regrow. This can allow the fascia to lengthen, reducing or even eliminating pain. (Pollock, 2023) The surgery carries potential risks and is not an effective solution for every patient. If a client has recently had plantar fascia release surgery, the safest course of action is to get the treating physician’s approval before working in the area. If the client had the surgery some time ago, be aware that there may be some structural abnormalities to the plantar fascia and proceed with caution when working in the area. Though they are not necessarily treatments, physicians may also make recommendations to patients suffering from plantar fasciitis, based on their presentation of the risk factors described previously. For example, overweight patients may be advised to start a weight loss plan, athletes may be advised to avoid the activity that is causing the
If a client comes to you soon after having a steroid injection in the plantar fascia (within a few days of the injection), the safest course of action is to leave the area alone while the anti-inflammatories take effect. The injection site may also be tender to the touch. In those cases, it might be far more effective to work on the calf muscles and apply gentle stretching to the calf and Achilles tendon until the injection has had some time to work. Manual therapy applications will be discussed further in Section 3 of this course. Surgery Surgical treatment for plantar fasciitis is usually reserved as a last resort, after no other treatments have been able to improve symptoms. Only about 5% of those suffering from plantar fasciitis resort to a surgical solution, called a plantar fascia release. A person may be a candidate for surgery after 12 months of intensive nonsurgical treatment that has not effectively treated the pain. A plantar fasciotomy, or plantar fascia release, is a procedure that detaches the fascia from the heel bone. This relieves tension built-up from damage to the muscle. Depending on the type of procedure, it may only require local anesthesia. After the surgery, the connective tissue in the area begins to Our approach to working with clients who have been diagnosed with, or are having a recurrence of, plantar fasciitis would depend on whether it is an acute episode or a chronic condition. Obtaining a thorough health history from your client, as well as getting any necessary updates from existing clients, can give you a wealth of information to allow you to proceed safely. It is appropriate for you to ask questions about any soft tissue injury or condition that your clients may have, as that is within your scope of practice. The information you need to determine how to proceed might include how long ago the injury took place or how long ago the issue started (if it is not a definitive injury), what treatments they have used or are currently using, which of those have provided them some relief, and any patterns they may have noticed with the occurrence of symptoms. Often, clients who have recurring episodes of Acute plantar fasciitis An acute episode of plantar fasciitis is one in which your client is in frequent and excessive pain, indicating that the plantar fascia is very inflamed. As with any active inflammation, it is wise to proceed with caution, as therapy can sometimes temporarily increase inflammation as part of the healing process. Clients who have minimal experience with therapy may think that it has made their condition worse, and they may come to doubt your skills or the efficacy of therapy in general. In those situations, clear communication about their expectations and your treatment decisions is paramount. If the situation, based on your professional assessment, calls for you to give the plantar fascia only light work or to leave it alone completely, your planned course of action should be spelled out for your client. Let them know why you are either working lightly or avoiding the area, and that it is in their best interest. Not all inflammation benefits from hands-on work, depending on what point the tissues are at in the inflammatory process, Deep tissue massage Applying deep tissue massage to the muscles of the calf can be an effective treatment, especially if decreased dorsiflexion in the ankle, as described previously, is contributing to the problem. While the gastrocnemius is usually the biggest contributor, due to its size, density, and
problem for a period of time, or patients whose work requires long periods of standing may be given footwear recommendations. It is important for us, as therapists, to be part of our clients’ comprehensive healthcare team, especially if we are to be taken seriously by the medical community. Our goal should be to work with whatever medical treatments our clients are receiving and provide complementary care. Our role in their treatment and recovery will be discussed further in the next section. SECTION 3: HOW CAN WE TREAT PLANTAR FASCIITIS WITH THERAPY?
plantar fasciitis can identify what may have set it off, like a change in activity, an event, or a certain pair of shoes. On the other hand, clients who are new to the experience may not have enough of a history behind them to be able to identify any patterns. Clients who are completely new to the pain of plantar fasciitis may not even know what they are dealing with, and you must be careful with what information or advice you give them. If your client has not been formally diagnosed but you suspect they may be experiencing plantar fasciitis, be sure that you refer them to a physician for a diagnosis. Choose your words wisely when discussing the potential situation, and always stay within your scope of practice. Be careful about saying anything that can be misconstrued as medical advice, and refer them to someone qualified to make that call. and plantar fasciitis is a prime example of this. Sometimes, working it too aggressively or working on it at all can do more harm than good, making it more painful than when your client came in. Let your experience guide you. If you are relatively new to the therapy world and have not yet seen many cases of plantar fasciitis, confer with more experienced practitioners or teachers about their experiences and ask for their advice. Listed subsequently are some techniques to use in cases of acute plantar fasciitis. As we learned previously in this course, the problem is not always limited to the plantar fascia itself. Addressing the other participating structures as your primary focus may be the best course of action in some acute cases of plantar fasciitis. Even with little or no attention paid to the plantar fascia, we may be able to reduce the client’s symptoms and start to improve the health of structures causing the problem.
primary function and attachment to the Achilles tendon, the soleus and peroneus longus, the most superficial of the peroneal muscles, can also play a part in inhibiting dorsiflexion. The gastrocnemius is the easiest to access, as it is the most superficial and the densest muscle of the group,
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