Plantar fasciitis

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PLANTAR FASCIITIS and its patho-mechanics

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Plantar fasciitis

  1. 1. AND IT'S PATHO-MECHANICS PLANTAR FASCIITIS
  2. 2. PLANTAR FASCIA <ul><li>The plantar fascia is the thick connective tissue which supports the arch on the bottom of the foot </li></ul><ul><li>It runs from the tuberosity of the calcaneus forward to the heads of the metatarsal bones </li></ul><ul><li>The plantar fascia contributes to support of arch of the foot </li></ul><ul><li>The plantar fascia also has an important role in dynamic function during gait </li></ul>
  3. 3. What is PLANTAR FASCIITIS? <ul><li>Plantar fasciitis is a painful foot condition caused by inflammation of insertion of the plantar fascia on the medial process of the calcaneal tuberosity. </li></ul><ul><li>This associated with </li></ul><ul><ul><li>Pain </li></ul></ul><ul><ul><li>Swelling </li></ul></ul><ul><ul><li>Warmth of the affected area </li></ul></ul><ul><ul><li>Redness of the adjacent skin </li></ul></ul><ul><li>RISK FACTORS </li></ul><ul><li>Foot arch </li></ul><ul><li>Obesity or sudden weight gain </li></ul><ul><li>Long-distance running </li></ul><ul><li>Tight Achilles tendon </li></ul><ul><li>Shoes with poor arch support or soft soles </li></ul>
  4. 4. PATHOMECHANICS <ul><li>Tightness of gastro soles muscles . </li></ul><ul><li>During midstance to heel off phase of gait cycle there is 5 degree dorsiflexion is needed, in order to clear the surface. </li></ul><ul><li>(anterior translation of tibia over the talus. closed kinematics) </li></ul>
  5. 5. PATHOMECHANICS <ul><li>In case of gastro soles shortness, there is limited range of dorsi-flexion and these short musculature don’t allow tibia to glide anteriorly. </li></ul><ul><li>This can be compensated by pronation of the subtalar joint. </li></ul><ul><li>This pronated foot causes lots of stress over the plantar fascia during the push of phase of gait. </li></ul><ul><li>That will lead to plantar fasciitis. </li></ul>
  6. 6. PATHOMECHANICS <ul><li>Absence of windlass mechanism </li></ul><ul><li>During propulsive phase of gait cycle dorsiflexion of the 1 st mtp will occur. </li></ul><ul><li>That’s winds the plantar fascia around the head of the meta tarsal causing calcaneal inversion,shortening the truss and lead to subtalar jt supination. </li></ul><ul><li>Absence of this mechanism affects the subtalar jt supination that will lead to plantar fasciitis. </li></ul>
  7. 7. PATHOMECHANICS <ul><li>Tibialis posterior weakness </li></ul><ul><li>The tibialis posterior eccentrically control pronation during footflat and midstance phase of gait cycle. </li></ul><ul><li>Weakness of this muscle can cause excessive pronation of the subtalar joint and this can also leads to plantar fasciitis. </li></ul>
  8. 8. CONSERVATIVE TREATMENT
  9. 9. ELECTROTHERAPY
  10. 10. MANUAL THERAPY <ul><li>Talocrural joint posterior glide </li></ul><ul><li>Subtalar joint lateral glide </li></ul><ul><li>Anterior and posterior glides of 1 st tarsometatarsal joint </li></ul><ul><li>Subtalar joint distraction manipulation </li></ul>
  11. 11. STRETCHING <ul><li>Calf muscle stretch </li></ul><ul><li>Calf muscle stretching can be either 3 times or 2 times day, sustained(3mini) or intermittent(20sec). </li></ul><ul><li>Plantar fascia specific stretch </li></ul><ul><li>Performed in sitting, with the patient placing the fingers of one hand across the toes of the involved foot. Then pulling the toes back. </li></ul>
  12. 12. TAPING <ul><li>Calcaneal taping or low-dye taping used for short-term pain relief. Taping does cause improvement in function. </li></ul>
  13. 13. ORTHOTIC DEVICES <ul><li>Heel cuffs </li></ul><ul><li>Viscous elastic heel pad </li></ul><ul><li>Accommodative inlays </li></ul><ul><li>Prefabricated and custom made orthosis: All these orthosis used for exceesive foot pronation and improvement of the condition. </li></ul>
  14. 14. TRIGGER POINT THERAPY <ul><li>In some cases trigger points and myo-fascial pain syndrome contribute to heel pain that mimicking plantar fasciitis. </li></ul><ul><li>Common location of trigger point is either muscle belly of gastrocnemius or in soleus. This will lead to referred pain at heel. </li></ul><ul><li>Deep cross fiber friction or ischemic compression done for reduction of taut muscular and facial band with Trigger point. </li></ul>
  15. 15. NIGHT SPLINTS <ul><li>It is used for patient with symptoms greater than 6 months in duration. </li></ul><ul><li>The desire length of time for wearing the splint is 1 to 3months. </li></ul><ul><li>This splint maintain ankle in neural position and toes in slight extension. </li></ul>
  16. 16. SUMMARY <ul><li>Plantar Fasciitis is a painful condition caused by overuse of the plantar fascia or arch tendon of the foot. </li></ul><ul><li>The most common cause of plantar fasciitis is very tight calf muscles </li></ul><ul><li>Treatment can last from several months to 2 years </li></ul><ul><li>Some people may need surgery. </li></ul>

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