Upload
karla-suzatte-dasargo
View
651
Download
4
Embed Size (px)
DESCRIPTION
A power point presentation of plantar fasciitis.
Citation preview
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
Muscles & ligaments of the Sole of the Foot
Muscles & ligaments of the Sole of the Foot
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
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.
Biomechanics of Plantar fascia
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.
Biomechanics of Plantar fascia
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.
Biomechanics of Plantar fascia
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).
The Effects of Massage Therapy in Treatment of Chronic Plantar Fasciitis: a Case Study By Glenda Keller RMT BPHE
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 Effects of Massage Therapy in Treatment of Chronic Plantar Fasciitis: a Case Study By Glenda Keller RMT BPHE
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.
The Effects of Massage Therapy in Treatment of Chronic Plantar Fasciitis: a Case Study By Glenda Keller RMT BPHE
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.
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
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).
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
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