Plantar Fasciopathy Flashcards
What is plantar fasciopathy?
-Damage to plantar fascia: Inflammation, degeneration or heel pain
What is the anatomy of the plantar fascia?
- Thin layer of connective tissue supporting the arch of the foot
- Bow string function stabilizes the long arch
- Three bands of the plantar fascia middle is the aponeurosis
What are the clinical findings and tests for plantar fasciitis?
- Gradual onset of pain
- Morning pain, worsens with dorsiflexion of toes
- Single traumatic event
- Tenderness are posterior medial of heel
-5 locations of palpation:
1, calcaneal periostitis/fat pad impingement
2, plantar fasciopathy
3, entrapment of the 1st branch of the lateral plantar nerve
4, abductor hallucis
5, plantar fibroma
-EMG to rule out entrapment
What are some radiographic imaging you would perform?
- Ultrasound to confirm diagnosis >4mm thickness
- X-ray no recommended but can get to rule out fracture or very prominent heel spur
- MRI for surgical planning
What are the DDX for the injury?
-Inflammation of ABH, FDB and quadratus plantae
-Associated conditions:
triceps surae tightness, calcaneal apophysitis
What is the management plan for this patient?
- Identify what they have tried
- ICE 1-2 a day 10 min
- Maintain current activity levels
- Footwear assessment
- Strapping and Stretching
Second line
- orthoses
- exercise/strength conditioning
- massage
- NSAIDS or corticosteroid injection
- Laser
- Surgery
What are some taping you would use for this injury?
Low dye taping technique
-Will help relieve pain
-predict success of orthotics
MOA
-Increase DF stiffness of med column = decrease tensile stress on PF
-increase forefoot PF moment = decrease force to establish windlass
-fat pad immobilization = decompression
What are some medications you would prescribe this patient?
NSAID
-Ibuprofen for 10 days to reduce inflammation and pain
Corticosteroid injection
-hydrocortisone pain relief however there are risks of skin thinning , fat pad atrophy and plantar fascia rupture
