A power point presentation of plantar fasciitis.

1. Plantar Fasciitis
Karla Suzatte M. Dasargo
DDC- PT Intern’14

2. Plantar Fasciitis
It is also referred to as plantar
heel pain syndrome, heel spur
syndrome, or painful heel
syndrome.

3. Definition
It is a painful inflammatory
process of the plantar fascia, the
connective tissue or ligament on
the sole of the foot.

4. Description
It is an overload injury usually
associated with biomechanical
abnormalities.

5. Etiology
Deterioration of the plantar fascia.
Mechanical overload of the plantar
fascia
Damaged by direct impact or
repetitive trauma
Damage to other supporting
structures

6. Epidemiology
most common cause of pain in the
inferior heel
Estimated to account for 11 to 15 %
of all foot symptoms requiring
professional care among adults.
affects 15-20% of runners

7. Epidemiology
common among military personnel.
ages of 40 and 60 years in the
general population
Women>Men
65% non-sports demographics are
over-weight
70% unilat. involvement

8. Anatomy

9. Foot
supports the body weight
provides leverage for walkin
running.
constructed in the form of ar
serves as a resilient spring to
shocks.
d

10. The Sole of the Foot - skin
The skin of the sole of the foot is
thick and hairless.
Shows a few flexure creases at the
sites of skin movement.
Sweat glands are present in large
numbers.

11. Deep Fascia
a triangular thickening of the
fascia that protects the under
nerves, blood vessels, and
Apex: medial and lateral
the calcaneum.
Base: divides into five
into the toes.
pass

12. Deep Fascia
Have indirect relationship with
Achilles Tendon, if toes are
dorsiflexed plantar fascia tightens
via WINDLASS MECHANISM

13. Muscles & ligaments of the Sole of the
Foot

14. Muscles & ligaments of the Sole of the
Foot

15. Muscles & ligaments of the Sole of the
Foot

16. Muscles & ligaments of the Sole of the
Foot

17. Arteries of the Sole of the Foot
Medial Plantar
Artery
Lateral Plantar
Artery

18. Nerves of the sole of the Foot
Sensory nerve supply: medial calcaneal
branch of the tibial nerve which
innervates the medial side of the heel
branches from the medial plantar nerve:
innervate the medial 2/3 of the sole
branches from the lateral plantar nerve:
innervate the lateral 1/3 of the sole.

20. The Arches of the Foot

21. Bones of the Arches
Medial longitudinal arch calcaneum, the talus, the navicular
bone, the 3 cuneiform bones, and the
1st 3 metatarsal
 Lateral longitudinal arch calcaneum, the cuboid, and the 4th
and 5th metatarsal bones

22. Bones of the Arches

23. The Bones of the Arches
Transverse arch metatarsal bones
and the cuboid
and the three
cuneiform bones.

24. Biomechanics of Plantar
fascia

25. Biomechanics of Plantar fascia
It contributes to support of arch of the
foot by acting as a tie-rod, where it
undergoes tension when the foot bears
weight.
It carries as much as 14% of the total
load of the foot.

26. Biomechanics of Plantar fascia
Complete rupture or surgical release of
the plantar fascia
leads to a ↓ in arch stiffness and a
significant collapse of the longitudinal arch
of the foot.
↑ both stress in the plantar ligaments and
plantar pressures under the metatarsal
heads.

27. Biomechanics of Plantar fascia
Has an important role in dynamic
function during gait.
continuously elongated during the
contact phase of gait.
reaches a maximum of 9% to 12%
elongation between mid-stance and
toe-off.
plantar fascia behaves like a spring.

28. Biomechanics of Plantar fascia
The plantar fascia has a critical role in
normal mechanical function of the
foot, contributing to the "windlass
mechanism".

29. Pathology

30. Pathology
The site of abnormality is typically
near the site of origin of the plantar
fascia at the medial tuberosity of the
calcaneus.
It is more likely caused by
degeneration or weakening of the
tissue.

