the effect of strengthening exercises on improving plantar fasciitis have been inconclusive (Rhim et al., 2021). However, a comprehensive examination of patients should include assessment of foot and ankle muscle strength with prescription of exercises to address weakness. Boob et al. (2023) recommend strengthening of the anterior and posterior tibialis muscles to aid in optimal functioning of the windlass mechanism and to decrease stress to the plantar fascia. Stretching Rhim et al. (2021) state that static stretching of the plantar fascia has been shown to help patients with plantar fasciitis more than static calf stretching. However, since a correlation has been found between gastrocnemius tightness and plantar fasciitis (Boob et al., 2023), most treatment programs include stretching to both the plantar fascia and Both soft tissue and joint mobilization techniques are utilized in manual therapy for plantar fasciitis. A study by Grim et al. (2019) looked at the effect of rearfoot mobilization as well as impairment-based programs of mobilizations to the ankle, knee, and hip and concluded that manual therapy offers significant benefit in terms of decreasing pain and improving function in patients with plantar fasciitis. A systematic review aimed at assessing the effect of manual therapy in patients with plantar fasciitis determined that this approach clearly resulted in improved function and likely led to decreased pain. Both soft tissue and joint mobilization techniques were included as follows: myofascial release to the gastrocnemius and soleus muscles and plantar fascia, trigger point therapy to the gastrocnemius, subtalar joint traction and lateral glide, talocrural posterior glide, first tarsometatarsal joint dorsal glide, and mobilization to the knee and hip as indicated (Fraser et al., 2018). gastrocnemius. Manual therapy their feet over the end of the table. The examiner visualizes the Achilles tendon from above while the client actively plantarflexes and dorsiflexes the ankle on the side of the painful Achilles tendon. The test is considered positive if the swelling or nodule on the Achilles tendon moves up and down during this active ankle range of motion (Achilles Tendinopathy, 2024). Royal london hospital test For this test, the patient is For this test, the patient is positioned prone with the foot over the end of the table. The point of maximum Achilles tendon tenderness is palpated with the ankle in neutral. Then the patient is asked to actively dorsiflex the ankle. The area of maximum tenderness is again palpated with the ankle in maximum dorsiflexion. This test is considered positive if the amount of tenderness at the injury site is significantly decreased or disappears when the tendon is under tension in the position of maximum dorsiflexion. Mechanical overloading is considered one of the primary factors related to onset of Achilles tendinopathy (Medina Pabón & Navqi, 2023). Subjective interviewing of runners with Achilles tendinopathy should include questions regarding training, with a focus on recent increases in mileage, the addition of speed focused or hill training, and/ or changes in running surface or running shoes. Two biomechanical factors have been shown via better quality studies to correlate with onset of Achilles tendinopathy. The first factor identified is the amount of rearfoot eversion from initial contact of the foot with the ground to maximum eversion during stance phase (Willwacher et al., 2022). This correlates with the amount
Mechanical treatments Mechanical treatments are focused on relieving the mechanical stress to the plantar fascia, typically by decreasing the rate or degree of pronation. Insoles and custom orthotics have some evidence to support their effectiveness in improving function and decreasing pain. Taping to control pronation (low dye technique) has been shown to have short-term benefits for improving pain, but these benefits were not long term (Rhim et al., 2021). Extracorporeal shock wave therapy Charles et al. (2023) looked at the effectiveness of extracorporeal shock wave therapy (ESWT) in treating plantar fasciitis and concluded that it demonstrates both short- and long-term benefits in decreasing pain and improving function. ESWT was also found to provide better long-term benefits than cortisone shots and ultrasound therapy (Rhim et al., 2021). Dry needling Studies of low quality (small sample size, treatment approach heterogeneity) have demonstrated that dry needling provides both short- and long-term benefits for patients with plantar fasciitis (Rhim et al., 2021). Low-level laser therapy Meta-analysis of random controlled trials investigating the effect of low-level laser therapy (LLLT) in treating plantar fasciitis have shown that is beneficial in decreasing pain and improving function (Rhim et al., 2021). Strengthening There is evidence to indicate that, compared with persons without plantar fasciitis, those with plantar fasciitis have lower muscle function and size in hallux and lesser toe plantar flexors, ankle dorsiflexors, and ankle invertors and evertors. Foot muscle volume was also smaller. These results are considered to be low-quality evidence, and further investigation is warranted. Studies that have investigated Achilles tendinopathy Runners with Achilles tendinopathy will typically describe pain that is localized to the Achilles tendon at an area 2 to 6 cm above the calcaneal insertion. They often report tendon stiffness and an increase in pain with tendon loading, including running. Insertional tendinopathy is less common, but when present, the client will describe pain and swelling at the calcaneal insertion of the Achilles tendon (Matthews et al., 2021). Clinical examination Clinical examination begins with visualizing and palpating the Achilles tendon. Often swelling will be present at the injury site. In addition, a visible and palpable thickening of the tendon may be noted. Palpation will reveal tenderness at the injury site (Matthews et al., 2021). Limited dorsiflexion range of motion is linked to onset of Achilles tendinopathy. In fact, patients with less than 11.5 degrees of ankle dorsiflexion are over 3 times more likely to develop Achilles tendinopathy. Subtalar joint hypomobility and decreased ankle plantarflexion strength have also been identified as potentially causative factors with Achilles tendinopathy (Jayaseelan et al., 2017). Two objective tests that are used to diagnose midportion Achilles tendinopathy are the painful arc sign and the Royal London Hospital test. Painful arc sign This sign involves swelling or nodules within the Achilles tendon that move up and downThis sign involves swelling or nodules within the Achilles tendon that move up and down with active plantarflexion and dorsiflexion of the ankle (Medina Pabón & Navqi, 2023). The patient lies prone with
Page 114
EliteLearning.com/Physical-Therapy
Powered by FlippingBook