Heel pain/Plantar fasciitis Flashcards
What is the evidence grade for manual therapy and what is its goal in regards to plantar fasciitis?
Grade A - Treat lower extremity joint mobility and calf flexibility, decrease pain and improve function.
What technique is being used here and what’s its purpose?
STM to the soleus and weight bearing to increase dorsiflexion.
What is the technique applied and what is the target muscle?
STM to the medial head of the gastrocnemius for dorsiflexion ROM.
What technique is being applied here, what is the target structure and the goal?
STM to the pre-tibials for extensibility.
What technique is being demonstrated and what is the purpose?
Anterior grade mobilization of the mortise on the talus for dorsiflexion.
What is the technique being applied and what is the purpose?
Grade mobilization to gain rear foot mobility or decrease pain.
What technique is this and what is the purpose of it?
Talocrural long axis distraction thrust manipulation.
The purpose is to increase dorsiflexion.
What is the technique and what is the purpose of it?
Cuboid or navicular thrust manipulation aimed at decrease arch pain or heel pain.
What is the technique applied and what is the purpose of such technique?
Mobilization with movement in weight bearing of mortise on talus to increase dorsiflexion.
What is the indication for stretching for heel pain and plantar fasciitis and what is the grade of evidence?
Grade A
Use plantar fascia and gastroc/soleus stretching for
short-term pain relief.
Use heel pads to increase beneftis.
What are the recommendation for neuromuscular facilitation and strengthening and grade of evidence for heel pain?
Grade F
Strengthening exercises to control pronation and attenuate forces during weight bearing activities.
What is the pictured exercise and what is the purpose of it?
This is a plantar fascia stretch.
Shoulder performed with toe dorsiflexion as well as stretching of the sole of the foot.
What is the exercise depicted and what is the purpose?
Gastroc stretch.
Increase dorsiflexion.
What is the recommendation for tape for patients with heel pain related to plantar fasciitis?
Grade A
Consider use of anti-pronation tape for short-term relief.
Elastic tape to the gastrocnemius for short-term pain reduction (1 week)
What is the purpose of the technique depicted?
Lo-die - McConnel tape
Off-load the heel fat pad.
What is the test being performed and what it the differential diagnosis it confirms in terms of heel pain/plantar fasciitis?
Windless test
(Heel fat pad irritation)
What is the purpose of this taping technique?
Off-load the plantar fascia.
What is the purpose of this taping technique?
Tape type: Zinc Oxide
Tape Sliper
Support the longitudinal arch
Should therapist use foot orthosis and what is the level of evidence for the recommendation?
Level A
Consider using pre-fabricated or custom foot orthoses to support longitudinal arch.
What patients respond better to foot orthoses?
Those patients who responde positively to antipronation taping technique.
What devices could be used to heel pain?
Off the shelf semi-rigid devices
Heel pads
Gel heel cups
What should be the recommendation for night splints in plantar fasciitis?
Evidence level A
1-3 months of night splints for individuals with heel pain/plantar fasciitis who have first step pain in the morning.
What are the physical agents recommended for plantar fasciitis?
1 - Electrotherapy - Level D
2 - Low level laser (new) - Level C
3 - Phonophoresis (new) Ketoprofen - Level D
4 - Ultrasound - Level C (Not recommended)
What footwear should be recommended for patients with plantar fasciitis?
What is the level of evidence?
Rocker-bottom shoes + foot orthoses
Rotation of shoes during the work week for those who stand for long periods of time.
What is the recommendation for education and weight loss for plantar fasciitis?
Level D
Education and counseling regarding weight loss for optimal body mass.
Referral to appropriate professional.
What is the recommendation for dry needling for plantar fasciitis?
Level of evidence.
Level F
It cannot be recommended at this time.
Study from 2014
Are steroid injections beneficial for heel pain/plantar fasciitis?
No. Clinical benefits did not outweigh the risk of harm.
Risk of plantar fascia rupture.
Is shockwave therapy indicated for plantar fasciitis?
Better studies did not favor the use of shock wave therapy.
