Plantar fasciitis


The average plantar heel pain episode lasts longer than 6 months and it affects up to 10-15% of the population. However, approximately 90% of cases are
treated successfully with conservative care.

[1] Although this condition is seen in all ages, it is most commonly expereinced during middle age. Females present with plantar heel slightly more commonly than males and occurs more frequently in an athletic population such as running, accounting for up to 8-10% of all running related injuries.

[2] There are many risk factors which contribute to plantar heel pain including but not limited to:

  • Loss of ankle dorsiflexion (talocrural joint, deep or superficial posterior compartment)
  • Pes cavus OR pes planus deformities
  • Excessive foot pronation dynamically
  • Impact/weight bearing activities such as prolonged standing, running, etc
  • Improper shoe fit
  • Elevated BMI > kg/m2
  • Diabetes Mellitus (and/or other metabolic conditions)

 

Clinical Presentation

  • Heel pain with first steps in the morning or after long periods of non-weight bearing
  • Tenderness to the anterior medial heel
  • Limited dorsiflexion and tight achilles tendon
  • A limp may be present or may have a preference to toe walking
  • Pain is usually worse when barefoot on hard surfaces and with stair climbing
  • Many patients may have had a sudden increase in their activity level prior to the onset of symptoms

 

Osteopathy Management

Strength Training.

Similar to tendinopathy management, high-load strength training appears to be effective in the treatment of plantar fasciitis. Highload strength training may aid in a quicker reduction in pain and improvements in function

[3] Stretching consists of the patient crossing the affected leg over the contralateral leg and using the fingers cross to the base of the toes to apply pressure into toe extension until a stretch can be felt along the plantar fascia. Achilles tendon stretching can be performed in a standing position with the affected leg placed behind the contralateral leg with the toes pointed forward.
The front knee was then bent, keeping the back knee straight and heel on the ground. The back knee could then be in a flexed position for more of a soleus stretch

[5] Mobilisations and manipulations have also been shown to decrease pain and relieve symptoms in some cases. Posterior talocrural joint mobilsation and subtalar joint distraction manipulation have been performed with the hypomobile talocrural joint.

Foot orthoses produce small short-term benefits in function and may also produce small reductions in pain for people with plantar fasciitis. When used in conjunction with a stretching program, a prefabricated shoe insert is more likely to produce improvement in symptoms as part of the initial treatment of proximal plantar fasciitis than a custom polypropylene orthotic device.

Plantar fasciitis is one of the most common foot pain conditions and often goes misdiagnosed. If you ever wish to discuss our treatment protocols, or co-management of patients, please do not hesitate to contact this clinic. We would welcome the opportunity to dialogue with you.

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