so it may be helpful for this patient to have an orthotic that addresses the need for both support of the arch and a heel pad. 2. Stretching : This patient has already found stretching to be helpful, so he should continue. The home exercise program should include stretching for both the plantar fascia, and the gastrocnemius/soleus muscle group. The patient also needs to understand the importance of regaining full ankle dorsiflexion range to the treatment of his condition. The patient has reported that he stretches in the morning, but he likely needs to incorporate stretching into his routine multiple times a day. Manual stretching in the clinic can be included as well with the goal of increasing dorsiflexion. 3. Exercise : There are multiple strength deficits in this patient’s hip, knee, as well as in the ankle. Home exercises need to include resisted hip internal and external rotation, hip abduction, hamstring strengthening, and unilateral heel raises for the calf muscles. 4. Trigger point therapy : This should be combined with use of ice to help manage pain symptoms. 5. Night splints : This patient would likely benefit from these, so a conversation with him about the importance of night Conclusion Plantar fasciitis is a complicated condition to treat. As there is no one right way to treat this condition, many patients attempt self-treatment prior to seeking help and the patient may read or hear of a variety of different devices or treatment, many of which are ineffective to treat the pain and loss of function associated with this condition. However, the plantar fascia has multiple biomechanical functions that make it incredibly important to a normal gait pattern. If the condition is not treated appropriately, normal gait and function of the foot may never resume. The cause of this condition is not specifically known, though it is well established that increased BMI; decreased ankle dorsiflexion; pronation or supination of the foot; extensive Resources Links to Special Tests • Windlass Test : http://www.thestudentphysicaltherapist.com/windlass-test. html Abbasian, M., Baghbani, S., Barangi, S., Fairhurst, P. G., Ebrahimpour, A., Krause, F., & Hashemi, M. (2020). Outcomes of ultrasound- guided gastrocnemius injection with botulinum toxin for chronic plantar fasciitis. Foot & Ankle International, 41(1), 63-68. https://doi.org/10.1177/1071100719875220 Basford, J. R., Malanga, G. A., Krause, D. A., & Harmsen, W. S. (1998). A randomized controlled evaluation of low-intensity laser therapy: plantar fasciitis. Archives of Physical Medicine and Rehabilitation, 79(3), 249-254. https://doi.org/10.1016/s0003- 9993(98)90002-8 Beyzadeoğlu, T., Gökçe, A., & Bekler, H. (2007). The effectiveness of dorsiflexion night splint added to conservative treatment for plantar fasciitis. Acta Orthopaedica Et Traumatologica Turcica, 41(3), 220-224. Bleakley, C., McDonough, S., & MacAuley, D. (2004). The use of ice in the treatment of acute soft- tissue injury: a systematic review of randomized controlled trials. The American Journal of Sports Medicine, 32(1), 251-261. https://doi.org/10.1177/0363546503260757 Butterworth, P. A., Landorf, K. B., Smith, S. E., & Menz, H. B. (2012). The association between body mass index and musculoskeletal foot disorders: a systematic review. Obesity Reviews: An Official Journal Of the International Association for the Study of Obesity, 13(7), 630-642. https://doi. org/10.1111/j.1467-789X.2012.00996.x Celik, D., Kuş, G., & Sırma, S. Ö. (2016). Joint mobilization and stretching exercise vs steroid injection in the treatment of plantar fasciitis: A randomized controlled study. Foot & Ankle International, 37(2), 150-156. https://doi.org/10.1177/1071100715607619 Chou, A. C., Ng, S. Y., & Koo, K. O. (2016). Endoscopic Plantar Fasciotomy Improves Early Postoperative Results: A Retrospective Comparison of Outcomes After Endoscopic Versus Open Plantar Fasciotomy. The Journal of Foot and Ankle Surgery: Official Publication of The American College of Foot and Ankle Surgeons, 55(1), 9-15. https://doi.org/10.1053/j.jfas.2015.02.005 