Heel pain/Plantar fasciitis

Question 1

What is the evidence grade for manual therapy and what is its goal in regards to plantar fasciitis?

Answer 1

Grade A - Treat lower extremity joint mobility and calf flexibility, decrease pain and improve function.

Question 2

What technique is being used here and what’s its purpose?

Answer 2

STM to the soleus and weight bearing to increase dorsiflexion.

Question 3

What is the technique applied and what is the target muscle?

Answer 3

STM to the medial head of the gastrocnemius for dorsiflexion ROM.

Question 4

What technique is being applied here, what is the target structure and the goal?

Answer 4

STM to the pre-tibials for extensibility.

Question 5

What technique is being demonstrated and what is the purpose?

Answer 5

Anterior grade mobilization of the mortise on the talus for dorsiflexion.

Question 6

What is the technique being applied and what is the purpose?

Answer 6

Grade mobilization to gain rear foot mobility or decrease pain.

Question 7

What technique is this and what is the purpose of it?

Answer 7

Talocrural long axis distraction thrust manipulation.

The purpose is to increase dorsiflexion.

Question 8

What is the technique and what is the purpose of it?

Answer 8

Cuboid or navicular thrust manipulation aimed at decrease arch pain or heel pain.

Question 9

What is the technique applied and what is the purpose of such technique?

Answer 9

Mobilization with movement in weight bearing of mortise on talus to increase dorsiflexion.

Question 10

What is the indication for stretching for heel pain and plantar fasciitis and what is the grade of evidence?

Answer 10

Grade A

Use plantar fascia and gastroc/soleus stretching for

short-term pain relief.

Use heel pads to increase beneftis.

Question 11

What are the recommendation for neuromuscular facilitation and strengthening and grade of evidence for heel pain?

Answer 11

Grade F

Strengthening exercises to control pronation and attenuate forces during weight bearing activities.

Question 12

What is the pictured exercise and what is the purpose of it?

Answer 12

This is a plantar fascia stretch.

Shoulder performed with toe dorsiflexion as well as stretching of the sole of the foot.

Question 13

What is the exercise depicted and what is the purpose?

Answer 13

Gastroc stretch.

Increase dorsiflexion.

Question 14

What is the recommendation for tape for patients with heel pain related to plantar fasciitis?

Answer 14

Grade A

Consider use of anti-pronation tape for short-term relief.

Elastic tape to the gastrocnemius for short-term pain reduction (1 week)

Question 15

What is the purpose of the technique depicted?

Answer 15

Lo-die - McConnel tape

Off-load the heel fat pad.

Question 16

What is the test being performed and what it the differential diagnosis it confirms in terms of heel pain/plantar fasciitis?

Answer 16

Windless test

(Heel fat pad irritation)

Question 17

What is the purpose of this taping technique?

Answer 17

Off-load the plantar fascia.

Question 18

What is the purpose of this taping technique?

Answer 18

Tape type: Zinc Oxide

Tape Sliper

Support the longitudinal arch

Question 19

Should therapist use foot orthosis and what is the level of evidence for the recommendation?

Answer 19

Level A

Consider using pre-fabricated or custom foot orthoses to support longitudinal arch.

Question 20

What patients respond better to foot orthoses?

Answer 20

Those patients who responde positively to antipronation taping technique.

Question 21

What devices could be used to heel pain?

Answer 21

Off the shelf semi-rigid devices

Heel pads

Gel heel cups

Question 22

What should be the recommendation for night splints in plantar fasciitis?

Answer 22

Evidence level A

1-3 months of night splints for individuals with heel pain/plantar fasciitis who have first step pain in the morning.

Question 23

What are the physical agents recommended for plantar fasciitis?

Answer 23

1 - Electrotherapy - Level D

2 - Low level laser (new) - Level C

3 - Phonophoresis (new) Ketoprofen - Level D

4 - Ultrasound - Level C (Not recommended)

Question 24

What footwear should be recommended for patients with plantar fasciitis?

What is the level of evidence?

Answer 24

Rocker-bottom shoes + foot orthoses

Rotation of shoes during the work week for those who stand for long periods of time.

Question 25

What is the recommendation for education and weight loss for plantar fasciitis?

Answer 25

Level D Education and counseling regarding weight loss for optimal body mass. Referral to appropriate professional.

Question 26

What is the recommendation for dry needling for plantar fasciitis? Level of evidence.

Answer 26

Level F It cannot be recommended at this time. Study from 2014

Question 27

Are steroid injections beneficial for heel pain/plantar fasciitis?

Answer 27

No. Clinical benefits did not outweigh the risk of harm. Risk of plantar fascia rupture.

