PLANTAR FASCIITIS.
DEFINITION
– Plantar fasciitis is defined as pain on plantar surface of heel and is one of the commonest cause of posterior heel pain.
– Plantar fascia is extends from the plantar surface of the calcaneum to the metatarsal heads and it provides dynamic shock absorption.
• Causes
– Pes cavus or pes planus deformity
– Flat foot
– In old patients , due to excessive walking in non supportive footwear.
– obesity
– inflammation of plantar aponeurosis
– Weight bearing , hopping, jumping or running
• Clinical features
– Pain in heel ( more in morning but gradually reduces when patient takes few steps.)
– Pain increases due to prolonged standing and walking.
– Tenderness ( At inner part of calcaneum )
– Stretching of plantar fascia reproduce pain
• Radiography
√ X-ray : shows sharp bony spur projecting forwards from calcaneal tuberosity
– AP view, lateral view , oblique view.
√ Ultrasound
• Clinical test
– Passive stretching of toes increases the pain in heel.
• Treatment
– Measures should be taken to reduce pain and inflammation, taping, Temparature or percutaneous shoe orthoses , heel cushion and weights management etc.
– Measures taken to improve neurodynamics of tibial nerve , active calf muscle stretching.
– Joint moblization along with talocalcaneal glides
– Muscle strengthening
– Hydrocortisone
– If no response : surgery is indicated
– Cryo, NSAID’s , stretching and self massage
– Intrinsic muscle strengthening is done
– Silicon gel heel pad
– Footwear with arch support should be given
– night splints are used
– Soft tissue therapy
– Plantar fasciectomy.
• Rehabilitation
1) Strength training
– More effective treatment of plantar fasciitis is high load strength training.
– Helpful in quick reduction of pain and functional improvement.
2) Stretching
– Stretching is done by crossing patient’s affected leg over the other leg and using fingers across first base of toes to apply pressure into toe extension until the strech is felt along the plantar fascia.
– In standing Achilles tendon stretching can be performed.
3) Mobilization and manipulation
– Helps in reducing pain and relieves symptoms
– Example:
√ Posterior talocrural joint moblization Nd subtalar joint distrcation manipulation
4) Posterior night splints
– This splint helps in maintaining the ankle in Dorsiflexion and toe in extension.
5) Taping combined with acetic acid iontophoresis.
6) Foot orthoses
– It produces small reduction and small benifits in function ( short term benefits )
– but they do not have long-term effects.
7) Taping
– Place the tape on gastrocnemius and plantar fascia for an entire week.
