Chapter 10: Plantar Fasciitis: Diagnosis and Treatment 1 CC Hour
By: Katherine Rush, PT Learning objectives After completing this course, the learner will be able to: Identify the anatomical structure of the foot and the function of the plantar fascia. Identify common risk factors that may cause an individual to be more susceptible to plantar fasciitis as well as foot pain. Discuss the most common symptoms attributed to plantar fasciitis, as well as other conditions often mistaken for plantar fasciitis. Course overview An estimated one million visits to medical professionals per year are attributed to the treatment of plantar fasciitis; the annual cost of the condition is presumed to be between $192 and $376 million dollars (Nahin, 2018). Although the condition is notoriously difficult to treat, most patients have a positive outcome (Tong & Furia, 2010). Physical therapists are an important part of the treatment team for this issue. However, only 7.1% of patients with plantar fasciitis are seen in physical therapy. (Fraser, Glaviano, Hertel, 2017). Traditionally, treatment by physical therapists Implicit bias in healthcare Implicit bias significantly affects how healthcare professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments,
Describe specifics of a physical therapy examination for a patient with suspected plantar fasciitis, including special tests. Discuss conservative and surgical treatments for plantar fasciitis.
would primarily entail ultrasound, ice, and stretching, but there are many more effective treatments available. The purpose of this course is to educate physical therapists about the most successful evaluation and treatment techniques available at this time. This course will cover the function of the plantar fascia, differential diagnosis of plantar fasciitis, special tests used, the most common risk factors to develop plantar fasciitis, a review of the most effective treatments and case studies to demonstrate practical application. all of which can adversely impact health outcomes. Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
BIOMECHANICAL FUNCTION OF THE PLANTAR FASCIA
tion. The plantar fascia helps to stabilize the medial longi- tudinal arch against excessive subtalar joint (STJ) pronation motion. Therefore, it indirectly assists the deep compartment muscles to increase subtalar supination. 4. Assisting plantar intrinsic muscles to flattening of the medial longitudinal arch. The large plantar intrinsic muscles share a similar location with the plantar fascia, and as such, have a similar biomechanical purpose. 5. Reducing tension forces within the plantar ligaments. The plantar ligaments also work to stiffen the longitudinal arch. If the plantar fascia has been ruptured or cut as in a plantar fasciotomy, increased stress is placed on these ligaments to support the arch during weight bearing. 6. Preventing excessive dorsal interosseous compression forces in mid tarsal and mid foot joints. Dorsal compression occurs within the mid tarsal and mid foot to resist flattening of the longitudinal arch during weight bearing. Without the plantar fascia intact to support this arch, pain may develop in the dor - sal mid foot. 7. Preventing excessive dorsiflexion bending moments on meta- tarsals. The plantar fascia acts to prevent excessive dorsiflex- ion of the metatarsals during weight bearing. If the plantar fas- cia is not intact, it can increase the stress on the metatarsals, even leading to stress fractures of the third metatarsal.
The plantar fascia is the thick, fibrous connective tissue that supports the arch on the bottom of the foot. It runs from the heel bone (calcaneus) forward to the heads of the metatarsal bones and functions as a “tension bridge” in the foot, providing support and shock absorption (Young, 2019). The plantar fascia is made up of collagen fibers and has three distinct structural components: the medial component, the central component, and the lateral component. In addition to support and shock absorption, there are ten biomechanical functions of the plantar fascia (Kirby, 2016). These functions include: 1. Stiffening medial and lateral longitudinal arches and reducing longitudinal arch flattening. During stance, the arches tend to lose height; the plantar fascia provides support to minimize this (see Figure 1). 2. Assisting in resupination of the subtalar joint during propul- sion. This occurs as a result of what is most commonly known as the “windlass” effect. Dorsiflexion of the hallux will raise the longitudinal arch, supinate the subtalar joint, and externally rotate the leg. This is all done without direct muscular involve- ment. This primarily occurs during heel lift off. 3. Assisting deep posterior compartment muscles by increasing the subtalar supination moment. The posterior tibial, flexor digitorum longus, and flexor hallucis longus muscles all run medial to the subtalar joint, causing supination at this loca-
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Book Code: PTCA2624
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