsic foot muscles, tibialis posterior
external rotation of the foot/knee
- Pes planus
- Pes cavus
Are you sure it's Plantar Fasciitis?
Soft Tissue
Achilles tendonitis
= pain is retrocalcaneal
Calcaneal stress fracture
= calcaneal swelling, warmth, tenderness
Bone bruise
= generalized pain over inferior heel after excessive weight bearing
Fat pad atrophy
= pain atrophic heel pad
Plantar fascia rupture
= intense tearing sensation on bottom of foot
Retrocalcaneal bursitis
= pain is retrocalcaneal
Abductor digiti quinti nerve entrapment
= buring in heel pad
Lumbar spine disorders
- pain radating down the leg to the heel, weakness, abnormal reflexes
Tarsal tunnel syndrome
= pain, burning sensation, and tingling on the sole of the foot
Subtalar arthritis
= heel pain is supracalcaneal
Tumors (rare)
= deep bone pain, night pain
Vascular insufficiency
= pain in muscle groups that is reproducible with exertion
Clinical Presentation
gradual onset of pain
worse in morning or periods of inactivity
pain decreases with gradual increase in activity
prior to onset, patient likely increased activity
antalgic gait: heel contact
tenderness at calcaneal tubercle
also along medial longitudinal arch
dorsiflexion due to gastroc/soleus tightness
pt knee bent to 90 in supine
PT passively DFs great toe
pt sitting with feet on stool
weight through heel and meta-tarsal heads, examiner passively DFs great toe
Windlass Test
reproduces pain at the heel or beneath the 1st MT head
relative rest, or activity modification
stretching exercises (plantar fascia, gastroc, soleus)
strengthening (intrinsic foot muscles, dorsiflexors)
cross-friction massage, deep tissue massage
joint mobilization/manipulation
low-dye taping (short-term)
orthotics, heel pads and cups
night splints

local cortisone injection
surgery (rare)
Out of Scope
may include:
plantar fasica manual tissue stretch
lateral glide of rear foot
distraction of rear foot
talocrural A-P
tib-fib A-P
cuboid manip
intertarsal mob
tib post manual stretch
knee flexion with valgus and IR
knee flex with varus and ER
patellofemoral mob
P-A hip into flex/abd/ER
IR in hip ext
significant advantage to manual rx +exercise over modalities+exercise
mobilizations depend on ax and clinical judgement
(Cleland et al. 2009)
(Cleland et al. 2009)
variation exist - supportive over the medial arch
good for short term fixes
Semi Rigid vs Custom
which is better?
has good effects when used but LOW compliance
Extracorporeal Shockwave Therapy (ESWT)
- studies show this is an effective treatment in reducing heel pain in patients with chronic plantar fasciitis

- effective at reducing morning pain as well as overall pain
- needling at acupoint PC 7
- many studies show that it is effective in diagnosing PF (measuring the thickness of the PF)
- it can also aid treatment by guiding the ESWT or steroid injections
- not much evidence for the benefits for treatment
(Haake, 2003; Malay, 2006; Wang, 2006)
(Zhang, 2009)
Home Exercise Program
Heel Trap
Heel Circles
- Place the affected foot against the wall with your heel on the ground and toes against the wall. Straighten your knee and drive your hip forward toward the wall.
- Stretches the muscles at the back of your calf, feeding slack into your plantar fascia and increasing its mobility.
- Hold for 30 seconds, two times a day.
- Imagine your big toe is a pen. Draw a picture, or spell the alphabet. Get that foot moving!

-Strengthen the muscles of the calf and warm up the plantar fascia.

- Complete this exercise every morning for 30 seconds to 1 minute, 5 times a day - Do this as much as you want.
Foot ROLL Outs
The Towel Scrunch
- Place the ball on the sole of your foot and apply pressure down. Roll the ball along your foot. Feel free to wiggle your toes throughout.

- This can be tender but it is important to loosen up the tissue.

- Roll around for 1-2 minutes per day.

*Can also be done with a frozen water bottle for pain relief.
- Using your toes, grab a towel, and pull it piece by piece toward/under your foot.

- Strengthening of internal foot muscles.

- Complete 10 reps of 3 sets. Do this everyday.
We hope this has helped you
your patients!
(Buchbinder et al., 2002)
Tibialis Posterior Strengthening
- Attach the theraband to secure object. Loop theraband around forefoot. Without moving your leg, pull theraband in away from secure object and point toes.

- This muscle supports the arch in your foot and needs to be strong to support the plantar fascia.

- Complete 10 reps of 3 sets. Do this everday.
Tightened structures don't allow for shock absorption
Full transcript