31. Pathology
This process probably begins with
small tears that occur during activity
and that, in normal circumstances, the
body simply repairs, strengthening the
tissue as it does.
The small tears don’t heal. They
accumulate

32. Most common Signs & Symptoms
Pain
Tenderness
Antalgic gait

33. Examination & Diagnostic
procedures

34. Examination & Diagnostic procedures
Ocular inspection
X-ray
Bone scans
MRI
Laboratory tests

35. Differential diagnosis

37. Management

38. Medical and Surgical
Surgery is considered only after 12
months of aggressive nonsurgical
treatment.
Surgical plantar fasciotomy with or
without heel spur removal.
Gastrocnemius recession

41. Pharmacology
NSAIDs medication
Cortisone injections.

42. Physical Therapy
More than 90% of patients with
plantar fasciitis will improve within
10 months of starting simple
treatment methods.

43. General Measures
Rest
Ice
(20 min; 3-4x/day)

44. Taping
No studies have
adequately
evaluated the
effectiveness of
taping or
strapping for
managing
plantar fasciitis.

45. Shoe inserts

46. Night splints

47. Stretching

48. Modalities
Therapeutic ultrasound
Extracorporeal shockwave therapy
(ESWT).

49. Massage
Deep tissue Massage
MFR

50. Evidence –based practices

51. Indian Journal of Physiotherapy and Occupational Therapy
Effectiveness of Myofascial Release in treatment of Plantar
Fasciitis: A RCT Author(s): Suman Kuhar, Khatri Subhash, Jeba
Chitra; Vol. 1, No. 3 (2007-07 - 2007-09)
Purpose of study: To find out the effectiveness of
myofascial release in treatment of plantar fasciitis.
Materials and Methods:
 30 subjects with the clinical diagnosis of chronic plantar
 Group A (control) received therapeutic ultrasound(1 MHz, 1
Watt/cm2,pulsed mode 1:4,5 minutes), contrast bath for 20
minutes, foot intrinsic muscles strengthening exercises, plantar
fascia stretching exercises
 group B (experimental) received conventional treatment as group
A added with myofascial release for 15 minutes for 10
consecutive days.

52. Indian Journal of Physiotherapy and Occupational Therapy
Effectiveness of Myofascial Release in Treatment of Plantar
Fasciitis: A RCT Author(s): Suman Kuhar, Khatri Subhash, Jeba
Chitra; Vol. 1, No. 3 (2007-07 - 2007-09)
 The outcome was assessed in terms of VAS and Foot Function
Index.
Results: In this study we found that there was significant
change in pain relief as per the VAS score (p=0.000) and
functional ability as per Foot Function Index (p= 0.024).
Conclusion: It is concluded that myofascial release is an
effective therapeutic option in the treatment of plantar
fasciitis.

53. The Effects of Massage Therapy in Treatment of Chronic
Plantar Fasciitis: a Case Study By Glenda Keller RMT BPHE
 Treatment plan
 the chronic stage of plantar fasciitis is treated with a deep moist
heat application before stretching the plantar fascia (Rattray,
2000).
 Fascial techniques are applied to gastrocs and soleus with cross
hand spreading and finger tip spreading (Rattray, 2000).
 Effleurage and petrissage are used for shortened hypertonic
gastrocnemius and soleus, more specifically wringing, fingertip
and palmar kneading (Rattray, 2000).
 Trigger points and taut bands are successfully treated using
repetitive muscle stripping (Travell, 1992).

54. The Effects of Massage Therapy in Treatment of Chronic
Plantar Fasciitis: a Case Study By Glenda Keller RMT BPHE
 Swedish techniques such as thumb kneading are used on the
intrinsic muscles of the foot (Travell, 1992).
 Deep transverse friction can be used directly on the plantar fascia
to stimulate Fibroblast activity and tissue healing from chronic
overuse (Lowe, 2003).
 Cross-fiber frictions are applied for adhesions in the plantar
fascia, particularly near the calcaneal attachments (Oloff, 1994).
 Oloff et. al. state that the techniques (performed in the treatment of
plantar fasciitis) should be followed by icing and stretching
(Oloff, 1994).
 Increasing flexibility of the calf muscles is particularly important
in the treatment of plantar fasciitis (Young, 2000).
 Repetitive effleurage is used on the posterior leg and foot muscles
to increase local circulation and remove metabolites.
(Rattray, 2000).

