A 45-year-old male self-referred to an outpatient physical therapy clinic with complaints of left heel pain for the past several months. He denies any specific trauma and also denies pain in the right heel or foot. He reports that ibuprofen helps his pain temporarily, but that overall the pain is getting worse. He reports that the pain is worse in the morning and evenings, and that he has had to terminate his walking program due to the pain. His goal is to eliminate his pain and return to walking 1 to 2 miles per day, 4 to 5 times per week.
Based on the patient's subjective report, and likely diagnosis of plantar fasciitis, what do you anticipate may be the contributing factors to his condition?
What examination signs may be associated with this diagnosis?
What are the most appropriate physical therapy outcome measures to assess his functional capacity?
What are the most appropriate physical therapy interventions?
PLANTAR FASCIITIS: Inflammatory condition affecting the plantar fascia and the perifascial structures of the foot
WINDLASS MECHANISM: Describes the manner by which the plantar fascia supports the foot during weightbearing; provides a model of the biomechanical stresses placed on the plantar fascia1
Describe plantar fasciitis and identify potential risk factors associated with this diagnosis.
Describe appropriate joint range of motion and/or flexibility exercises for a person with plantar fasciitis.
Discuss current evidence supporting the use of appropriate modalities, taping, and orthotic fabrications for a person with plantar fasciitis.
PT considerations during management of the individual with a diagnosis of plantar fasciitis:
- General physical therapy plan of care/goals: Decrease pain; increase muscular flexibility; prevent or minimize loss of aerobic fitness capacity
- Physical therapy interventions: Patient education regarding functional anatomy and injury pathomechanics; modalities to decrease pain and inflammation; manual therapy to decrease pain and increase joint mobility; stretching exercises to address tight triceps surae and plantar fascia; orthotic fabrication
- Precautions during physical therapy: Address contraindications for exercise based on patient's pre-existing condition(s)
- Complications interfering with physical therapy: Lack of compliance with home exercise program
The plantar fascia is a fascial layer investing the plantar aspect of the foot that originates from the calcaneus and, via a complex network, inserts on the plantar aspect of the forefoot.2 Composed largely of collagen and elastic fibers, the plantar fascia's robust and fibrous structure serves to assist with weightbearing of the foot.2 It is divided into two layers in the transverse plane: the superficial plantar fascia and the deep plantar fascia.3 The deep plantar fascia is further divided into three layers in the coronal plane (central, lateral, and medial portions).2 The superficial fascia forms a tough and thick padding over the sole, and has strong retinacula ...