How many levels of evidence are there for plantar fasciitis guidelines and what are they derived from?
I-V
I - High level studies
II - Lower level studies
III - Case controlled studies or retrospective studies
IV - Case series
V - Expert opinions
What are the grades of recommendation?
A - F
A - Strong evidence -
B - Moderate evidence
C - Weak evidence
D - Conflicting evidence
E - Foundational evidence
F - Expert opinion
What is the lifetime percentage of people expected to be affected by plantar fasciitis?
10% of the population
(Approximately 2 million people)
What is the prevalence of plantar fasciitis in runners?
5-18%
What are the most common foot overuse injuries?
Achilles tendinopathy
Plantar fasciitis
Stress fractures
What is the relation between plantar fascia thickness and plantar fasciitis?
Increased thickness is associated with symptoms and altered compressive properties of the fat pad and plantar heel pain.
What is the strongest contributor for disability of people with general foot and ankle disability?
Pain-related fear of movement.
What is the mean duration of symptoms for people with heel pain related to plantar fasciitis?
13.3 to 14.1 months.
What are risk factors for plantar and heel pain according to 2014 CPGs?
High body mass (in nonathletic population)
Decreased dorsiflexion range of motion
Running
Work-related weight bearing activities (with poor shock absorption)
What is the relationship between hamstring tightness and leg length discrepancy and plantar fasciitis?
Plantar fasciitis tends to present itself at the longer leg.
What are the indicators of plantar fasciitis?
First step out of bed
Pain worse with weight bearing
Precipitated by increase in weight bearing activities (such as standing, running)
What is the relationship of foot posture as measured by the Foot Posture Index (FPI-6) and people with plantar fasciitis?
More foot pronations for chronic plantar heel pain (2.4 - 3.3) than controls (1.1-2.3)
What is the current “Level B” 8 factors utilized to determine plantar fasciitis?
Plantar medial heel pain: first step pain or pain after inactivity
Worse after prolonged of activity
Pain at proximal insertion of plantar fascia
Positive Windlass test
Negative tarsal tunnel test
Limited dorsiflexion AROM / PAROM
Abnormal Foot Posture Index (FPI)
High BMI in non-athletic individuals
What are some common differential diagnosis for symptoms consistent with plantar fasciitis?
Fat-pad atrophy
Spondyloarthritis (rheumatological)
Plantar fibroma
What are two of the most important pen and paper assessment tools for plantar fasciitis?
Foot and ankle ability measure
Visual analog scale
What is the MDC and MCID for ADL section of the FAAM questionnaire?
6 Points for the MDC
8 Points for the MCID
What is the MDC and MCID for Sport section of the FAAM questionnaire?
12 Points for the MDC
9 Points for the MCID
What is the following test and its sensitivity/specificity?
Specificity 100%
Sensitivity 32%
What is the following test called and that is the specificity and sensitivity for it?
Tarsal Tunnel Test
(Dorsiflexion/Eversion test)
Sp 99%
Sn 92%
What are the common nerve entrapments which could produce plantar pain?
Sciatic
Femoral
Tarsal Tunnel
Peroneal/Fibular
Lateral plantar
Which condition affects this structure normally?
Tarsal tunnel
What condition affects Baxter’s nerve?
Tarsal tunnel syndrome
What are the six criteria of the FPI-6?
Rear foot:
Talar head palpation
Contour above and below the malleoli
Calcaneal position
Forefoot:
Talonavicular congruence
Medial arch height
Forefoot position
-2 to 3+
What are the score ranges for FPI-6?
- 12 to -5: Highly supinated
- 4 to -1: Supinated
0 to +5: Neutral
+6 to +9: Pronated
+10 to +12: Highly pronated
If the first metatarsophalangeal joint has less than 65º of extension at pre-swing it indicates what?
Plantar flexion limitation.
What is one of the main functions of the tibialis posterior fibularis longus?
Control the rate and extent of foot pronation.
What is the relationship of hamstring tightness and plantar fasciitis?
And what should be the ankle of SLR for normal HS length?
People with tight hamstrings are 9x as likely to get plantar fasciitis?
70º