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MSK II - FOOT and ANKLE > Foot and Ankle- Plantar Fasciopathy > Flashcards

Foot and Ankle- Plantar Fasciopathy Flashcards

1
Q

What is plantar fasciopathy also known as?

A

aka plantar fasciitits and heel pain

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2
Q

What is the prevalence of plantar fasciopathy?

A

MOST common foot condition

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3
Q

What are risk factors for plantar fasciopathy?

A
  • increased PF ROM
  • High BMI
  • running and work related prolonged WBing with poor shock absorption
  • impaired 1st MTP extension
  • increased age
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4
Q

Why is increase PF ROM a risk factor for plantar fasciopathy?

A
  • indicated ankle instability and resulting excessive pronation
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5
Q

What does impaired 1st MTP ext do to be a risk factor for plantar fasciopathy?

A
  • reduces potential energy of fascia
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6
Q

What are some unclear risk factors for plantar fasciopathy?

A
  • tendinopathy origins
  • decreased DF
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7
Q

What are some tendinopathy origins that are a risk factor for plantar fasciopathy?

A
  • excessive dynamic pronation
  • excessive standing calcaneal EV
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8
Q

What can decreased DF contribute to that can be a risk factor for plantar fasciopathy?

A
  • excessive pronation!
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9
Q

What are the three bands of the fascia involved with plantar fasciopathy?

A

3 bands
- Medial
- Central- originates on medial tubercle
- Lateral

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10
Q

Where does the plantar fascia insert?

A

Inserts on all proximal
phalanges

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11
Q

How does the plantar fascia assist with gait?

A

through “windlass effect” that is potential energy developed by normal foot and ankle motion

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12
Q

What structures are involved with plantar fascipathy?

A
  • foot intrinsic muscles
  • Heel (fat) pad innervated by tibial nerve
  • Achilles tendon fibers connect with plantar fascia
  • Medial and Lateral plantar nerves
  • Bone spurring
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13
Q

When is bone spurring observed?

A

With and WITHOUT plantar fascipathy

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14
Q

What are better indicators of plantar fasciopathy than bone spurs?

A
  • plantar fascia thickening (sounds like tendinosis, filling with non-collagen matrix)
  • Fat pad thinning
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15
Q

What is the etiology/pathomechanics of plantar fascipathy?

A

= tendinopathy origins

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16
Q

What are some functional questionnaires for plantar fasciopathy?

A
  • FAAM (foot and ankle ability measure)
  • FHSQ (foot health status questionnaire)
  • FFI (foot function index)
  • LEFS (lower extremity functional scale)
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17
Q

What is the onset of plantar fasciopathy typically?

A
  • often gradual onset of heel pain after recent increase in WBing activity
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18
Q

Where is the heel pain with plantar fasciopathy?

A

medial>central heel pain

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19
Q

When is the heel pain especially apparent plantar fasciopathy?

A

especially after a period of inactivity such as the first step in the morning

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20
Q

What can improve the heel pain with plantar fasciopathy?

A

may improve with mild to moderate activity

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21
Q

What makes the Heel pain worse with plantar fasciopathy?

A
  • at the end of the day or after prolonged WBing
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22
Q

What are signs of plantar fasciopathy we can find with observation?

A
  • thickened plantar fascia
  • possible static calcaneal EV
  • possible asymmetric and antalgic gait
  • possible excessive dynamic pronation
  • Possible impaired LQ control
23
Q

What are some signs of plantar fasciopathy in ROM that we may find?

A
  • Possible pain and limitation with DF and 1st MTP ext
  • Limited DF with knee extended
  • Limited 1st MTP extension
24
Q

What are some signs of plantar fasciopathy in resisted/MMT?

A
  • possible weak and painful toe flexors
25
Q

What is a special test for plantar fasciopathy?

A

lack of plantar fascia tautness

26
Q

What will we find with palpation with plantar fasciopathy?

