plantar fasciitis, calcaneal spur & tendo achillitis …
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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!!!