Cleland, J. A., Abbott, J. H., Kidd, M. O., Stockwell, S., Cheney, S., Gerrard, D. F., & Flynn, T. W. (2009). Manual physical therapy and exercise versus electrophysical agents and exercise in the management of plantar heel pain: a multicenter randomized clinical trial. The Journal of Orthopaedic And Sports Physical Therapy, 39(8), 573-585. https://doi.org/10.2519/ jospt.2009.3036 References Cox, J., Varatharajan, S., Côté, P., & Optima Collaboration. (2016). Effectiveness of acupuncture therapies to manage musculoskeletal disorders of the extremities: A systematic review. Journal of Orthopaedic & Sports Physical Therapy, 46(6), 409-429. https://doi.org/10.2519/jospt.2016.6270 De Garceau, D., Dean, D., Requejo, S. M., & Thordarson, D. B. (2003). The association between diagnosis of plantar fasciitis and Windlass test results. Foot & Ankle International, 24(3), 251–255. https://doi.org/10.1177/107110070302400309 Eslamian, F., Shakouri, S. K., Jahanjoo, F., Hajialiloo, M., & Notghi, F. (2016). Extra corporeal shock wave therapy versus local corticosteroid injection in the treatment of chronic plantar fasciitis, a single blinded randomized clinical trial. Pain Medicine, 17(9), 1722- 1731. https://doi.org/10.1093/pm/ pnw113 Ferber, R., & Hettinga, B. A. (2016). A comparison of different over-the-counter foot orthotic devices on multi-segment foot biomechanics. Prosthetics and orthotics international, 40(6), 675-681. https://doi.org/10.1177/0309364615584660 Fong, D. T., Pang, K. Y., Chung, M. M., Hung, A. S., & Chan, K. M. (2012). Evaluation of combined prescription of rocker sole shoes and custom-made foot orthoses for the treatment of plantar fasciitis. Clinical biomechanics (Bristol, Avon), 27(10), 1072-1077. https://doi.org/10.1016/j. clinbiomech.2012.08.003 Foot Posture Index (FP1-6). (2019, August 25). Physiopedia. Retrieved November 4, 2020 from https://www.physio- pedia.com/index.php?title=Foot_Posture_Index_(FP1-6)&oldid=220371 Golightly, Y. M., Hannan, M. T., Dufour, A. B., Hillstrom, H. J., & Jordan, J. M. (2014). Foot disorders associated with overpronated and oversupinated foot function: The Johnston county osteoarthritis project. Foot & Ankle International, 35(11), 1159-1165. https://doi.org/10.1177/1071100714543907
splints in the treatment of chronic plantar fasciitis would be indicated as well as a discussion of the types of night splints available, to ascertain what he would be most likely to comply with. 6. Shoes : He has already obtained new shoes that have helped some. The types of shoes that are most likely to help will provide arch support and encourage a neutral position of the foot. As this patient already has mild pronation of the foot, he is not likely to tolerate minimalistic shoes. 7. Education : This patient also needs extensive education about the benefits of research-based physical therapy treatment. He will need an explanation about why the previous therapy was not effective: it did not include strengthening, he continued running, tendinitis was not addressed, iontophoresis has limited/no effectiveness, dorsiflexion has not increased despite limited stretching, indicating a need for more stretching to increase range of motion. He also only completed three visits of physical therapy previously. This patient also needs to understand the amount of time recovery from plantar fasciitis as well as Achilles tendinitis can take for him to be compliant with his new program. time standing; and a recent change in training patterns, most commonly with running, are common risk factors. Therefore, the most likely way to design an effective treatment plan is to complete a thorough examination, being careful to eliminate all other possibilities. Then address the individual deficits of each patient, focusing on treatments that have been proven by research to improve outcomes for plantar fasciitis. The most effective known treatments include low-dye taping, stretching of the calf musculature and the plantar fasciitis, strengthening of the intrinsic musculature of the foot, strengthening of the gastrocnemius and soleus, orthotics for arch support, trigger point massage, and night splints.
