Heel P!, Plantar Fascitis

Question 1

What is Plantar Fasciitis?

Answer 1

Heel pain that results from pathology
- A painful condition due to repetitive overload of the tissue

Most common condition treated by healthcare providers

Question 2

What is the most common location for those with heel pain due to Plantar Fasciitis?

Answer 2

At the insertion of the Central Band of the Plantar Fascia at the Medial Plantar Tubercle of at the medial heel

• less commonly individuals may present with the pai located along the mid portion of the central band, just prior to its splitting into the 5 slips that go to the toes

Question 3

What are the Risk Factors for those with Plantar Fasciitis?

Answer 3

• BMI > 30
• Mechanical Overload
  -Running
  -Prolonged standing activities
• Abnormal foot posture
• Decreased ankle DF

Question 4

What is the DD for Plantar Fasciits?

Answer 4

• Inflammatory Spndyloarthropathy
• Fat Pad syndrome
  -Calcaneal stress fracture
• Tumors
• Infection
• Primary Neuropathic mechanisms
  -S1 Radiculopathy
  -Tarsal tunnel syndrome
  -Lateral Plantar nerve impingement

Question 5

With patients with Plantar Fasciitis, what may you hear in the history?

Answer 5

• Plantar heel pain
  -1st step after inactivity or with prolonged weight bearing
• Recent increase in physical activity/demand

Question 6

With patients with Plantar Fasciitis, what may you find in the Obervation?

Answer 6

• Abnormal foot posture (Foot Posture Index -6)
  -Supination/Pronation/Weak foot intrinsics
• Leg Length Discrepancy

Question 7

With patients with Plantar Fasciitis, what may you find in the ROM Testing?

Answer 7

• A/PROM limited DF
  -limited 1st MTP extension
• Mid-Range Isometric Testing
  -Strong/Pain-Free

Question 8

With patients with Plantar Fasciitis, what examination findings may you find with palpations?

Answer 8

• Localized pain at medial plantar tubercle of calcaneus
• Midportion of central band

Question 9

With patients with Plantar Fasciitis, what examination findings may you find with Special Test?

Answer 9

• (+) Windlass Test
• (-) Neuro Finding
  -Tinel’s at Tarsal Tunnel
  -DF-Eversion Test

Question 10

What can be done for interventions for Plantar Fasciitis?

Answer 10

Strong Evidence
- Therapeutic Exercise
-Plantar Fascia Specific Stretch
-Gastroc/Soleus Stretch
- Manual Therapy
- Taping
- Night Splints

Moderate Evidence
- Low level laser
- Dry needling
- Strengthening/Neuromuscular re-education