Ankle & foot

Question 1

Plantar Fasciitis definition?

Answer 1

Plantar fasciitis is the result of collagen degeneration of the plantar fascia at the origin, the calcaneal tuberosity of the heel as well as the surrounding perifascial structures

Question 2

Physical Therapy Management?

Answer 2

pt.education:

Patients need to be told that the symptoms may take weeks or even months to improve (depending on circumstances of injury).
To follow the advice given eg rest from aggravating activities initially, ice, stretch.
Be aware of the importance of a home exercise plan[2]

Common treatments include: stretching and strengthening of the gastrocnemius/soleus/plantar fascia; orthotics; ultrasound; iontophoresis; night splints and joint

Strength Training. Similar to tendinopathy management, high-load strength training appears to be effective in the treatment of plantar fasciitis. High-load strength training may aid in a quicker reduction in pain and improvements in function. Level of evidence 1b[15].

Stretching consists of the patient crossing the affected leg over the contralateral leg and using the fingers across to the 1base of the toes to apply pressure into toe extension until a stretch can be felt along the plantar fascia. Achilles tendon stretching can be performed in a standing position with the affected leg placed behind the contralateral leg with the toes pointed forward. The front knee was then bent, keeping the back knee straight and heel on the ground. The back knee could then be in a flexed position for more of a soleus stretch[16].

3.Mobilizations and manipulations - decrease pain and relieve symptoms in some cases. eg

Posterior talocrural joint mobilization and subtalar joint distraction manipulation (for hypomobile talocrural joint).[17].
Ankle, subtalar and midfoot joint mobilizations[18]

4. Posterior-night splints maintain ankle dorsiflexion and toe extension, allowing for a constant stretch on the plantar fascia. Some evidence reports night splints to be beneficial but in a review by Cole et al he reported that there was limited evidence to support the use of night splints to treat patients with pain lasting longer than six months, and patients treated with a custom made night splints improved more than prefabricated night splints[19].
5. Acetic acid iontophoresis combined with taping [20]
6. Foot orthoses produce small short-term benefits in function and may also produce small reductions in pain for people with plantar fasciitis, but they do not have long-term beneficial effects compared with a sham device whether they are custom made or prefabricated. Level of evidence 1b [21]. When used in conjunction with a stretching program, a prefabricated shoe insert is more likely to produce improvement in symptoms as part of the initial treatment of proximal plantar fasciitis than a custom polypropylene orthotic device [22].
7. Taping - eg For an entire week tape placed on the gastrocnemius and the plantar fascia. [23],[24],[25]

Question 3

what is calcaneal angle?

Answer 3

also known as Calcaneal pitch.

Calcaneal pitch is an angle of the calcaneus and the inferior aspect of the foot, with different sources giving different reference points. The first line making up the angle is defined as either:

The calcaneal inclination axis, extending from the calcaneus by the inferior portion of the calcaneocuboid joint to the inferior border of the calcaneus.[1]
Tangential to the inferior distal border of the calcaneus.[2]
The second line is defined as extending from either of the two above to either of the following:

The inferior border of the head of the fifth metatarsal bone.[1]
The inferior aspect of the medial sesamoid bone.[3]
Parallel to the ground.[4]

The calcaneal pitch is an angle used mainly in the diagnosis and severity grading of flat feet and pes cavus.

Interpretation

Calcaneal pitch is increased in pes cavus, with cutoffs ranging from 20° to 32°.[5] A calcaneal pitch of less than 17° or 18° indicates flat feet.[6]