Plantar Fasciitis

Dick Evans PT,OCS

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

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

Frequency

• Occurs in 10 % of runners and may be associated with training errors

• Accounts for 11-15% of all foot symptoms requiring medial care

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

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

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

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

Prognosis

• 80% are better in 12 months

• Surgical intervention is rare

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

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

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

THANKS