plantar fasciitis, calcaneal spur & tendo achillitis …

PLANTAR FASCIITIS, CALCANEAL SPUR & TENDO ACHILLITIS…

PLANTAR FASCIITIS

Plantar fasciitis is a painful inflammatory process of the plantar fascia

Most common cause of foot pain in outpatient medicine

Majority of cases occur in patients with no other disease

CAUSES Feet roll inward too much when you walk

(excessive pronation) High arches or flat feet Walk, stand, or run for long periods of time,

especially on hard surfaces Overweight Wear shoes that don't fit well or are worn out Tight Achilles tendons or calf muscles

RISK FACTORS Extrinsic factors

Training errors Improper footwear Unyielding running surfaces

Intrinsic factors Pes planus w/ hyperpronation Pes cavus w/ supination Tight heel cords Weak intrinsic foot muscles

SYMPTOMS Classic presentation: heel pain in the morning

when first rising from bed May improve through the day but tends to hurt

again by afternoon and evening Reoccurs upon standing after prolonged sitting Worse with walking barefoot and walking up

stairs

DIAGNOSIS X-ray MRI

DIFFERENTIAL DIAGNOSES Calcaneal stress fracture Flexor hallucis longus tendonitis Tarsal tunnel syndrome Fat pad insufficiency Paget’s disease of bone Mid foot DJD Reiter’s syndrome (inflammatory arthritis)

SPECIAL TESTS Planta fascia test vs foot intrinsics Plantar fascitis

Passively DF toes & ankle & palpate medial plantar tubercle of the calcaneus

Foot intrinsics Curl toes around finger & then resist (+ = pain for

both tests)

MEDICAL MANAGEMENT Nonsteroidal anti-inflammatory drugs (NSAIDs).

Ibuprofen (advil, motrin) Naproxen (aleve)

Corticosteroids Iontophoresis Injection

Surgery Few people need surgery to detach the plantar fascia

from the heel bone Side effects include a weakening of the arch in your

foot

PYSIOTHERAPY MANAGEMENT Modalities

Iontophoresis Ultrasound

Shoe inserts Taping Supportive shoes Night splints (orthitic) Stretching program: arch, calf Soft tissue massage Ice

CALCANEAL SPUR

A calcaneal spur is a small bony projection that is formed on the calcaneus or heel bone, either at the back of the heel or under the sole of the heel

SYMPTOMS A sharp, stabbing or dull but intense pain under or on

the inside of the heel The pain is typically relieved during rest, but is worse

after getting up again As a rule of thumb, it is most painful first thing in the

morning The feet or calf muscles may feel very stiff in the

morning, making walking difficult

The pain is made worse by walking on a hard surface or carrying something heavy

The pain can become so severe that it becomes difficult to continue your daily work

Calcaneal spurs may cause no symptoms at all

CAUSES It's caused by damage to the bone accumulating

over a long period of time as a result of chronic inflammation of the Achilles tendon in the calf or the tough sinewy tissues called the plantar fascia, which is found on the soles of the feet

RISK FACTORS People who are overweight and middle-aged Weekend athletes whose muscles aren't tuned

up for sudden intense activity People who have feet that are pronated and not

corrected

DIAGNOSIS X-ray

SPECIAL TESTS Heel Tap ("Bump") Test

Patient sitting or lying supine The involved foot off the end of the table & the knee

straight Examiner stabilizes the lower leg with one hand &

bumps the calcaneus with the other hand Examiner bumps the calcaneus 2–3 times with

progressively more force Positive test pain (at area of complaint)

MEDICAL MANAGEMENT

Avoidance of wearing high heels is recommend in all cases

Pain killers Cortisone injection Surgery

PHYSIOTHERAPY MANEGEMENT Stretching exercises Shoe recommendations Shoe inserts or orthotic devices Taping or strapping to rest stressed

muscles and tendons

TENDO ACHILLITIS

It is the inflammation of the Achilles tendon The weakest area of the Achilles tendon in adults

is found approximately 3 cm above the point of attachment on the heel bone

In children and adolescents the weakest area is often at the actual point of attachment on the heel bone

Inflammation of the Achilles tendon is therefore relatively rarely seen in children and adolescents

SYMPTOMS Pain when activating the Achilles tendon

(running and jumping), when applying pressure and with stretching of the tendon

The tendon often feels thickened

CAUSES & RISK FACTORS Age Overuse of the tendon Sudden extra exertion, such as a final sprint Calf pain Starting up too quickly, especially after a long

period of rest

DIAGNOSIS X-ray MRI

SPECIAL TESTS Anterior Drawer Test

Steps Athlete is sitting over the edge of the table with the knee bent

Examiner stabilizes the lower leg with one hand & cups the calcaneus with the forearm supporting the foot in slight plantar flexion (~ 20° ) and slight inversion (few degrees)

Examiner draws the calcaneus & talus anteriorly and slighlty medially

Positive test pain, anterior translation, dimple/sulcus, and/or "clunk"

MEDICAL MANAGEMENT Rest, to allow the inflammation to settle Regular pain relief with non-steroidal anti-

inflammatory drugs (NSAIDs), such as ibuprofen Steroid injections Surgery (rarely needed) to remove fibrous tissue

and repair tears

PHYSIOTHERAPY MANEGEMENT Stretching Strengthen the weak muscle group in the front of

the leg and the upward foot flexors Footwear to be in good condition (good running

shoes with shock absorbing heel and close fitting heel cap if an athlete)

Pressure on the Achilles tendon can be relieved by using shoes with an elevated heel

If experiencing tenderness in the Achilles tendon during the rehabilitation period, treatment with ice for a period of at least 20 minutes is recommended

Bandaging Ultrasound

THANK

YOU!!!