• Tarsal Tunnel Tes t: http://www.thestudentphysicaltherapist.com/tarsal-tunnel- syndrome-test.html
Gollwitzer, H., Saxena, A., DiDomenico, L. A., Galli, L., Bouché, R. T., Caminear, D. S., Fullem, B., Vester, J. C., Horn, C., Banke, I. J., Burgkart, R., & Gerdesmeyer, L. (2015). Clinically relevant effectiveness of focused extracorporeal shock wave therapy in the treatment of chronic plantar fasciitis: a randomized, controlled multicenter study. The Journal of Bone and Joint Surgery. American Volume, 97(9), 701-708. https://doi.org/10.2106/JBJS.M.01331 Grice, J., Marsland, D., Smith, G., & Calder, J. (2017). Efficacy of Foot and Ankle Corticosteroid Injections. Foot & ankle international, 38(1), 8-13. https://doi.org/10.1177/1071100716670160 Hawke, F., Burns, J., Radford, J. A., & du Toit, V. (2008). Custom-made foot orthoses for the treatment of foot pain. The Cochrane Database of Systematic Reviews, 2008(3), CD006801. https://doi.org/10.1002/14651858.CD006801.pub2 Huffer, D., Hing, W., Newton, R., & Clair, M. (2017). Strength training for plantar fasciitis and the intrinsic foot musculature: A systematic review. Physical Therapy In Sport: Official Journal of the Association of Chartered Physiotherapists in Sports Medicine, 24, 44-52. https://doi.org/10.1016/j. ptsp.2016.08.008 Jain, K., Murphy, P. N., & Clough, T. M. (2015). Platelet rich plasma versus corticosteroid injection for plantar fasciitis: A comparative study. The Foot, 25(4), 235-237. https://doi.org/10.1016/j. foot.2015.08.006 Jasiak-Tyrkalska, B., Jaworek, J., & Frańczuk, B. (2007). Efficacy of two different physiotherapeutic procedures in comprehensive therapy of plantar calcaneal spur. Fizjoterapia Polska, 7, 145-154. Kamonseki, D. H., Gonçalves, G. A., Yi, L. C., & Júnior, I. L. (2016). Effect of stretching with and without muscle strengthening exercises for the foot and hip in patients with plantar fasciitis: A randomized controlled single-blind clinical trial. Manual Therapy, 23, 76-82. https://doi. org/10.1016/j.math.2015.10.006 Kinoshita, M., Okuda, R., Morikawa, J., Jotoku, T., & Abe, M. (2001). The dorsiflexion-eversion test for diagnosis of tarsal tunnel syndrome. The Journal of Bone and Joint Surgery. American Volume, 83(12), 1835–1839. https://doi.org/10.2106/00004623- 200112000-00011 Kirby, K.A. (2016, July). Understanding ten key biomechanical functions of the plantar fascia. Podiatry Today, 29(7), 62-71. Retrieved on December 4, 2020 from https://www.podiatrytoday. com/understanding-ten-key-biomechanical-functions-plantar-fascia Knobloch, K., Yoon, U., & Vogt, P. M. (2008). Acute and overuse injuries correlated to hours of training in master running athletes. Foot & Ankle International, 29(7), 671-676. https://doi. org/10.3113/FAI.2008.0671 Kogler, G. F., Solomonidis, S. E., & Paul, J. P. (1996). Biomechanics of longitudinal arch support mechanisms in foot orthoses and their effect on plantar aponeurosis strain. Clinical biomechanics (Bristol, Avon), 11(5), 243-252. https://doi.org/10.1016/0268-0033(96)00019- 8 Kogler, G. F., Veer, F. B., Solomonidis, S. E., & Paul, J. P. (1999). The influence of medial and lateral placement of orthotic wedges on loading of the plantar aponeurosis. The Journal of Bone And Joint Surgery. American Volume, 81(10), 1403-1413. https://doi.org/10.2106/00004623-199910000-00005 Kogler, G. F., Veer, F. B., Verhulst, S. J., Solomonidis, S. E., & Paul, J. P. (2001). The effect of heel elevation on strain within the plantar aponeurosis: in vitro study. Foot & Ankle International, 22(5), 433-439. https://doi.org/10.1177/107110070102200513 Landorf, K. B., & Menz, H. B. (2008). Plantar heel pain and fasciitis. BMJ Clinical Evidence, 2008, 1111. Lee, W. C., Wong, W. Y., Kung, E., & Leung, A. K. (2012). Effectiveness of adjustable dorsiflexion night splint in combination with accommodative foot orthosis on plantar fasciitis. Journal of Rehabilitation Research And Development, 49(10), 1557-1564. https://doi.org/10.1682/ jrrd.2011.09.0181 Mahindra, P., Yamin, M., Selhi, H. S., Singla, S., & Soni, A. (2016). Chronic plantar fasciitis: Effect of platelet-rich plasma, corticosteroid, and placebo. Orthopedics, 39(2), e285-e289. https://doi. org/10.3928/01477447-20160222-01
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