injuries, or serious injuries that require surgical repair that affect the weight distribution on the sole of the foot, can be even more problematic. Injuries or surgeries to the Achilles tendon can also greatly reduce the range of motion of the ankle joint, causing a very awkward gait, especially in the early stages of healing or return to weight bearing. Case study An active 74-year-old woman was placed in a walking boot for six weeks after a small tear in her left Achilles tendon was diagnosed by an orthopedic surgeon. The injury to the Achilles tendon occurred approximately 16 months after she underwent knee replacement surgery for the right knee. Presumably, the left leg was bearing more of her weight when standing and walking for quite some time due to the poor condition of her right knee that led to the need for replacement, followed by the recovery from the knee replacement surgery. Because the boot stabilized her ankle joint to prevent any movement beyond very limited plantar flexion and dorsiflexion, her ankle joint became stiff, and her calf muscles became hypertonic. An area of scar tissue was palpable in the Achilles tendon. After the six-week period was over and she was allowed to discontinue wearing the boot, she noted that her foot, ankle, and lower leg were very stiff. For the brief periods of time when she walked barefoot at home (coming and going from the shower), she complained about pain in the sole of her foot. When she returned to normal footwear after wearing the boot for six weeks, she noted that many of her shoes caused a similar pain in the sole of her foot, with occasional foots cramps if she had been on her feet for longer periods of time. She found the most comfort in supportive athletic shoes. The gastrocnemius and soleus muscles were worked during therapy sessions that included passive stretching. When the plantar fasciitis pain became a recurring problem, she had custom orthotics made to place in her shoes. When flareups occurred, she worked on calf stretches and applied ice to the plantar fascia at home. The plantar fasciitis continued to be an occasionally recurring problem but was manageable with consistent treatment and self-care. Night splints Night splints are devices that hold the ankle in a position of dorsiflexion and are intended to provide consistent stretching to the calf muscles and Achilles tendon when the feet are at rest. They are typically worn during sleep, as it would be difficult to walk in them. Many patients find that using night splints can help to avoid those painful first few steps upon waking that are associated with plantar fasciitis. Physical therapy A treating physician may prescribe physical therapy for patients with chronic or particularly stubborn plantar fasciitis. This can work well for those whose plantar fasciitis is caused by limited dorsiflexion in the ankle, as described previously, or after surgery to the foot or ankle. Physical therapy typically involves strengthening exercises to stabilize the foot and ankle as well as stretching exercises for the calf muscles, and it may also address abnormalities in the gait and balance issues. Steroid injections A treating physician may also use anti-inflammatory steroid injections either as an initial course of treatment or in conjunction with some of the other treatments listed here. Steroid injections are usually administered into the heel where the pain commonly presents in cases of plantar fasciitis. However, this treatment may not be effective for everyone, and steroid injections cannot be given frequently.
for the feet can provide a protective barrier between the plantar fascia and the constant impact of the hard surface beneath them. Age Although plantar fasciitis can strike at any age, the most common age group to seek medical care for this affliction is between 40 and 65 years old. The medical community believes that getting older is a risk factor primarily because of the degenerative processes of aging. As we age, the fat pads on the heels of the feet become thinner, thus providing less of a cushion for the soles of the feet, right at the location where the plantar fascia attaches to the calcaneus. The production of collagen also diminishes with age, as does the elasticity of the body’s connective tissue, so there is less ability for the body to repair minor damage to the plantar fascia. A condition called fallen arches, or adult acquired flat foot, which is a dysfunction of the posterior tibial tendon, is an age-related problem and can also be a contributing factor to inflammation of the plantar fascia. The posterior tibial tendon is responsible for creating and maintaining the arch of the foot, and if it is injured or degenerating, the arch will eventually collapse and result in flat feet. As mentioned previously, flat feet are susceptible to plantar fasciitis. Aging feet are also more prone to arthritis and bone spurs, which can hinder the normal joint articulations in the feet and damage the tendons and ligaments. When the foot cannot function normally, the plantar fascia often pays the price. Injury to the foot or ankle Any injury, even a temporary one, to the foot or ankle that would affect the weight distribution on the sole of the foot can be a risk factor for an injured or inflamed plantar fascia. Any awkward gait or limp can cause plantar fasciitis, and the inflammation could last as long as or longer than the abnormal walk. If, for example, the big toe has sustained a minor injury and soreness causes the weight to be distributed more toward the outer edge of the foot while walking to favor the painful area, the plantar fascia can become inflamed for a few days until the soreness subsides and the weight distribution returns to normal. Long-term Common medical treatments for plantar fasciitis Clients who come to us for therapy who have already been diagnosed with plantar fasciitis by a physician may already have undergone treatment, or they may be in the process of treating it. It is important for us to know what treatments our clients may be receiving, so as not to interfere with those treatments and, ideally, to work in conjunction with them to fix the problem. Keep in mind that therapists cannot give medical advice to our therapy clients, because it is outside of our scope of practice. We cannot diagnose plantar fascia or any other condition (unless you also hold a medical license in your state or have direct access as a physical therapist). However, it is appropriate to ask your clients questions about what treatments they are receiving, how long they have been getting them, and how effective those treatments seem to be. Listed in the following sections are the most common treatments used for plantar fasciitis. Orthotics Orthotics are supportive inserts that go inside the shoes. They are available over the counter, or they can be prescribed by a physician and be custom made to meet the patient’s specific needs. Orthotics typically offer more arch support than normal shoes, but they can also be designed to stabilize the foot. Some types of orthotics also cup the heel, thus assisting to replace a worn fat pad described previously under age risk factors. Many patients find relief by consistently wearing properly fitted orthotics.
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Book Code: MLA1225
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