MSK #7- Plantar Fasciitis

Question 1

Risk Factors

Answer 1

• Limited Dorsiflexion ROM
• High BMI (non-athletic)
• Activities: running, WB activities, conditions with poor shock absorption

Question 2

Diagnosis/ Classification

Answer 2

• plantar medial pain, most noticeable w/ first steps after resting and/or WB activity
• heel pain developing after increased WB activity
• pain w/ palpation of proximal insertion of plantar fascia (tuberosity of calcaneous)
• positive windlass test
• negative tarsal tunnel test
• limited AROM/PROM talocrural joint dorsiflexion
• abnormal foot posture index score
• high BMI in non-athletic person

Question 3

Differential diagnosis- What to check for if finding not consistent w/ criteria for Plantar Fasciitis or interventions for PF are not working

Answer 3

• spondyloarthritis
• fat pad atrophy
• proximal plantar fibroma

Question 4

Exam: valid self-report outcome measures

Answer 4

• Foot and Ankle Ability Measure (FAAM)
• Foot Health Status Questionnaire (FHSQ)
• Foot Function Index (FFI)
• Lower Extremity Function Scale (LEFS)

Question 5

Exam: Activity Limitation and Participation Restriction Measures and Physical Impairment

Answer 5

• Utilized easily reproducible performance based measures of activity limitation and participation restriction measures to assess changes in the patient’s level of function associated with heel pain/Plantar Fasciitis over the episode of care
• Physical Impairment- same as above but use AROM/PROM dorsiflexion measurements and BMI

Question 6

Interventions- Use of Physical Agents (Modalities)

Answer 6

• Use manual therapy, stretching, and foot orthoses instead of modalities to promote intermediate and long-term (1-6 months) improvement in outcomes
• May use iontophoresis w/ dexamethasone or acetic acid for short-term (2-4 weeks) pain relief

Question 7

Interventions- should you use ultrasound

Answer 7

Probably not. Not good evidence to support it.

Question 8

Interventions: Modalities that some PTs use and have some success

Answer 8

• low-level laser

- phonophoresis w/ ketoprofen gel

Question 9

Interventions: Manual Therapy

Answer 9

• use joint and soft tissue mobilizations
• treat relevant LE joint mobility
• treat calf flexibility deficits

Question 10

Interventions: Stretching

Answer 10

• use plantar fascia stretch
• use gastroc/soleus stretch
• may use heel pads to increase benefits of stretch
• roll foot on tennis ball or rolling pin to massage plantar fascia
• Provide for short term relief (1 week - 4 months)

Question 11

Interventions: Taping

Answer 11

• use anti-pronation (up to 3 weeks)

- may tape gastroc and PF for 1 week for pain reduction

Question 12

Intervention: Dry Needling

Answer 12

Not a good idea. Don’t do it

Question 13

Intervention: Foot Orthoses

Answer 13

• prefab or custom
• support longitudinal arch and cushion heel
• minimize hyper-pronation
• good for short-term relief (2 weeks) or long-term (1 year)
• tends to be a good option for people who respond positively to taping

Question 14

Interventions: Night Splints

Answer 14

• prescribe 1-3 month program of night splinting

- good option for people who have heel pain w/ first steps in morning.

Question 15

Interventions Footwear

Answer 15

• rocker bottom shoe construction in conjunction w/ orthosis
• shoe rotation during work week for those who stand for long periods of time

Question 16

Interventions: weight loss

Answer 16

may give exercise strategy advice or may refer out to nutrition specialist

Question 17

Interventions: Therex and Neuro Re-ed

Answer 17

may prescribe strengthening exercises and movement training for muscles that control pronation and attenuate forces during WB activities