Week 3 Flashcards
Main culprit and risk factors of plantar fasciopathy
Main culprit - change/increase in training load. Increased loading of plantar fascia
- Risk factors:
○ High BMI
○ Standing in work profession
○ Running
Advice and education for plantar fasciopathy
- Relative rest/modify activity
- Pain monitoring (Silbernagel 2007)
- Pain levels up to 5/10
- No residual pain within 24h
- No exacerbation after
- How much and for how long is guided by irritability
- Education: training load error/increase in load, plantar fascia unable to tolerate load placed on it, risk factors – high BMI, standing in work profession, running - It is important that you decrease or avoid activities that will cause your heel pain to flair up. When you want to start up with these activities again you should be careful and slowly progress.
Plantar heel pain: Shoe insert + stretch group vs shoe insert + 12 week HSL strength training group
Both groups reduce significantly over 12 months
3 months - strength training group doing better on foot function index
Heavy slow loading + shoe insert (heel cups) are significantly better than stretching + shoe inserts at 3 months
At 12 months - becomes even again
Shoe inserts and stretching had similar effect to shoe inserts and strength training in the long term
Orthotics for Plantar heel pain
- Found no difference between prefabricated orthoses and sham orthoses for pain at short term
Foot orthoses are not superior for improving pain and function compared with sham or other conservative treatment in patients with PHP.
maybe useful as adjunct
Can orthotics work for some patients
Yes - can determine if patient is suitable for orthotics (as an adjunct to exercise) by performing a treatment direction testing. Get patient to perform painful activity, then apply anti-pronation tape to see if it changes their symptoms. Tape acts in similar way to orthotic so may suggest if patient will respond favourably to an orthotic. Could help in short to medium term to reduce pain in patients that respond well with TDT
Role of manual therapy in treating plantar fasciopathy
You CANNOT
- “Release” muscles and fascia
- Or reduce stiffness of the plantar fascia
- Not an important player - Little use/efficacy compared to main treatments of advice and education on load management and a loaded training program - maybe useful as an adjunct
Dry needling for plantar heel pain:
Dry needling vs sham needling
Generally avoid
Dry needling slightly more effective than sham needling, however adverse effects were really high
NNH of 3 - dry needle three patients, you’ll harm one person
Small effect compared to sham dry needling so not worth the risk
What is NNH
Number needed to harm
What running style overloads plantar fascia
forefoot striking
Exercise rehabilitation for plantar fasciopathy
Exercise Rehabilitation
* Phase 1: Acute/subacute stage of rehabilitation
- Low dye taping to reduce symptoms
- The use of ice or stretching if it makes the patient more comfortable
* Phase 2: Conditioning phase of rehabilitation
- Seated Double Leg Calf Raise
- Seated Single Leg Calf Raise
- Unilateral heel raises with the towel under the toes to increase dorsal flexion the toes during the heel raise
- Previous exercise but weighted
* Phase 3: Sports Specific Rehabilitation
- Change in direction
- Power/Plyometrics
* Phase 4: Return to Sport Phase
- 6 minute walk test
- Calf raise test for endurance
Taping for plantar fasciopathy
- Low Dye Taping
- Reverse 6
- Calcaneal sling
- Augmented Low Dye Taping
Risk factors of MTSS
Might be risk factors
- Previous history of MTTS
- Sex (females)
- Higher BMI
- Greater navicular drop (pronated foot)
- Greater plantar flexion ROM (???)
Not risk factors of MTSS
Might not be risk factors
- Q-angle
Hip IR ROM
Best treatment for MTSS
- There is no evidence for the effect of any intervention in treating MTSS
No evidence for effect of any intervention in treating MTSS so what can you do
NO clinical evidence of good treatment so need to understand aggravating factors and conduct physical examination and tailor treatment to impairments
- Load management
- Reduce painful activities
- Strength training
- Continue with activities that may be pain free
- Treat as general load stress injury
- Advice and education
o Bone overload theory: strain placed on bone > exceeds microdamage threshold
o Rest (activity modification) until symptoms settle down
o Ice if required
o Address relevant impairments - Treat individual impairments
o Hip ABD/ER weakness
o Observation during walking/running
o Reduced control of foot pronation
o Ankle/calf weakness – inverters/evertors, tibialis anterior, plantarflexors
o Intrinsic foot muscle weakness
running retraining for MTSS
Running Re-training
- Must always observe your patient perform there aggravating activity
- Transition to forefoot running
- Increase steps per minute (cadence)
Technique Modification
- Increased dorsiflexion (heel landing)
- Decrease knee flexion at initial contact
- Increased vertical loading rate
- Increased Tibialis anterior activity
- Increased (eccentric) gastrocnemius activity
- Increased pressure on the base of the 1st metatarsal
What is medial collapse for running, what is it associated with and how can it be fixed?
Legs coming together (collapsing)
Knee collapsing inwards –> associated with MTSS or hip pain
Can see the contralateral hip drop which may be associated with hip weakness
Associated with knee pain or gluteal tendinopathy
Changing stride length may help this adjunct with an exercise based program
What is cross over gait, what is it associated with
Leg crosses over midline
Common for Lateral knee pain (ITB syndrome)
What is overstride, what is it associated with and how can it be fixed
Associated with achilles tendinopathy
Lots of load going through structure
Reduce stride length by increasing cadence
Adjunct with strength training
Running retraining for PHP
Transition to forefoot striking running adjunct to exercise program and increase steps per minute (cadence)
Exercise for forefoot running
○ Strengthening
○ Intrinsic foot muscles/plantar flexors
High-load exercises for the plantar fascia - 8 re-training sessions (during 2 to 3 weeks)
What are the implications of transitioning to Forefoot striking
- ↑ (eccentric) gastrocnemius activity - Could increase risk of AT, PHP, strains
- Increased pressure on the base of the 1st metatarsal
Rearfoot striking and muscle activation
Rearfoot strike - tibialis anterior works a lot harder
Reasons for anti-pronation taping
- Plantar heel pain
- Tarsal tunnel syndrome: tibial nerve compression
- Shin splints
- Knee conditions – patellofemoral pain
- Tibialis posterior tendinopathy
