Table 1: FPI Test Scores
-2
-1
0
+1
+2
Talar head palpation
Talar head palpable on lateral side/but not on medial side. Curve below the malleolus either straight or convex. More than an estimated 5° inverted (varus). Area of TNJ markedly concave. Arch high and acutely angled towards the posterior end of the medial arch. No lateral toes visible. Medial toes clearly visible.
Talar head palpable on lateral/ slightly palpable on medial side. Curve below the malleolus concave, but flatter/ more than the curve above the malleolus. Between vertical and an estimated 5° inverted (varus). Area of TNJ slightly, but definitely concave. Arch moderately high and slightly acute posteriorly.
Talar head equally palpable on lateral and medial side.
Talar head slightly palpable on lateral side/palpable on medial side. Curve below the malleolus more concave than curve above malleolus. Between vertical and an estimated 5°everted (valgus). Area of TNJ bulging slightly. Arch lowered with some flattening in the central position.
Talar head not palpable on lateral side/but palpable on medial side. Curve below the malleolus markedly more concave than curve above malleolus. More than an estimated 5° everted (valgus). Area of TNJ bulging markedly. Arch very low with severe flattening in the central portion - arch making ground contact. No medial toes visible. Lateral toes clearly visible.
Supra and infra lateral malleoli curvature (viewed from behind)
Both infra and supra malleolar curves roughly equal.
Calcaneal frontal plane position (viewed from behind) Prominence in region of TNJ (viewed at an angle from inside Congruence of medial longitudinal arch (viewed from inside)
Vertical.
Area of TNJ flat.
Arch height normal and concentrically curved.
Abduction/adduction of forefoot on rearfoot (view from behind)
Medial toes clearly more visible than lateral.
Medial and lateral toes equally visible.
Lateral toes clearly more visible than medial.
Note . Adapted from Redmond, A. C., Crosbie, J., & Ouvrier, R. A. (2006). Development and validation of a novel rating system for scoring standing foot posture: the Foot Posture Index. Clinical biomechanics (Bristol, Avon), 21 (1), 89-98. https://doi.org/10.1016/j.clinbiomech.2005.08.00. TREATMENT OPTIONS
dorsiflexion, tight calf musculature, or excessive pronation or supination of the foot. As pain and lack of function are the most likely reasons the patient has come into the clinic for treatment, these also will be priorities for treatment. The following is a review of common treatments for plantar fasciitis, including what is most likely to be effective. specifically unilateral heel raises with a towel under the toes. This study concluded that high-load exercise was more effective than plantar stretching alone, specifically at 3 months. A meta-analysis that reviewed multiple studies looking for the effectiveness of stretching alone found only minimal evidence that stretching was effective, but stretching of the Achilles tendon with plantar- fasciitis stretching did provide more benefit than stretching the plantar fascia alone (Sweeting et al., 2011). Some more recent studies have looked into the effectiveness of strengthening on plantar fasciitis. A randomized controlled trial with 84 patients randomly assigned subjects to either a stretching group or a lower extremity strengthening group. All patients received 8 physical therapy interventions two times per week in the first 4 weeks and performed daily strengthening or stretching exercises three times per day. After 4 weeks, they continued the assigned exercise programs every day for 8 weeks. The study found that both programs focused on stretching or strengthening created significant improvements in the patient’s worst pain, morning pain, cadence, stride time, stride length, total double support, and gait speed (Thong-On et al., 2019). With this information, a physical therapy treatment program should include both Achilles tendon and plantar fascia stretching with high- load exercise of the lower extremity like unilateral heel raises. Strengthening of the hip abductors and hip external rotators may be beneficial in some cases. Many therapists will also incorporate strengthening of the intrinsic foot musculature to decrease pain. Some limited evidence suggests that this is helpful. A systematic
After the examination has been completed and it has been determined that the patient does, in fact, have plantar fasciitis, treatment can begin. Since one single course of treatment does not work for every patient, clinicians should use a multifactorial approach. Physical therapists should start by addressing the objective deficits found in the examination: decreased ankle Manual therapy can encompass several different treatments, including nerve glides, deep tissue massage to the calf musculature, trigger point therapy, and various joint glides in the foot and ankle. Renan-Ordine and colleagues (2011) found that trigger-point therapy to the calf musculature was an effective treatment when compared to self-stretching of the calf musculature alone. One study compared the effectiveness of joint mobilization and stretching to the use of steroid injections. While both groups made improvement and the steroid group made more progress earlier on, the joint-mobilization group made more improvement at 12-week and one-year milestones (Celik et al., 2016). One study published in the 2015 Journal of Orthopaedic and Sports Physical Therapy found that there was no statistical difference between stretching and ultrasound with the group that also received joint mobilization to the mid and forefoot (Shashua et al., 2015). Based on this research, the manual therapy treatment that is most likely to be effective is soft tissue mobilization including trigger-point therapy. Joint mobilization to the ankle may be effective to a lesser extent. Exercise Physical therapy interventions Manual therapy The treatment most commonly used by physical therapists for plantar fasciitis is stretching of the plantar fascia. A study by Rompe et al. (2010) found that plantar-fascia-specific stretching was superior to the treatment of acute plantar fasciitis than shockwave therapy. A separate study by Ratleff and colleagues (2015) compared plantar stretching with high-load exercise,
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