anatomy, causes and management of plantar fascitis

1. PLANTAR FASCIITIS

2. ➢ Plantar fasciitis is the painful condition caused by inflammation of the
plantar fascia. The pain is usually felt on the bottom of foot near the heel
and is worst when getting out of bed in the morning or after sitting for a
long time. The pain is usually caused by collagen degeneration at the origin
of the plantar fascia at the medial tubercle of the calcaneus. The cause of
degeneration is repetitive micro tear of the plantar fascia that overcome the
body ability to repair itself.

3. ➢ What is plantar fascia ?
It is a thick , web like ligament that connects your heel to the front of
your foot . It supports the arch of your foot and helps you walk . It is the
largest ligament in the human body .These ligament act as shock
absorbers, supporting the arch of the foot. Too much pressure on your
feet can damage or tear the ligament, the plantar fascia inflamed ,and the
inflammation cause heel pain and stiffness
The plantar fascia is a thickened fiber that originates from the medical
tubercle of the calcaneus and runs forward to from the longitudinal foot
arch . The function of the plantar fascia is to provide static support of the
longitudinal arch and dynamic shock absorption.

4. ➢ Not well understood
➢ Mechanical overload and excess strain
➢ Microscopic tears in the fascia
➢ Tiggering the inflammatory repair processes
➢ Entesal fibrocartilage –prone to degenerative change
➢ Increase cartilage cell clustering
➢ Formation of fissures within the fibrocartilage
➢ Ossification= spurs

5.  Excessive pronation of foot
 Poor arch support in the shoe
 Flat foot
 Prolonged standing
 Fat pad atrophy
 Repetitive strength imbalance
 Stress, tension and pulling in plantar fascia
 Overuse may cause micro tears and inflammation
 Congenital problem such as pescavus
 Obesity
 Some cause of plantar fasciitis may include:
Excessive running or even walking uphill
lack of stretching prior to exercise
wearing flexible ,soft shoes that don’t protect your feet
Injuries to plantar fascia

6. ➢ AGE
Plantar fasciitis is most common between the ages of 40 -60.
➢ SEX
women are more likely to develop plantar fasciitis when compared to men.
➢ OBESITY
Excess weight put extra stress on your plantar fascia.
➢ OCCUPATION
people with occupations that require a lot of walking or standing on hard
surface such factory workers, teachers and waitresses can damage their
plantar fascia.
➢ IMPROPER SHOES
Shoes that are thin soled ,loose,lacking arch support or the ability to absorb
shock cannot protect the feet.

7. ➢ Pain at the base of the heel.
➢ Pain is most severe in the morning on getting out of bed ,and in the
beginning of a run.
➢ Pain and tenderness at the bottom of the foot.
➢ Pain is burning ,often sharp ,and can be severe.
➢ Moving after any inactivity ,such as sitting in a car or at a desk
➢ Post static dyskinesia
➢ Plantar fasciitis is sometimes also associated with warmth and swelling of
the bottom of the foot.
➢ After prolonged activity ,the pain can flare up due to increased inflammation
.pain isn’t usually felt during the activity but rather just after stopping .

8.  MEDICAL HISTORY
The doctor will ask about personal and family medical history as well as recent and
current symptoms such as pain tenderness, stiffness, difficulty moving.
➢ PHYSICAL EXAMINATION
The doctor will examine the joint ,looking for tenderness ,swelling, warmth and painful
or limited movement.
➢ IMAGING TESTS
X rays –may be taken to rule out a stress fracture of the heel bone
MRI- show thickening of plantar fascia.
BONE SCAN- It show increase uptake at the calcaneus

10.  MEDICATION
pain relievers such as ibuprofen and naproxen sodium can ease pain and
inflammation associated with plantar fasciitis.
PHYSIOTHERAPY TREATMENTS GOALS:
SHORT TERM GOALS:
• To reduce pain
• To reduce inflammation
• To reduce swelling
• To reduce tenderness
LONG TERM GOALS:
• To maintain the muscle property
• To normalize the function
• To improve flexibility
• To improve strength of the muscle
• To maintain balance

11. ➢ Wall exercises for calf stretching
➢ Stair stretch
➢ Slant board
➢ Dynamic stretching
➢ Towel stretching
➢ Frozen can role
➢ Resisted foot exercise
➢ Towel prickup
REPEAT ALL THE EXERCISES 10 TIMES,2 SETS
IN A DAY .
➢ DEEP MASSAGE

12. ELECTROTHERAPY MODALITIES
>Ultrasound-for 5 minutes, 1.2w/cmsq
>Contrast bath therapy – for 10 to 15 minutes
➢Night splints-
➢ orthotics-

13. NAME: Mukesh
GENDER: Male
AGE:35
ADDRESS: Pitampura
REFERRED BY: Dr. alok
C/C: pain in the heel of both foot for the past 12 days,he is having problem in
walking.The pain is worse when he stand after sitting for long time’
HISTORY
CURRENT JOB: Employee in ms home credit india finance for the past 5 years ‘
NATURE OF CURRENT JOB : his job include collection of payment from the client
for this travelled for 3 -4 hours daily on bike .
DURATION : 6 hours
PRESENT HISTORY
ON SET : burning pain occurs when he first gets out the bed and takes his
first steps .
COURSE: fluctuant
DURATION : 3 years

14. AGGRAVATING AND RELIEVEING FACTORS: walking aggravates the symptoms
while lying and taking rest relieves the symptoms
SIGNS OF INFLAMMATIONS: present
VAS:8
PAST HISTORY
SURGERY AND ILLNESS: nil.
FLAT FOOT: yes
TRAUMA : in may he went for a trip in agra and continously travelled for four
days , he then first noticed his heel pain.
PHYSIOTHERAPY TREATMENT : not taken
TEST
XRAY: not available
M.R.I :N.A.
ADICTION OF ANY DRUG OR ABUSE: no
POSTURE: normal
GAIT: antalgic
DAIGNOSIS: plantar fasciitis

15. TREATMENT
Towel stretching 10 reps ,2 sets
wall stretch 10 reps , 2 sets
dynamic stretching with a can or bottle 10 reps 2 sets
Calf stretch or stair stretch 10 reps ,2 sets
Modality : ultrasound for 5mins 1.2 w/cmsq
HOME TREATMENT
Do towel stretch before taking first step out of the bed in the
morning
Do all the exercise atleast one time in a day
Buy arch support and change foot wear
apply ice pack 2 times for 10 mins in a day

16. Thank you