Plantar Heel Pain

Question 1

Describe plantar fasciitis/osis and its potential causes?

Answer 1

Fasciitis - inflammation of plantar fascia

Fasciosis - Degeneration of plantar fascia

Theoretical causes - micro tears in fascia, acute injury to fascia, muscle injuries in area or spur involvement

Question 2

What is the clinical presentation for Plantar Fasciitis/osis

Answer 2

• variable
• pain under heel medial tubercle and arch
• pain on periphery of heel
• pain worse in morning or after sitting for long periods
• pain exacerbated with activities activation plantar fascia such as climbing stairs
• pain secreases as patient start moving

Question 3

What are some objective assesmment for plantar fasciitis/osis?

Answer 3

footwear- support and cushioning 
activity type/frequency- work and sport 
foot dorsiflexion range, hamstring range 
stance asssesment 
dynamic gait assessement

Question 4

What are the management strategy/goals for plantar fasciitis/opathy in podiatry?

Answer 4

• Pt history, what have they tried
• identify and treat RF and consider Pt needs (biopsychosocial model)
• understand and empathise with the Pt reassure its commone and treatable
• aim to relieve pain ASAP using simple inexpensive methods of treatment
• No universal treatment and treatement may take longer to work Pt to Pt important to have realitic expectations and change treatment direction as symptoms and responses dictate

Question 5

What is the first line treatment for plantar fasciitis/osis?

Answer 5

• Ice
• PT should perform normal tasks and keep activity levels
• footwear, supportive and cushioned
• strapping
• stretching/night splints

Question 6

What is the second line treatment for plantar fasciitis/osis

Answer 6

• orthoses
• excercise/strengthening protocol
• massage/deep tissue friction therapy/shockwave therapy/ golf ball
• NSAIDs
• corticosteroid injection, short term
• PRP/laser therapy
• surgery

Question 7

what are the signs and symptoms of plantar fascia rupture and tear?

Answer 7

-total rupture
- severe swelling and bruising
-pain
-lack of resistance to DF
-flat foot
Partial rupture, degree of above symptoms
Tear, localized pain not responding to ice strapping etc

Question 8

What is the treatment for plantar fascial tear/rupture?

Answer 8

total rupture
-Surgery
-non weightbearing case or moonboot
Partial/tear
-strapping, soft orthosis in moon boot , moon boot alone

Question 9

Plantar heel enthesitis?

Answer 9

• pain under heel with similar pattern to plantar fasciitis
• calcaneal spur
• treat similarly to plantar fasciitis with additional padding in calcaneal tubercle area

Question 10

What is plantar fat pad inflammation/contusion?

Answer 10

-chronic or acute inflammatory process within fat pad of heel 
Aetiology
-running or impact on hard surfaces 
-poor surfaces 
Diagnosis
-tenderness on heel palpation and compression may need MRI to confirm
Treatment
-Rest
-ice
-padding and strapping
-NSAIDS
-shoe education
-moon boot 
-massage

Question 11

Plantar heel nerve pain?

Answer 11

• Pt complaint of paraesthesia, dysaesthesia or hyperaesthesia
• neural sensations, sharp, shooting, tingling, burning
• pain may also present as a dull ache continuously or at rest and night

Question 12

What is the treatment for plantar heel nerve pain?

Answer 12

Neural tightness - neural stretching/ flossing

mobilization/deep tissue massage if area has been swollen and now fibrosed or immobilized for a prolonged period

NSAID

injection therapy to relieve swelling/diagnosis, local anaesthetic or corticosteriod

moon boot

decompression surgery