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Foot Case Study 1: Plantar Fascitis

Case Study 1 – Ankle & FootDanny Watson is a 32-year-old postman who sustained a sharp pain in the right heel3-4 months ago. He was running 60 miles per week and noticed a gradual ache in theheel on the medial aspect that has been gradually worsening. It has been diagnosed asPlantar Fascitis and he has been advised by his GP to rest from running for 2 weeks.There is no bony injury on x-ray but he complains of stiffness am and is unable to runmore than 1 mile without pain. He also has some slight limitation in ROM of dorsiflexion and extension of the toes due to mild pain. He lives with his wife and 2young children in a 3 bedroom house.

Anatomy & Pathology

Plantar Fascistic is a bowstring – connects ball of foot to heel and helps propulsion – as toes extend in stance phase – elevates arch and externally rotates leg and invertshind foot.P.F. is a painful inflammatory condition of foot cause by excessive wear and tear tothe plantar fascia that supports the arch of the foot – some times its build can betraumatic – other times it can be caused by the gradual effects of an inhibited gait pattern.Build up – gait complication. There is a dynamic relationship between dorsiflexionand plantarflexion – they create a rolling motion. If plantarflexion is impaired so isrolling and the foot tends to hit the ground with extra pressure on heel strike. Thisrepeated motion can cause injury – and in this case plantar fascitis might be associatedwith a tight gastrocnemius.Trauma – tear from calcaneus followed by inflammation – oseophytes – 50% of sufferers have these – against 20 % in the overall population. Patients over 30 are prone to this – as are overweight individuals or athletes.Passive dorsiflexion stretches the plantar fascia.

Subjective Examination

Where\What:

right heel – expect pain at front and bottom of heel

When

: 3-4 months ago – expect pain to come over days/weeks/months