PLANTAR FASCITIS

Healing phase/stage
• Inflammatory phase: + inflammatory sign, pain, redness, tenderness (pain
on palpation), swelling..
=Pain =constant 24 hours, pain will not go away even though the injured part
of the body is not moving. Chemical mediators such as 5 HT, prostaglandin will
release after injury.
Rx: PRICE, protection, rest, ice, compression, elevation
• Repair phase: Collagen accumulation, intermittent pain, mechanical pain
(Rx: Slow stretching, vigorous stretching will break down collagen and lead
to inflammatory stage once again)
• Remodelling: excessive collage crossed linked. Decrease tissue mobility-
====microtrauma===injury===inflammation
Etiology/ Mechanism of Injury
• Overuse injury caused by pulling on the medial calcaneal tuberosity
by the plantar fascia
• Cause: overtraining – sudden increase in frequency in jogging,
overloading/overweight of feet; also, by overgrowth of medial
calcaneal tubercle (aka calcaneal spur) as the plantar fascia attaches
to the tubercle
Risk Factors:
• Excessive or repetitive weight bearing work
• Excessive unaccustomed activity or increase in training
• Obesity
• Flat feet OR high arches
• Decreased DF in ankle
• Hyperpronation
• Leg length discrepancy
Signs and Symptoms
Presents with:
• Pain over plantar fascia and calcaneal tuberosity
• Pain first thing in morning (first few steps) or when weight bearing
after prolonged rest
• Antalgic gait
• 30% of patients presents bilaterally
• Decreased DF
Diagnosis
Special test: windlass effect
• Identifies windlass effect of plantar fascia
Weight bearing test: patient stands on step with toes positioned over
the edge of the step and equal weight bearing . The examiner then
passively extends the first MTP joint
NWB test : seated in NWB position with knee flexed to 90 >>>>
examiner stabilizes the ankle and passively extends the patients first
MTP
=Positive test is reproduction of plantar fascia symptoms
windlass effect
General Approach to Treatment
Activity modification – decrease load on plantar fascia
Strassberg Sock
Low dye taping
Stretching & Strengthening
• Increase calf length
• Intrinsic foot muscles
Mobilizations
• Increase DF
Biomechanics
• Observe if pronator or supinator
ANKLE ABC's

• While in a seated position, write

out the alphabet in the air with
your big toe.

• Your ankle should be moving as

you perform this.
BALL Soft tissue massage - PLANTAR FASCIA

• While seated, place a small ball

under the arch of your foot and
press into it while rolling it
around.

• Use this form of self-soft tissue

massage technique for the arch
of the foot.
MARBLE PICK UPS

• Place several marbles, dice or

other small items on the floor
and pick them up using your
toes as shown. Place them in a
cup or bowl and repeat.
Education Points
• Activity modification
Non-weight bearing activities
• PRICE
Roll frozen water bottle under foot
• Wearing proper shoes with insoles for arch support