PLANTAR FASCITIIS :MANAGEMENT AND PHYSIOTHERAPY

PLANTAR FASCIITIS
Dr.DHARANI MAVURU

• Plantar fascia is a thick connective tissue that
supports the arch on the bottom of your foot.
• It runs from calcaneum to the toes.
• It absorbs shock while walking.
PLANTAR FASCIA

ANATOMY
medial band
lateral band
central band
It is dense , fibrous connective tissue structure originating from the medial tuberosity of calcaneous.
Consists of 3 portions
Central band is the largest – originates from medial process
of calcaneal tuberosity superficial to the origin of
flexor digitorum brevis, quadratus plantae,
adbuctor hallucis muscles.

• The fascia extends from the medial longitudinal
Arch into individual bundles and inserts into
each proximal phalanx.
• The medial longitudinal arch receives the sensation from
Medial calcaneal nerve.
• The nerve to the abductor digiti minimi
may rarely be compressed by the intrinsic
muscles of the foot.

The plantar fascia is an important static support for the longitudinal arch of the foot.
 Strain on the longitudinal arch exerts its maximal pull on the plantar fascia, especially its origin
on the medial process of the calcaneal tuberosity.
The plantar fascia elongates with increased loads to act as a shock absorber, but its ability
to elongate is limited.

Causes
Repetitive stresses
Weak foot muscles
overweight/ obese
Gait / posture instability
Tight calf muscles

Clinical features
Pain and tenderness located inferiorly at the plantar fascia origin.
Almost all patients complain of inferior heel pain in the mornings with the first few steps and
may complain of pain after prolonged walking or standing
Pain over inferio medial aspect of the foot
Stiffness
Early morning pain
Onset: gradual insidious
Pain after prolonged ambulation
Antalgic gait

Diagnosis
Ultrasonography has been reported to be effective for identifying plantar fasciitis.
-plantar fascia thickness will be increased.
Electromyographic (EMG) studies if clinical suspicion of nerve entrapment.
Xray for bone scan.

Treatment
Conservative
Surgical

Based on the levels of evidence, the assigned levels of recommendation to several common
treatment methods are.
Level A Recommendation (Strong Evidence)
• Prefabricated or custom foot orthoses can provide short-term (3 months) reduction in pain
and improvement in function.
Level B Recommendation (Moderate Evidence)
• Calf muscle and/or plantar fascia–specific stretching can provide short-term (2–4 weeks) pain
relief and improved function. The dose for calf stretching can be either 3 times a day or 2 times a
day utilizing either a sustained (3 minute) or intermittent (20 seconds) stretching time, as
neither dosage produced a statistically significant better effect.
• Night splints (1–3 months) should be considered for patients with symptoms lasting more
than 6 months. The desired length of time wearing the splints is 1 to 3 months. The type of night
splint (posterior, anterior, or sock type) does not appear to affect outcome.
• Dexamethasone 0.4% or acetic acid delivered through iontophoresis can provide short-term
(2–4 weeks) pain relief and improved function

Level C Recommendation (Weak Evidence)
• Effectiveness of manual therapy and nerve mobilization to provide short-term (1–3 months)
pain relief is supported by minimal evidence.
• Calcaneal taping can provide 7 to 10 days of pain relief

Physiotherapy
Stretching
Soft cushion heel pads/silicon heel pads
NSAID’s
Cryotherapy
Walking cast
Injection of corticosteroids
Shock wave therapy

Surgical :
Removal of bony spur on the plantar aspect of calcaneous.
Removal of plantar fascia about 40%.

Rehabilitation Protocol
A. Initial Treatment
• Nonsteroidal anti inflammatories (NSAIDs) (weak evidence to support this)
• Heel pads or orthosis
• Plantar fascia-specific and Achilles tendon home stretching exercises
• Night splinting
B. If No Improvement After 4–6 Weeks
• Immobilization in a cast or cam walker
• Radiographic evaluation to rule out stress fracture or other pathology
• Physical therapy with emphasis on plantar fascia stretching and Achilles stretching

• Custom orthosis
• Prescription NSAIDs
• Corticosteroid injection at plantar fascia origin
C. Persistent Symptoms Beyond A and B
• If some improvement has been made, treatment plan is continued
• If no improvement, MRI to confirm diagnosis, rule out stress fracture, etc.
• Consideration of alternative treatments, such as extracorporeal shock wave therapy (ESWT)
• Surgery is considered only if all other treatments fail and the patient has pain that prevents
work and recreation.

PLANTAR FASCITIIS :MANAGEMENT AND PHYSIOTHERAPY

PLANTAR FASCITIIS :MANAGEMENT AND PHYSIOTHERAPY

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