Question 28

Is shockwave therapy indicated for plantar fasciitis?

Answer 28

Better studies did not favor the use of shock wave therapy.

Question 29

How many levels of evidence are there for plantar fasciitis guidelines and what are they derived from?

Answer 29

I-V I - High level studies II - Lower level studies III - Case controlled studies or retrospective studies IV - Case series V - Expert opinions

Question 30

What are the grades of recommendation?

Answer 30

A - F A - Strong evidence - B - Moderate evidence C - Weak evidence D - Conflicting evidence E - Foundational evidence F - Expert opinion

Question 31

What is the lifetime percentage of people expected to be affected by plantar fasciitis?

Answer 31

10% of the population | (Approximately 2 million people)

Question 32

What is the prevalence of plantar fasciitis in runners?

Answer 32

5-18%

Question 33

What are the most common foot overuse injuries?

Answer 33

Achilles tendinopathy Plantar fasciitis Stress fractures

Question 34

What is the relation between plantar fascia thickness and plantar fasciitis?

Answer 34

Increased thickness is associated with symptoms and altered compressive properties of the fat pad and plantar heel pain.

Question 35

What is the strongest contributor for disability of people with general foot and ankle disability?

Answer 35

Pain-related fear of movement.

Question 36

What is the mean duration of symptoms for people with heel pain related to plantar fasciitis?

Answer 36

13.3 to 14.1 months.

Question 37

What are risk factors for plantar and heel pain according to 2014 CPGs?

Answer 37

High body mass **(in nonathletic population)** Decreased dorsiflexion range of motion Running Work-related weight bearing activities (with poor shock absorption)

Question 38

What is the relationship between hamstring tightness and leg length discrepancy and plantar fasciitis?

Answer 38

Plantar fasciitis tends to present itself at the longer leg.

Question 39

What are the indicators of plantar fasciitis?

Answer 39

First step out of bed Pain worse with weight bearing Precipitated by increase in weight bearing activities (such as standing, running)

Question 40

What is the relationship of foot posture as measured by the Foot Posture Index (FPI-6) and people with plantar fasciitis?

Answer 40

More foot pronations for chronic plantar heel pain (2.4 - 3.3) than controls (1.1-2.3)

Question 41

What is the current “Level B” 8 factors utilized to determine plantar fasciitis?

Answer 41

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

Question 42

What are some common differential diagnosis for symptoms consistent with plantar fasciitis?

Answer 42

Fat-pad atrophy Spondyloarthritis (rheumatological) Plantar fibroma

Question 43

What are two of the most important pen and paper assessment tools for plantar fasciitis?

Answer 43

Foot and ankle ability measure Visual analog scale

Question 44

What is the MDC and MCID for ADL section of the FAAM questionnaire?

Answer 44

6 Points for the MDC 8 Points for the MCID

Question 45

What is the MDC and MCID for Sport section of the FAAM questionnaire?

Answer 45

12 Points for the MDC 9 Points for the MCID

Question 46

What is the following test and its sensitivity/specificity?

Answer 46

Specificity 100% Sensitivity 32%

Question 47

What is the following test called and that is the specificity and sensitivity for it?

Answer 47

Tarsal Tunnel Test (Dorsiflexion/Eversion test) Sp 99% Sn 92%

Question 48

What are the common nerve entrapments which could produce plantar pain?

Answer 48

Sciatic Femoral Tarsal Tunnel Peroneal/Fibular Lateral plantar

Question 49

Which condition affects this structure normally?

Answer 49

Tarsal tunnel

Question 50

What condition affects Baxter's nerve?

Answer 50

Tarsal tunnel syndrome

Question 51

What are the six criteria of the FPI-6?

Answer 51

Rear foot: Talar head palpation Contour above and below the malleoli Calcaneal position Forefoot: Talonavicular congruence Medial arch height Forefoot position -2 to 3+

Question 52

What are the score ranges for FPI-6?

Answer 52

- 12 to -5: Highly supinated - 4 to -1: Supinated 0 to +5: Neutral +6 to +9: Pronated +10 to +12: Highly pronated

Question 53

If the first metatarsophalangeal joint has less than 65º of extension at pre-swing it indicates what?

Answer 53

Plantar flexion limitation.

Question 54

What is one of the main functions of the tibialis posterior fibularis longus?

Answer 54

Control the rate and extent of foot pronation.

Question 55

What is the relationship of hamstring tightness and plantar fasciitis? And what should be the ankle of SLR for normal HS length?

Answer 55

People with tight hamstrings are 9x as likely to get plantar fasciitis? 70º