plantar fasciitis- my second oral revalida presentation

Plantar FasciitisKarla Suzatte M. Dasargo

DDC- PT Intern’14

Plantar Fasciitis

It is also referred to as plantar heel pain syndrome, heel spur syndrome, or painful heel syndrome.

Definition

It is a painful inflammatory process of the plantar fascia, the connective tissue or ligament on the sole of the foot.

Description

It is an overload injury usually associated with biomechanical abnormalities.

Etiology Deterioration of the plantar fascia. Mechanical overload of the plantar fascia Damaged by direct impact or repetitive trauma Damage to other supporting structures

Epidemiology

most common cause of pain in the inferior heel Estimated to account for 11 to 15 % of all foot symptoms requiring professional care among adults. affects 15-20% of runners

Epidemiologycommon among military personnel. ages of 40 and 60 years in the general populationWomen>Men65% non-sports demographics are over-weight70% unilat. involvement

Anatomy

Footsupports the body weightprovides leverage for walking and running. constructed in the form of archesserves as a resilient spring to absorb shocks.

The Sole of the Foot - skin

The skin of the sole of the foot is thick and hairless.Shows a few flexure creases at the sites of skin movement.Sweat glands are present in large numbers.

Deep Fascia a triangular thickening of the deep fascia that protects the underlying nerves, blood vessels, and muscles.Apex: medial and lateral tubercles of the calcaneum. Base: divides into five slips that pass into the toes.

Deep Fascia

Have indirect relationship with Achilles Tendon, if toes are dorsiflexed plantar fascia tightens via WINDLASS MECHANISM

Muscles & ligaments of the Sole of the Foot

Arteries of the Sole of the Foot

Medial Plantar Artery

Lateral Plantar Artery

Nerves of the sole of the Foot

Sensory nerve supply: medial calcaneal branch of the tibial nerve which innervates the medial side of the heelbranches from the medial plantar nerve: innervate the medial 2/3 of the solebranches from the lateral plantar nerve: innervate the lateral 1/3 of the sole.

The Arches of the Foot

Bones of the Arches

Medial longitudinal arch - calcaneum, the talus, the navicular bone, the 3 cuneiform bones, and the 1st 3 metatarsal Lateral longitudinal arch - calcaneum, the cuboid, and the 4th and 5th metatarsal bones

Bones of the Arches

The Bones of the Arches

Transverse arch - metatarsal bones and the cuboid and the three cuneiform bones.

Biomechanics of Plantar fascia


It contributes to support of arch of the foot by acting as a tie-rod, where it undergoes tension when the foot bears weight. It carries as much as 14% of the total load of the foot.


Complete rupture or surgical release of the plantar fascia leads to a ↓ in arch stiffness and a significant collapse of the longitudinal arch of the foot.

↑ both stress in the plantar ligaments and plantar pressures under the metatarsal heads.


Has an important role in dynamic function during gait. continuously elongated during the contact phase of gait.reaches a maximum of 9% to 12% elongation between mid-stance and toe-off.plantar fascia behaves like a spring.


The plantar fascia has a critical role in normal mechanical function of the foot, contributing to the "windlass mechanism".

Pathology

Pathology

The site of abnormality is typically near the site of origin of the plantar fascia at the medial tuberosity of the calcaneus. It is more likely caused by degeneration or weakening of the tissue.

Pathology

This process probably begins with small tears that occur during activity and that, in normal circumstances, the body simply repairs, strengthening the tissue as it does. The small tears don’t heal. They accumulate

Most common Signs & Symptoms

Pain TendernessAntalgic gait

Examination & Diagnostic procedures

Examination & Diagnostic procedures

Ocular inspection X-rayBone scans MRILaboratory tests

Differential diagnosis

Management

Medical and Surgical

Surgery is considered only after 12 months of aggressive nonsurgical treatment. Surgical plantar fasciotomy with or without heel spur removal. Gastrocnemius recession

Pharmacology

NSAIDs medication Cortisone injections.

Physical Therapy More than 90% of patients with plantar fasciitis will improve within 10 months of starting simple treatment methods.

General MeasuresRestIce

(20 min; 3-4x/day)

Taping

No studies have adequately evaluated the effectiveness of taping or strapping for managing plantar fasciitis.

Shoe inserts

Night splints

Stretching

ModalitiesTherapeutic ultrasound Extracorporeal shockwave therapy (ESWT).

Massage

Deep tissue MassageMFR

Evidence –based practices

Indian Journal of Physiotherapy and Occupational Therapy Effectiveness of Myofascial Release in treatment of Plantar Fasciitis: A RCT Author(s): Suman Kuhar, Khatri Subhash, Jeba Chitra; Vol. 1, No. 3 (2007-07 - 2007-09)

Purpose of study: To find out the effectiveness of myofascial release in treatment of plantar fasciitis.

