Cheatography
https://cheatography.com
Presentation, managment etc
This is a draft cheat sheet. It is a work in progress and is not finished yet.
Plantar Fascia
- Deep fibrous band - stabiliser and protects neurovascular structures on the plantar aspect of the foot
- Plantar fasciitis = acute inflammation to chronic fibrotic degeneration
- Most commonly affected is the medial portion of the band - involves calcanael attachment
- From medial calcaneal tubercle to all five toes
Biomechanics
- Stabilises foot during gait - "windlass" |
- Slack plantar fascia at heel strike during gait
allows foot to accomodate uneven surfaces |
- Heel lifts up, forefoot dorsiflexes ready for toe off |
- Plantar fascia "winds up" and around first MTP - pulls plantar fascia |
- This mechanism shortens the distance between heel and forefoot so that the arch is raised thus creating stiffer lever for propulsion |
Demographics
- Common in young runners and middle aged women |
- Age >40yo |
- Can be bilateral |
Causes
- Repetitive eccentric strain |
- Pes planus (repetitive micro trauma at medial calcaneus) |
- Pes cavus (immobility -joint dissipation) |
- Tightness/weakness in gastroc soleus - increases tensile strain on plantar fascia by limiting dorsiflexion
plantar fascia accommodates |
- Tightness in hammies - prolonged forefoot loading |
- Obesity/rapid weight gain |
- Prolonged ambulation |
Hx
- Sharp pain with first couple of steps in the morning |
- Noted on push off phase |
- Prolonged inactivity/activity (weight bearing) |
- Walking upstairs, barefoot, sprinting, forefoot running aggravates |
- Relief on lying down, taking the weight off |
PE
- Tenderness at medial calcaneal tubercule |
- Plantar fascia tightness |
- +ve Windlass test |
- Assess for other causes of foot pain (Sever's, retrocalcaneal bursitis, achilles tendinopathy, stress f#) |
- Pain whilst walking on toes (stress f#/heel spurs relieves) |
- ROM limited ankle dorsiflexion |
- Assess for gastro soleus, hammies, posterior tibialis and FDB strength and hypertonicitiy |
- Consider biomechanical stuff - LL inequality, pes cavus, hyperpronation, pes planus, shoes |
DDx
- TTS |
- Baxter's neuritis (compression of inferior calcaneal nerve - weakness of abductor digiti minimi, loss of fifth digit abduction, provoked by abducting and dorsiflexing forefoot)) |
- Bilateral PF - screen for inflammatory arthropathy |
- Contusion |
- Sever's disease |
- Stress f# |
- Periphereal neuropathy |
- Fat pad syndrome |
- Infection |
- Neoplasm |
- Inflammatory arthropathy |
- Neuropathic pain |
- Paget's disease |
- S1 radiculopathy |
- Tendinopathy/tendinitis |
Imaging
Image above shows US -
L normal PF
R thickening in PFitis
- MRI (Baxter's neuritis)
- US
- Bone scans to rule out stress f#
- Can be heel spurs (traction apophysitis - Wolf's Law) long standing tension (>6 months)
Management
- Moderate reoccurance rate after 10 years |
- Manual therapy |
- Stretching - gastro soleus, hammies, PF (figure 4 then fully dorsiflex great toe - hold for 10 seconds) |
- Myofascial release |
- Exercise - Gastro soleus, posterior tibialis, FHB (toe gripping with resistance band), Eccentric heel raises with great toe in passive dorsiflexion ,intrinsics (towel gripping) |
- Orthotics (hyperpronators) |
- Boot/Night splints (complete rest in lengthened state) |
- Education and reassurance (limit activities that bring on pain) |
- Increase pain free activity by 10% per week |
- Runners - reduce stride length increasing cadence |
- EMT of ankle |
- STW of gastroc soleus |
- CFS + IASTM at PF |
- Mobilisation of PF (golf ball/frozen water bottle beneath PF) |
- Shockwave therapy |
- Refer for surgery/steroid if no better/risk of rupture |
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