OH MY PAINFUL

FOOT!!!
PLANTAR FASCIITIS
INTRODUCTION

 Arches of the foot help in fast walking, running, jumping, weight bearing
and in providing upright posture.

 Arches are supported by intrinsic and extrinsic muscles of the sole in

addition to ligaments, aponeurosis and shape of the bones.
 DEFINITION

 pain caused by degenerative irritation at the insertion of the

plantar fascia on the medial process of the calcaneal tuberosity

 Various terms have been used to describe plantar fasciitis,

including jogger’s heel, tennis heel, and policeman’s heel

 A misnomer, this condition is sometimes referred to as heel

spurs by the general public
ANATOMY
 thickened fibrous aponeurosis
that originates from the medial
tubercle of the calcaneus, insert
into the deep, short transverse
ligaments of the metatarsal
heads
 plantar fascia is made up of 3
distinct parts: the medial, central,
and lateral bands.
 The central plantar fascia is the
thickest and strongest section,
and this segment is also the most
likely to be involved with plantar
fasciitis
 acts like a windlass mechanism to
provide tension and support through
the arch.
 It functions as a tension bridge in the
foot, providing both static support
and dynamic shock absorption
ETIOLOGY

Main cause : Biomechanical dysfunction

 often unclear and may be multifactorial.

 Due to its high prevalence in athletes (runners) it is best postulated to be caused

by repetitive microtrauma.

 Possible risk factors include obesity, occupations requiring prolonged standing and
weight-bearing, and heel spurs.

 Other risk factors may be broadly classified as either extrinsic (training errors and
equipment) or intrinsic (functional, structural, or degenerative).
 Pathophysiology
 pathology is traditionally believed to be secondary to the development of
microtrauma (microtears), with resulting damage at the calcaneal-fascial
interface

 The term fasciitis may, in fact, be something of a misnomer, because the disease
is actually a degenerative process that occurs with or without inflammatory
changes, which may include fibroblastic proliferation

“Time to abandon the “tendinitis” myth

Painful, overuse tendon conditions have a non-inflammatory
pathology
K M Khan, assistant professor
Department of Family Practice, University of British Columbia,
Vancouver, Canada V6T 1Z3, BMJ 2002 Mar 16
PRESENTATION

 history of intense sharp heel pain with the first couple of steps in the
morning or after other long periods without weight-bearing primarily on
the plantar surface
EXAMINATION
 palpating the plantar-medial calcaneal tubercle at the site of plantar
fascial insertion to the heel bone

 maneuvers that may reproduce the pain of plantar fasciitis include

passive dorsiflexion of the toes, which is sometimes called the windlass
test, and having the patient stand on the tiptoes

windlass test
patient stand on the tiptoes
WORKUPS
 laboratory studies are not needed in the workup of plantar fasciitis

 Radiographs typically are not necessary for diagnosing plantar fasciitis. However, to
rule out a bony tumor or fracture, always consider obtaining at least a plain
radiograph.

 may reveal a plantar heel spur

 spur forms in a manner consistent with Wolff’s law—that is, “form follows
function.”
 not the cause of the symptoms but, rather, a sequela of the process.
however, many patients with plantar fasciitis have no heel spur
TREATMENT APPROACH

TRADITIONAL THERAPEAUTIC EFFORTS

 ICE
 NON STEROIDAL ANTI-INFLAMMATORY DRUGS
(NSAIDS)
 REST AND ACTIVITY MODIFICATION

OTHERS :

 PHYSIOTHERAPY
PHYSIOTHERAPY TREATMENT
GOALS:

SHORT TERM GOALS:

• To reduce pain
• To reduce swelling
• To reduce
tenderness
LONG TERM GOALS:
• To normalize the
function
• To improve flexibility
• To maintain balance
PHYSIOTHERAPY

Extracorporeal Shock-Wave Therapy

 mechanism of action being to

 (1) stimulate blood flow for a beneficial immune response
 (2) to stimulate healing
 (3) shut down the neuronal pain pathways through the pulses hitting
the affected nerves
Splints and Orthoses

NIGHT SPLINTS

• splints maintain a neutral 90° foot-leg angle and provide constant passive stretching
of the Achilles tendon and plantar fascia
Shoe modifications and orthotics

 supportive heel counter and stiff midsole are important components of any
shoe for those experiencing heel pain
THERAPEUTIC EXERCISES

Plantar fascia stretching exercise

Calf stretch
TRI –PLANE ACHILLES STRETCH:

ROTATIONAL PLANTAR FASCIA

STRETCH:
Patient Education

 improvement often takes many weeks or months and requires considerable effort
to maintain a heel-cord stretching program or to wear a night splint

recommendations as follows

 Wear shoes with adequate arch support and cushioned heels

 Avoid long periods of standing
 Lose weight
 Stretch the plantar fascia and warm up the lower extremity before participating
in exercise
 Do not exercise on hard surfaces
 Avoid walking barefooted on hard surfaces Avoid high-impact sports that require
a great deal of jumping (eg, aerobics and volleyball) Apply ice for 20 minutes after
repetitive impact-loading activities
 SUMMARY

• The sub actue and chronic conditions will have poor prognosis where
steroids and the surgical procedures plays the major role in management.

• orthosis are helpful for the patients with plantar facitis. Properly casted and
designed foot orthoses should be cornerstone of non surgical treatment of
sub calcaneal pain.
• The prognosis of the plantar fascitis will be better with the physiotherapy
manoveours in acute stages