55. The Effects of Massage Therapy in Treatment of Chronic
Plantar Fasciitis: a Case Study By Glenda Keller RMT BPHE
The Treatment Plan in this case was two 30-minute
massage therapy session per week for four weeks
Deep moist heat was applied to the plantar aspect of the
affected foot in the form of a hydro collator pack for
five minutes while myofascial release techniques
combined with general Swedish massage techniques
were applied to the upper and lower leg. Palmar and
fingertip spreading myofascial techniques of the
posterior leg were performed before doing Swedish
techniques (including thumb kneading and repetitive
stripping). Trigger point therapy was applied if a trigger
point was found during that treatment.

56. The Effects of Massage Therapy in Treatment of Chronic
Plantar Fasciitis: a Case Study By Glenda Keller RMT BPHE
Conclusion
Massage therapy is beneficial in treating
clients with chronic plantar fasciitis. This
treatment plan combined traditional
massage therapy techniques with myofascial
release techniques

57. Randomized Controlled Trial of Calcaneal Taping, Sham
Taping, and Plantar Fascia Stretching for the Short-Term
Management of Plantar Heel Pain Matthew R. Hyland, PT, MPA,
CSCS1 Alisa Webber-Gaffney, PT, OTR/L2 Lior Cohen, PT3 Steven
W. Lichtman, EdD, FAACVPR4
 Study Design: Prospective, experimental, randomized, singlefactor, pretest/posttest design.
 Objectives: To examine the effects of a calcaneal and Achillestendon–taping technique, utilizing only 4 pieces of tape and not
involving the medial arch, on the symptoms of plantar heel pain.
 Background: Plantar fasciitis is one of the most common causes
of heel and foot pain. Physical therapists have applied many
techniques in an attempt to relieve the symptoms of plantar heel
pain, including various taping methods for which there is little
existing evidence.

58. Randomized Controlled Trial of Calcaneal Taping, Sham
Taping, and Plantar Fascia Stretching for the Short-Term
Management of Plantar Heel Pain Matthew R.
Hyland, PT, MPA, CSCS1 Alisa Webber-Gaffney, PT, OTR/L2 Lior
Cohen, PT3 Steven W. Lichtman, EdD, FAACVPR4
Methods and Measures: Subjects (n = 41) were
randomly assigned into 4 groups: (1) stretching of the
plantar fascia, (2) calcaneal taping, (3) control (no
treatment), and (4) sham taping. A visual analog scale
(VAS) for pain and a patient-specific functional scale
(PSFS) for functional activities were measured
pretreatment and after 1 week of treatment
(posttreatment).

59. Randomized Controlled Trial of Calcaneal Taping, Sham
Taping, and Plantar Fascia Stretching for the Short-Term
Management of Plantar Heel Pain Matthew R.
Hyland, PT, MPA, CSCS1 Alisa Webber-Gaffney, PT, OTR/L2 Lior
Cohen, PT3 Steven W. Lichtman, EdD, FAACVPR4
Results: A significant difference was found post-treatment
among the groups for the VAS (P.001). Specifically,
significant differences were found between stretching and
calcaneal taping, stretching and control , calcaneal taping
and control, and calcaneal taping and sham taping. No
significant difference among groups was found for
posttreatment PSFS.
Conclusions: Calcaneal taping was shown to be a more
effective tool for the relief of plantar heel pain than
stretching, sham taping, or no treatment.

60. Conservative therapy for plantar fasciitis: a narrative
review of randomized controlled trials Kent
Stuber, BSc, DC* Kevyn Kristmanson, BSc, DC**
Taping of the foot provides medial arch support for
plantar fasciitis patients and potentially removes strain
from the plantar fascia.
No data on the effectiveness of the taping was given;
therefore the specific effects of taping cannot be
determined.

61. INITIAL EVALUATION