Plantar Fasciitis

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Plantar Fasciitis

• Dick Evans PT,OCS

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Plantar Fascia

• Thick broad connective tissue that spans the arch
  of the foot
• Originates on the medial tubercle of the
  calcaneus and inserts onto the proximal phalanges
  and flexor tendon sheaths
• Forms longitudinal arch of the foot and functions
  as a shock absorber
• Supports the arch as weight is transferred over
  the foot from heel strike to toe off

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Fasciitis???

• A degenerative condition that may or may not be
  associated with inflammatory changes in the
  tissues
• Pain may be caused by repetitive micro trauma to
  the fascia

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Frequency

• Occurs in 10 of runners and may be associated
  with training errors
• Accounts for 11-15 of all foot symptoms
  requiring medial care

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Symptoms

• Classic presentation heel pain in the morning
  when first rising from bed
• May improve through the day but tends to hurt
  again by afternoon and evening.
• Reoccurs upon standing after prolonged sitting
• Worse with walking barefoot and walking up stairs

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Physical Exam

• Tenderness to palpation on the anteromedial
  aspect of the heel
• Ankle dorsiflexion limited by calf tightness
• Pain increased by toe extension or by standing on
  toes

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Risk Factors

• Obesity
• Occupation requiring prolonged standing
• Pes planus or cavus
• Calf tightness
• Toe runners, running up hills or in sand
• Rapid change in activity level intensity or
  duration
• Lack of warm up or cold weather

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Differential Diagnosis

• Tarsal tunnel
• Bone bruise or heel contusion
• Sever disease
• Calcaneal stress fracture
• Fat pad atrophy / central heel pain
• Inflammatory arthropathies
• Neuropathic pain
• Retrocalcaneal bursitis
• Achilles insertional pain

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Prognosis

• 80 are better in 12 months
• Surgical intervention is rare

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Treatment

• Activity modification
• Shoe inserts / orthotics / taping / supportive
  shoes
• Night splints
• Stretching program arch, calf, soft tissue
  massage, ice
• Modalities iontophoresis, ultrasound
• NSAIDS
• Corticosteroid injections
• Shock wave therapy

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Treatment Plan

• Take away source of irritation boot / crutches,
  if needed
• Stretching arch and calf and forefoot
• Ice
• Soft tissue massage gentle to start, advance to
  aggressive as tolerated
• Open chain strengthening manual, bands to both
  ankle and forefoot

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Treatment Plan

• Advance to closed chain strengthening and
  balance work as symptoms allow
• Brisk walking, cross training, pain free
• Add light impact
• Phase return to run program, watch running form
• Gradual progressions 10 rule
• Sports specific return to activities

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THANKS