PLANTER FASCITIS:

 

CONDITIONS

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•                   
caused by overuse injury commonly find
in middle aged people

•                   
common cause of heel pain

•                   
continuous  traction forces affecting on planter fasica
at origin point over the distal calcaneus may result in to this condition

PRESENTATION

•                   
During the physical examination its
important to ask the patient about the things that makes the pain worse or ease
the patient situation.

•                   
severe sharp pain history at early in
the morning at heel during the first couple of steps or after long non weight
bearing intervals.

•                   
Pain & tenderness , mostly  on the medial & anterior aspect of
caclacaneus near the sole of heel are its characteristics features. In case of
severity this pain may radiate proximally.

•                   
Along with the pain, there may be an
issue of localized heel swelling and foot stiffness.

•                   
Limping is obvious and the toe walking
may be preferred by patients.

•                   
Initially there is decrease in  pain as the patient begin to walk but it may
increase as well as the increase of the activity all over the day.

•                   
Pain may get stronger during  barefooted walk on hard surfaces or climbing
the stairs.

•                   
When there is less severity, the pain
will be loacalized below the heel bone but in more serve cases the pain may be
reproduced to the proximal of the planter fascia.

•                   
Tight Achilles tendon may add the severity
triggering the limited dorsi flexion

•                   
Other foot problems like pes planus,
pes cavus or overpronation can be observed.

•                   
Windlass Test (Passive dorsiflexion of
toes)

PHYSICAL EXAMINATION:

•                   
During the examination, palpation over
the planter medial calcaneal tubercle at point of planter fascia to heel bone ,
may reproduce the pain of planter fasciitis.

•                   
According to some studies, Sometime
patients adopt such walking pattern where they can offload the heel and medial
fore foot to compensate and reduce pain

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FACTORS WHICH MAY INCREASE THE RISK OF DEVELOPING THESE CONDITIONS

 

There are many proposed risk factors for plantar heel pain,
including

•                   
increased body mass index (BMI),

•                   
limited ankle joint dorsiflexion,

•                   
calcaneal spur,

•                   
leg length discrepancy,

•                   
diminished thickness of heel pad,

•                   
pes planus,

•                   
pes cavus,

•                   
excess pronation and

•                   
limited range of motion of the first
metatarsophalangeal joint (MPJ)

 

ORTHOTIC INTERVENTIONS

•                   
Non surgical treatments include rest,
massage therapy, non-steroidal anti-inflammatory drugs, night splints, heel
cups/pads, injections, cases and physiotherapy options like sock wave therapy.

•                   
Studies shows that 90% of patients are
successfully treated with non surgical management.

•                   
If condition remain same after 6
months of the start of non surgical treatment, surgery is the only option.

 

•                   
First treatment option for planter
fascitis is the orthotic management.

•                   
Orthotics management is low cost, non-invasive
and economically more acceptable to the patient.

•                   
The purpose of the orthotic treatment
is to adapt the unnecessary mechanical stresses and to prevent the strains due
to overloading on planter fascia.

•                   
When we are fabricating or selecting
the orthosis , at that time it is important to see the condition of the planter
arch and the fat pad under the heel. These two factors are considered to
increase the strain,

•                   
Foot orthosis is an effective way to
provide the immediate , intermediate or long term relief.

•                   
It is very much needed to get the
response of the patients either they we benefited , average or completely not
benefited from either of the options..

•                   
Strong evidence is still require to
choose between the prefabricated and customized orthses for such condition to
get effective outcomes.

 

HEEL CUSHIONS & PADS

Heel pads are usually  made
up  of polyvinyl chloride, silicone,
leather, polyethylene foams like Plastizote, and thermoplastics

 

•                   
Provision of extra shock absorption in
the heel area

•                   
Help to shock absorbing during heel
stricke and running.

•                   
Soft heel cups cushion containing the
fat pad, are effective for a plantar calcaneal bursitis or plantar heel spur
syndrome

•                   
Heel cushion made up of silicon has a
built-in softer durometer part. The special design is to dissolve weight around
the plantar medial tubercle of the calcaneus.

•                   
A slight heel lift not thicker than
one quarter inch is some time help fot to shift pressure to forefoot.

•                   
A heel lift is helpful in shifting
pressure to the forefoot. Keep in mind that

 

THE SOFT INSOLE

•                   
with adjusted medial arch support –
reduces the tension through out the fascia.

 

POSTERIOR NIGHT SPLINT

 

•                   
an ankle-foot orthosis (AFO)
positioned in about 5 degrees dorsiflexion.

•                   
only to wear at night.

•                   
To prevent the contractures of Planter
fascia at night in result of planter flexed position.