Heel Pain - PLantar Fasciitis CPG

Question 1

Plantar Fasciitis CPG: Risk factors

Answer 1

B level:

• limited ankle DF
• high BMI in non athletic individuals
• running
• work related WB activities (esp with poor shock absorption)

Question 2

Plantar Fasciitis CPG: Diagnosis/classification

Answer 2

B level: use hx and physical exam findings:

• plantar medial heel pain with initial steps after period of inactivity or prolonged WBing
• heel pain precipitated by recent increase in WBing
• Pain with palpation of proximal insertion of plantar fascia
• Positive windlass test
• negative tarsal tunnel tests
• limited active and passive talocrural jt DF
• abnormal FPI
• high BMI in nonathletic individuals

Question 3

Plantar Fasciitis CPG: Differential Diagnosis

Answer 3

C level: other causes of heel pain - spondyloarthritis, fat pad atrophy, proximal plantar fibroma

Question 4

Plantar Fasciitis CPG: Exam: Outcome measures

Answer 4

A level:
FAAM
FHSQ
FFI
LEFS

Question 5

Plantar Fasciitis CPG: Exam: activity limitation and participation restriction measures

Answer 5

F level: easily reproducible performance based measures

Question 6

Plantar Fasciitis CPG: Exam: physical impairment measures

Answer 6

B level: pain with initial steps, pain with palpation of proximal insertion of plantar fascia, AROM/PROM ankle DF, BMI in nonathletic individuals

Question 7

Plantar Fasciitis CPG: Interventions: Manual therapy

Answer 7

A level: use manual consisting of jt mobs and STM

Question 8

Plantar Fasciitis CPG: Interventions: Streteching

Answer 8

A level: stretch plantar fascia and gastroc/soleus for short term (1wk-4mo) pain relief

Question 9

Plantar Fasciitis CPG: Interventions: Taping

Answer 9

A level: antipronation taping for immediate (up to 3 wks), pain reduction. May use elastic tape applied to gastroc and plantar fascia for short term (1wk) pain reduction.

Question 10

Plantar Fasciitis CPG: Interventions: Foot orthoses

Answer 10

A level: prefab or custom orthoses to support medial longitudinal arch and cushion heel to reduce pain and improve function for short to long term (2wks to 1yr). Esp pts who respond positively to antipronation taping

Question 11

Plantar Fasciitis CPG: Interventions: Night splints

Answer 11

A level: 1-3mo program of night splints for pts with consistent pain with first step in morning.

Question 12

Plantar Fasciitis CPG: Interventions: Physical agents

Answer 12

D level: use manual, stretching, and orthotis over electrotherapy. may or may no use iontophoresis.
C level: may use low level laser to reduce pain
C level: may use phonophoressi with ketoprofen gel
C level: don’t use ultrasound

Question 13

Plantar Fasciitis CPG: Interventions: Footwear

Answer 13

C level:

1. use rocker bottom shoe with orthotics
2. rotate shoes during work week for those who stand for a long period

Question 14

Plantar Fasciitis CPG: Interventions: Ed and counseling for weight loss

Answer 14

E level: counseling on exercise to gain or maintain optimal lean body mass

Question 15

Plantar Fasciitis CPG: Interventions: Therex and NMR

Answer 15

F level: strengthening exercises and movement training for muscles that control pronation and attenuate forces in WB

Question 16

Plantar Fasciitis CPG: Interventions: Dry needling

Answer 16

F level: not recommended