Materials and Methods: 30 subjects with the clinical diagnosis of chronic plantar Group A (control) received therapeutic ultrasound(1 MHz, 1

Watt/cm2,pulsed mode 1:4,5 minutes), contrast bath for 20 minutes, foot intrinsic muscles strengthening exercises, plantar fascia stretching exercises

group B (experimental) received conventional treatment as group A added with myofascial release for 15 minutes for 10 consecutive days.

Indian Journal of Physiotherapy and Occupational Therapy Effectiveness of Myofascial Release in Treatment of Plantar Fasciitis: A RCT Author(s): Suman Kuhar, Khatri Subhash, Jeba Chitra; Vol. 1, No. 3 (2007-07 - 2007-09)

The outcome was assessed in terms of VAS and Foot Function Index.

Results: In this study we found that there was significant change in pain relief as per the VAS score (p=0.000) and functional ability as per Foot Function Index (p= 0.024).

Conclusion: It is concluded that myofascial release is an effective therapeutic option in the treatment of plantar fasciitis.

The Effects of Massage Therapy in Treatment of Chronic Plantar Fasciitis: a Case Study By Glenda Keller RMT BPHE

Treatment plan the chronic stage of plantar fasciitis is treated with a deep moist

heat application before stretching the plantar fascia (Rattray, 2000).

Fascial techniques are applied to gastrocs and soleus with cross hand spreading and finger tip spreading (Rattray, 2000).

Effleurage and petrissage are used for shortened hypertonic gastrocnemius and soleus, more specifically wringing, fingertip and palmar kneading (Rattray, 2000).

Trigger points and taut bands are successfully treated using repetitive muscle stripping (Travell, 1992).


Swedish techniques such as thumb kneading are used on the intrinsic muscles of the foot (Travell, 1992).

Deep transverse friction can be used directly on the plantar fascia to stimulate Fibroblast activity and tissue healing from chronic overuse (Lowe, 2003).

Cross-fiber frictions are applied for adhesions in the plantar fascia, particularly near the calcaneal attachments (Oloff, 1994).

Oloff et. al. state that the techniques (performed in the treatment of plantar fasciitis) should be followed by icing and stretching (Oloff, 1994).

Increasing flexibility of the calf muscles is particularly important in the treatment of plantar fasciitis (Young, 2000).

Repetitive effleurage is used on the posterior leg and foot muscles to increase local circulation and remove metabolites. (Rattray, 2000).


The Treatment Plan in this case was two 30-minute massage therapy session per week for four weeks

Deep moist heat was applied to the plantar aspect of the affected foot in the form of a hydro collator pack for five minutes while myofascial release techniques combined with general Swedish massage techniques were applied to the upper and lower leg. Palmar and fingertip spreading myofascial techniques of the posterior leg were performed before doing Swedish techniques (including thumb kneading and repetitive stripping). Trigger point therapy was applied if a trigger point was found during that treatment.


ConclusionMassage therapy is beneficial in treating clients with chronic plantar fasciitis. This treatment plan combined traditional massage therapy techniques with myofascial release techniques

Randomized Controlled Trial of Calcaneal Taping, Sham Taping, and Plantar Fascia Stretching for the Short-Term Management of Plantar Heel Pain Matthew R. Hyland, PT, MPA, CSCS1 Alisa Webber-Gaffney, PT, OTR/L2 Lior Cohen, PT3 Steven W. Lichtman, EdD, FAACVPR4

Study Design: Prospective, experimental, randomized, single-factor, pretest/posttest design.

Objectives: To examine the effects of a calcaneal and Achilles-tendon–taping technique, utilizing only 4 pieces of tape and not involving the medial arch, on the symptoms of plantar heel pain.

Background: Plantar fasciitis is one of the most common causes of heel and foot pain. Physical therapists have applied many techniques in an attempt to relieve the symptoms of plantar heel pain, including various taping methods for which there is little existing evidence.


Methods and Measures: Subjects (n = 41) were randomly assigned into 4 groups: (1) stretching of the plantar fascia, (2) calcaneal taping, (3) control (no treatment), and (4) sham taping. A visual analog scale (VAS) for pain and a patient-specific functional scale (PSFS) for functional activities were measured pretreatment and after 1 week of treatment (posttreatment).


Results: A significant difference was found post-treatment among the groups for the VAS (P.001). Specifically, significant differences were found between stretching and calcaneal taping, stretching and control , calcaneal taping and control, and calcaneal taping and sham taping. No significant difference among groups was found for posttreatment PSFS.

Conclusions: Calcaneal taping was shown to be a more effective tool for the relief of plantar heel pain than stretching, sham taping, or no treatment.

Conservative therapy for plantar fasciitis: a narrative review of randomized controlled trials Kent Stuber, BSc, DC* Kevyn Kristmanson, BSc, DC**

Taping of the foot provides medial arch support for plantar fasciitis patients and potentially removes strain from the plantar fascia.

No data on the effectiveness of the taping was given; therefore the specific effects of taping cannot be determined.

INITIAL EVALUATION

plantar fasciitis- my second oral revalida presentation

Education