A
  • TTP over medial calcaneal insertion > central heel pain
27
Q

What are some different dx with plantar fasciopathy?

A
  • tarsal tunnel syndrome, from medial and lateral plantar nerve syndrome
  • fibrous tumor
  • calcaneal apophysitis
  • radiculopathy
28
Q

What are some pt ed topics we can use with plantar fasciopathy?

A
  • soreness rule
  • load management
  • movement cues
  • weight losss
  • cushioned surfaces with prolonged standing
29
Q

What are some PT Rx for plantar fasciopathy?

A
  • pt ed
  • POLICED
  • Modalities
  • MT
  • taping
  • orthotics
  • proper footwear
  • night splint
  • MET
30
Q

What modalities provide short term pain relief with plantar fasciopathy?

A
  • Iontophoriesis with dexamethasone or acetic acid provided short term pain relief
  • LASER and phonophoresis
31
Q

What should we know about shockwave therapy for plantar fasciopathy?

A
  • NOT more effective than stretching and US
  • Potential for adverse effects
32
Q

What modality is NOT recommended for plantar fasciopathy?

A
  • US/Electrotherapy
33
Q

What is manual therapy for with plantar fasciopathy?

A
  • normalize mobility and muscle length for pain, ROM, and function
34
Q

What should we know about JM for plantar fasciopathy?

A

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

35
Q

What should we know about stretching of the calf and plantar fascia for plantar fasciopathy?

A
  • 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
36
Q

What should we know about JM and STM for plantar fasciopathy?

A

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

37
Q

What should we know about taping for plantar fasciopathy?

A
  • short term relief for pain and function with anti-pronation/arch taping
  • kinesio-tape to gastroc = unclear benefits
  • NO support for persistent symptoms
38
Q

What population is an orthotic indicated in for plantar fasciopathy?

A
  • those who benefit with arch taping
39
Q

Are prefabricated or custom orthotics more effective?

A

equally effective

40
Q

What is the benefit of plantar fasciopathy in comparison to other options?

A
  • orthotic better than heel pad
41
Q

What do orthotics do for plantar fasciopathy as a whole?

A
  • improve pain and function with pronation control and cushioning
42
Q

Are orthotics useful for persistent plantar fasciopathy?

A
  • YES
43
Q

What should we know about proper footwear for plantar fasciopathy?

A
  • 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
44
Q

What is the FPI for proprer footwear with plantar fasciopathy?

A
  • static standing method, the foot posture index (FPI), of perscribing in-shoe pronation control systems based on foot type
45
Q

What should we know about the FPI?

A
  • overly simplistic
  • potentially injurous
  • especially problematic with excessive pronators
  • several limitations in the study
  • inadequate representation of dynamic function
46
Q

How long should you wear a night splint with plantar fasciopathy?

A
  • wear between 1 and 3 months with consistent first
  • improves impaired DF due to shortened PFs
47
Q

What should we know about dry needling with plantar fasciopathy?

A
  • NOT recommended
48
Q

What is MET primarily for with plantar fasciopathy?

A

fascial proliferation

49
Q

What is the tendinosis perscription for plantar fasciopathy?

A
  • like Achilles tendinosis exercises with one difference - hyperextend toe with two different heel raises
50
Q

What specific exercises should we incorporate with plantar fasciopathy?

A

pronation control exercises, particularly of tibialis posterior, and other LE muscles that may contribute to impaired LQ control and excessive pronation

51
Q

What is the prognosis with plantar fasciopathy?

A
  • 80% resolution of symptoms
52
Q

What should we know about NSAIDs for plantar fasciopathy?

A

no clinical traials

53
Q

What should we know about cortisone injections for plantar fasciopathy?

A
  • limited and short-term supportive evidence
  • benefits don’t outweigh the risks including fascial ruptures
54
Q

What kind of surgeries can be done for plantar fasciopathy?

A
  • fasciotomy: cut to relieve fascial tension
  • excision of fibroma

MSK II - FOOT and ANKLE (6 decks)

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