Foot and Ankle- Plantar Fasciopathy Flashcards
What is plantar fasciopathy also known as?
aka plantar fasciitits and heel pain
What is the prevalence of plantar fasciopathy?
MOST common foot condition
What are risk factors for plantar fasciopathy?
- increased PF ROM
- High BMI
- running and work related prolonged WBing with poor shock absorption
- impaired 1st MTP extension
- increased age
Why is increase PF ROM a risk factor for plantar fasciopathy?
- indicated ankle instability and resulting excessive pronation
What does impaired 1st MTP ext do to be a risk factor for plantar fasciopathy?
- reduces potential energy of fascia
What are some unclear risk factors for plantar fasciopathy?
- tendinopathy origins
- decreased DF
What are some tendinopathy origins that are a risk factor for plantar fasciopathy?
- excessive dynamic pronation
- excessive standing calcaneal EV
What can decreased DF contribute to that can be a risk factor for plantar fasciopathy?
- excessive pronation!
What are the three bands of the fascia involved with plantar fasciopathy?
3 bands
- Medial
- Central- originates on medial tubercle
- Lateral
Where does the plantar fascia insert?
Inserts on all proximal
phalanges
How does the plantar fascia assist with gait?
through “windlass effect” that is potential energy developed by normal foot and ankle motion
What structures are involved with plantar fascipathy?
- foot intrinsic muscles
- Heel (fat) pad innervated by tibial nerve
- Achilles tendon fibers connect with plantar fascia
- Medial and Lateral plantar nerves
- Bone spurring
When is bone spurring observed?
With and WITHOUT plantar fascipathy
What are better indicators of plantar fasciopathy than bone spurs?
- plantar fascia thickening (sounds like tendinosis, filling with non-collagen matrix)
- Fat pad thinning
What is the etiology/pathomechanics of plantar fascipathy?
= tendinopathy origins
What are some functional questionnaires for plantar fasciopathy?
- FAAM (foot and ankle ability measure)
- FHSQ (foot health status questionnaire)
- FFI (foot function index)
- LEFS (lower extremity functional scale)
What is the onset of plantar fasciopathy typically?
- often gradual onset of heel pain after recent increase in WBing activity
Where is the heel pain with plantar fasciopathy?
medial>central heel pain
When is the heel pain especially apparent plantar fasciopathy?
especially after a period of inactivity such as the first step in the morning
What can improve the heel pain with plantar fasciopathy?
may improve with mild to moderate activity
What makes the Heel pain worse with plantar fasciopathy?
- at the end of the day or after prolonged WBing
What are signs of plantar fasciopathy we can find with observation?
- thickened plantar fascia
- possible static calcaneal EV
- possible asymmetric and antalgic gait
- possible excessive dynamic pronation
- Possible impaired LQ control
What are some signs of plantar fasciopathy in ROM that we may find?
- Possible pain and limitation with DF and 1st MTP ext
- Limited DF with knee extended
- Limited 1st MTP extension
What are some signs of plantar fasciopathy in resisted/MMT?
- possible weak and painful toe flexors
What is a special test for plantar fasciopathy?
lack of plantar fascia tautness
What will we find with palpation with plantar fasciopathy?
- TTP over medial calcaneal insertion > central heel pain
What are some different dx with plantar fasciopathy?
- tarsal tunnel syndrome, from medial and lateral plantar nerve syndrome
- fibrous tumor
- calcaneal apophysitis
- radiculopathy
What are some pt ed topics we can use with plantar fasciopathy?
- soreness rule
- load management
- movement cues
- weight losss
- cushioned surfaces with prolonged standing
What are some PT Rx for plantar fasciopathy?
- pt ed
- POLICED
- Modalities
- MT
- taping
- orthotics
- proper footwear
- night splint
- MET
What modalities provide short term pain relief with plantar fasciopathy?
- Iontophoriesis with dexamethasone or acetic acid provided short term pain relief
- LASER and phonophoresis
What should we know about shockwave therapy for plantar fasciopathy?
- NOT more effective than stretching and US
- Potential for adverse effects
What modality is NOT recommended for plantar fasciopathy?
- US/Electrotherapy
What is manual therapy for with plantar fasciopathy?
- normalize mobility and muscle length for pain, ROM, and function
What should we know about JM for plantar fasciopathy?
mixed benefits
- case series improvement with pain and function along with orthoses and MET
- helpful but no additional benefit to stretching
- may need to improve impaired DF and 1st MTP ext
What should we know about stretching of the calf and plantar fascia for plantar fasciopathy?
- calf stretching alone = no diffeent in DF and pain improvements
- calf vs. plantar fascial stretching
> both improved pain
> more reduction with fascia stretching (52% vs 22%) - be cautious as mentioned
What should we know about JM and STM for plantar fasciopathy?
BEST study as of 2017
- Deep massage to gastroc and plantar fascia
- rear foot JMs
- impairment based JM to hip and knee
SHORT AND LONG TERM BENEFITS
What should we know about taping for plantar fasciopathy?
- short term relief for pain and function with anti-pronation/arch taping
- kinesio-tape to gastroc = unclear benefits
- NO support for persistent symptoms
What population is an orthotic indicated in for plantar fasciopathy?
- those who benefit with arch taping
Are prefabricated or custom orthotics more effective?
equally effective
What is the benefit of plantar fasciopathy in comparison to other options?
- orthotic better than heel pad
What do orthotics do for plantar fasciopathy as a whole?
- improve pain and function with pronation control and cushioning
Are orthotics useful for persistent plantar fasciopathy?
- YES
What should we know about proper footwear for plantar fasciopathy?
- shoe rotation
- rocker bottom shoe
- little influence on injury with running shoes in military personnel when based on the shape of the plantar foot surface
What is the FPI for proprer footwear with plantar fasciopathy?
- static standing method, the foot posture index (FPI), of perscribing in-shoe pronation control systems based on foot type
What should we know about the FPI?
- overly simplistic
- potentially injurous
- especially problematic with excessive pronators
- several limitations in the study
- inadequate representation of dynamic function
How long should you wear a night splint with plantar fasciopathy?
- wear between 1 and 3 months with consistent first
- improves impaired DF due to shortened PFs
What should we know about dry needling with plantar fasciopathy?
- NOT recommended
What is MET primarily for with plantar fasciopathy?
fascial proliferation
What is the tendinosis perscription for plantar fasciopathy?
- like Achilles tendinosis exercises with one difference - hyperextend toe with two different heel raises
What specific exercises should we incorporate with plantar fasciopathy?
pronation control exercises, particularly of tibialis posterior, and other LE muscles that may contribute to impaired LQ control and excessive pronation
What is the prognosis with plantar fasciopathy?
- 80% resolution of symptoms
What should we know about NSAIDs for plantar fasciopathy?
no clinical traials
What should we know about cortisone injections for plantar fasciopathy?
- limited and short-term supportive evidence
- benefits don’t outweigh the risks including fascial ruptures
What kind of surgeries can be done for plantar fasciopathy?
- fasciotomy: cut to relieve fascial tension
- excision of fibroma
