plantar heel pain Flashcards
Plantar fasciitis
10% of the population at one point during their lifetime
Plantar heel pain with tenderness along the medial calcaneal tubercle
Symptoms first thing in the morning or after a period of rest
Progressive pain with weight-bearing
Present in both athletic and non-athletic populations
Likely not truly inflammatory
plantar fasciitis risk factors
Limited ankle dorsiflexion
High body mass index
Running
Work related, weight-bearing activities
tested measures for plantar fasciitis
Tender to palpation at proximal insertion
Limited active and passive dorsiflexion
Positive windlass test
negative tarsal tunnel test
Possible impaired neural dynamics
Clear lumbar spine
Diagnostic ultrasound
Interventions for plantar fasciitis
strong
manual therapy
Stretching
Taping
Night splints
moderate
Resistance training
Dry needling
Night splits
One to three months and First steps in the morning
differential diagnosis of plantar heel pain
Diabetic neuropathy and inflammatory arthritis
Altered neuron dynamics, tibial, nerve bias
S 2 radiculopathy
entrapment of lateral plantar nerve - innervates abductor digiti minimi
fat pad syndrome
Tarsal tunnel syndrome -tibial nerve
Calcaneal stress fracture
Posterior tibialis tendon dysfunction
fat pad Syndrome
reduced cushioning with the heel fat pad
Generally degenerates after age 40
Hard training surfaces
Repetitive stress
Activity modification
Heel cup or cushion
ice
tarsal tunnel syndrome
tibial nerve (or medial/lateral plantar nerve) entrapment as it passes deep to the flexor retinaculum posterior to medial malleolus
trauma
Excessive pronation/ pes planus
Tight shoes
Local edema
Space occupying lesion
tarsal tunnel exam findings
Burning numbness, tingling in medial ankle or plantar foot
Plantar foot paresthesias
Positive tinels
Manual muscle testing changes
Maximal passive ankle df and ev and MTP/IP extension held 5 to 10 seconds
neurodynamic testing
Calcaneal stress fracture
sudden or gradual onset of pain
Typically associated with one of the following
-Increase in load greater than normal bones capacity
-repetitive load with insufficient bone
-falls/impact
Pain with weight-bearing activities
Pain with…
calcaneal Palpation medial and lateral aspects
Positive calcaneal squeeze
positive calcaneal percussion
posterior tibialis tendon function
plantarflexes the ankle
inverts subtalar joint
integral to maintain the medial longitudinal arch
posterior tibialis tendon dysfunction
Acquired flatfoot
Frequently tender to palpation posterior and distal to the medial malleolus
Pain with weight-bearing
Terminal stance pre-swinging pushoff deficits
Difficulty with full heel lift
look for inability to invert calcaneus lack of varus
too many toes sign, positive unilateral navicular drop
taping, orthoses, strengthening
posterior tibialis origin, insertion, innervation
o- posterior tibia and fibula
i- navicular tuberosity, plantar aspects of the cuneiform bones, plantar aspects of 2-4 metatarsal bases
innervation- tibial nerve
