Plantar fasciitis
- 1. AND IT'S PATHO-MECHANICS PLANTAR FASCIITIS
- 2. PLANTAR FASCIA The plantar fascia is the thick connective tissue which supports the arch on the bottom of the foot It runs from the tuberosity of the calcaneus forward to the heads of the metatarsal bones The plantar fascia contributes to support of arch of the foot The plantar fascia also has an important role in dynamic function during gait
- 3. What is PLANTAR FASCIITIS? Plantar fasciitis is a painful foot condition caused by inflammation of insertion of the plantar fascia on the medial process of the calcaneal tuberosity. This associated with Pain Swelling Warmth of the affected area Redness of the adjacent skin RISK FACTORS Foot arch Obesity or sudden weight gain Long-distance running Tight Achilles tendon Shoes with poor arch support or soft soles
- 4. PATHOMECHANICS Tightness of gastro soles muscles . During midstance to heel off phase of gait cycle there is 5 degree dorsiflexion is needed, in order to clear the surface. (anterior translation of tibia over the talus. closed kinematics)
- 5. PATHOMECHANICS In case of gastro soles shortness, there is limited range of dorsi-flexion and these short musculature don’t allow tibia to glide anteriorly. This can be compensated by pronation of the subtalar joint. This pronated foot causes lots of stress over the plantar fascia during the push of phase of gait. That will lead to plantar fasciitis.
- 6. PATHOMECHANICS Absence of windlass mechanism During propulsive phase of gait cycle dorsiflexion of the 1 st mtp will occur. That’s winds the plantar fascia around the head of the meta tarsal causing calcaneal inversion,shortening the truss and lead to subtalar jt supination. Absence of this mechanism affects the subtalar jt supination that will lead to plantar fasciitis.
- 7. PATHOMECHANICS Tibialis posterior weakness The tibialis posterior eccentrically control pronation during footflat and midstance phase of gait cycle. Weakness of this muscle can cause excessive pronation of the subtalar joint and this can also leads to plantar fasciitis.
- 10. MANUAL THERAPY Talocrural joint posterior glide Subtalar joint lateral glide Anterior and posterior glides of 1 st tarsometatarsal joint Subtalar joint distraction manipulation
- 11. STRETCHING Calf muscle stretch Calf muscle stretching can be either 3 times or 2 times day, sustained(3mini) or intermittent(20sec). Plantar fascia specific stretch Performed in sitting, with the patient placing the fingers of one hand across the toes of the involved foot. Then pulling the toes back.
- 12. TAPING Calcaneal taping or low-dye taping used for short-term pain relief. Taping does cause improvement in function.
- 13. ORTHOTIC DEVICES Heel cuffs Viscous elastic heel pad Accommodative inlays Prefabricated and custom made orthosis: All these orthosis used for exceesive foot pronation and improvement of the condition.
- 14. TRIGGER POINT THERAPY In some cases trigger points and myo-fascial pain syndrome contribute to heel pain that mimicking plantar fasciitis. Common location of trigger point is either muscle belly of gastrocnemius or in soleus. This will lead to referred pain at heel. Deep cross fiber friction or ischemic compression done for reduction of taut muscular and facial band with Trigger point.
- 15. NIGHT SPLINTS It is used for patient with symptoms greater than 6 months in duration. The desire length of time for wearing the splint is 1 to 3months. This splint maintain ankle in neural position and toes in slight extension.
- 16. SUMMARY Plantar Fasciitis is a painful condition caused by overuse of the plantar fascia or arch tendon of the foot. The most common cause of plantar fasciitis is very tight calf muscles Treatment can last from several months to 2 years Some people may need surgery.