Plantar Fasciitis Algorithm

Report
Katie Barta
Michael DeDonder
Brenda Hozie
Shannon Lynch
Kelci McFarland
• Plantar fascia
• The plantar fascia is a
thick band of connective
tissue that supports the
arches of the foot. It
absorbs the ground
reaction forces from
weight-bearing activities
and distributes them
throughout the foot.
http://www.aidmyplantar.com/foot-anatomy.php
• Definition and Mechanism of Injury
• Plantar fasciitis is a condition which causes heel pain. Individuals can
acquire such pain from a sudden increase in activity, an increase in
standing or being in a weight-bearing position for a long period of time,
and/or a change in the biomechanics of the foot and subtalar joint. The
diagnosis is usually related to more of a repetitive stress to the plantar
fascia rather than an acute trauma. This repetitive stress causes an
inflammatory process of the fascia leading to pain during ambulation.
http://www.heel-that-pain.com/plantar_fascia/
• Biomechanics/Anatomy
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Rearfoot valgus
High plantar arches
Increased longitudinal medial plantar arches
Ankle equinous – leads to pronation of rearfoot and midfoot; straining of the
plantar fascia
Forefoot varus – leads to pronation of rearfoot and midfoot; straining of the
plantar fascia
Rearfoot varus – leads to rapid and excessive pronation of STJ right after
initial contact; causes strain on plantar fascia
Pes Plano Valgus– leads to rapid and excessive pronation of STJ right after
initial contact; causes strain on plantar fascia
Pes cavus – leads to each foot striking ground more often; limited pronation
of STJ limits pes cavus from absorbing GRF
• Age (over 40 yrs)
• Injury to the plantar fascia from
cumulative stress overload
• Occupational
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teachers
construction workers
cooks
nursing
military
• Sports Related
• repetitive strain injury (long
distance runners)
• beginning new running program
• rapid increase in length or levels
of activity
• Obese (BMI greater than 30)
• Sedentary
• Limited ankle dorsiflexion or
decreased calf muscle
flexibility
• Flat foot (over pronation)
• High plantar arches
• Poor biomechanics (previously
discussed) or structural
abnormalities
• Improper shoe selection
• How do these reflect which path we choose to take?
• When considering different causes of heel pain activity level, type of
activity and in some cases age will be a factor. Biomechanics can also be
a contributing factor to plantar fasciitis, but should also be considered for
other diagnoses such as Achilles tendinopathy, bursitis, or nerve
pathologies.
• Pain on medial undersurface of the heel
• Pain in the morning when stepping out of bed and taking first steps
of the day
• Stabbing pain
• Sensation of tightness and/or tenderness along arch of foot
• Pain with prolonged standing
• Pain when standing up after sitting for a long period of time
• Pain after an intense weight-bearing activity such as running
• Pain when climbing stairs
• Pain when walking barefoot or in shoes with poor support
• Symptoms may decrease during the day as the body warms up, but
will worsen again at the end of the day due to extended walking.
• Plantar fasciitis does not have a
specific test that can rule in the
diagnosis. The following list,
along with signs, symptoms, and
mechanism of injury, can lead to
the conclusion of plantar
fasciitis diagnosis versus some
other diagnosis.
• Positive tender to palpation
• Positive dorsiflexion, toe
extension PROM reproduction
of pain
• Potential change in navicular
drop test – biomechanical
change
• Negative radiographs
• Negative Morton’s neuroma test
• Negative Thomas test
• Negative neural test
• Limited ankle ROM
• Abnormal foot 4 points of
normalcy
Heel Pain
Yes
Neural Pain
Not Plantar fasciitis
Nerve
Entrapment
Neuroma
No
Not plantar fasciitis
Sharp ache
Location of pain
Calcaneal
Not plantar fasciitis
Bursitis
Plantar
Midfoot
Not plantar fasciitis
Tarsal
tunnel
Peroneal
teninopathy
Achilles
tendinopathy
Severs
No increased pain
with weight-bearing
Increased pain with
weight-bearing
Cancer – Refer out
Not plantar fasciitis
Pain at initial
weight-bearing
Plantar fasciitis: Including pain with passive toe
extension, limited ankle dorsiflexion
Pain with prolonged
weight-bearing
Calcaneal stress fracture
• The best way to diagnosis plantar fasciitis is to determine the
location and type of pain the patient is experiencing. Once
those are considered the algorithm can be used to rule in/out
plantar fasciitis. Remember, however, to use all of the subjective
and objective findings to aid in the diagnosis of plantar fasciitis
versus other foot/ankle pathologies.
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Aldridge, T. (2004). Diagnosing Heel Pain in Adults Title, 70(2).
American Physical Therapy Association. (2013). Physical Therapist's Guide to Plantar Fasciitis.
Retrieved April 2013, from Move Forward:
http://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=a2395ee9-08bb-47cc-9edc1943e2fdbf2e
Cole, C., Seto, C., & Gazewood, J. (2005). Plantar fasciitis: evidence-based review of diagnosis and
therapy. American family physician, 72(11), 2237–42. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/16342847
Dubin, J. (2007). Evidence Based Treatment for Plantar Fasciitis. Retrieved April 2013, from
http://www.dubinchiro.com/plantar.pdf
Dutton, M. (2004). Orthopaedic: Examination, evaluation, & intervention. New York, NY: McGraw-Hill.
Mayo Clinic. (2013). Risk Factors. Retrieved April 2013, from Plantar Fasciitis:
http://www.mayoclinic.com/health/plantar-fasciitis/DS00508/DSECTION=risk-factors
Orchard, J. (2012). Plantar fasciitis. Bmj, 345(oct10 1), e6603–e6603. doi:10.1136/bmj.e6603
Ribeiro, A. P., Trombini-Souza, F., Tessutti, V., Rodrigues Lima, F., Sacco, I. D. C. N., & João, S. M. A.
(2011). Rearfoot alignment and medial longitudinal arch configurations of runners with symptoms and
histories of plantar fasciitis. Clinics, 66(6), 1027–1033. doi:10.1590/S1807-59322011000600018
Tu, P., & Bytomski, J. R. (2011). Diagnosis of heel pain. American family physician, 84(8), 909–16.
Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22712192

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