PLANTAR FASCIITIS .pptx. This ppt is based on sports condition plantar fasciitis

Plantar fasciitis'heel pain' is the condition in which pain is occur in the plantar surface of heel...... In this ppt we disscus about condition and physiotherapy management

1. PLANTAR FASCIITIS GUIDED BY- DR.NEHA DUBEY PRESENTED BY- MOHINI YADAV BPT 4 TH YEAR 2020

2. INTRODUCTION INTERESTING FACTS ANATOMY AETIOLOGY RISK FACTOR CLINICAL PRESENTATION DIAGNOSIS PHYSICAL EXAMINATION TREATMENT JOURNAL REFERENCE CONTENT

3. Plantar fasciitis is the pain caused by degenerative irritation at the insertion of the plantar fascia on the medial process of calcaneal tuberosity . Also known as “jogger’s heel,tennis heel, policemen’s heel and gonorrheal heal. Despite contain “ itis ” this condition is characterised by an absence of inflammatory cells,hence it is consider degenerative not an inflammatory pathology . INTRODUCTION

4. Plantar fasciitis is the result of the collagen degradation of plantar fascia at the origin of the calcaneal tuberosity of the heel ,as well as surrounding perifascial structure . Plantar fascia play an important role in normal biomechanics of foot . The fascia itself is important in providing support for the arch and providing shock absorption . It function act as a tension bridge in the foot providing both Static support and, Dynamic shock absorption . Cont …..

5. 10% of people will suffer from plantar fasciitis in their lifetime. 90% of plantar fasciitis cases can be healed with conservative treatment. 50% of plantar fasciitis suffers are those who are on their feet all day. Heel spur are found 50% of plantar fasciitis case. INTERESTING FACT

6. The Plantar fascia is a thickening of the deep fascia of the plantar region that serve both protective and functional role . PROTECTIVE: superficial to foot intrinsic muscle,nerve vessels FUNCTIONAL : Windlass mechanism plantar fascia has thee parts … Medial band,central band and lateral band. central plantar fascia is the thickest and strongest section is also the most likely to be involved with plantar fasciitis . anatomy ( runnersedgemt.com )

7. CONTI…. Origin: calcaneus ( medial tubercle of the calcaneum ) Insertion: proximal to the attachment of the flexor digitorum brevis . Diveded into five process near the metatarsal head of the metatarsal bone ,one for each of the toes Each process further divided into two strata , superficial and deep

8. . Windlass mechanism

9. A “windlass” is the tightening of a rope or cable. The plantar fascia simulates a cable attached to the calcaneus and the metatarsophalangeal joints. Dorsiflexion during the propulsive phase of gait winds the plantar fascia around the head of the metatarsal. This winding of the plantar fascia shortens the distance between the calcaneus and metatarsals to elevate the medial longitudinal arch. The plantar fascia shortening that results from hallux dorsiflexion is the essence of the windlass mechanism principle This causes the plantar arch to Raise . CONT….

10. Biomechanical dysfunction of foot is the common cause of etioloy . Repetitive stress on plantar Fasciitis lead to collagen degradati - -on and microtrauma in fascia caused painful and inflammed . Prolonged weight bearing like standing,walking and running. AETIOLOGY

11. Tight achilles tendon Flat feet Obesity( increase pressure on plantar fasciia ) Loss of fat pad on heel due to ageing Limited ankle dorsiflexion. Prolonged standing and jumping. Heel spur Wearing flexible soft shoes that don’t protect feet Lack of stretching prior to exercise Conti….

12. 1.EXTRINSIC FACTOR a. Training error - athelete usually have a history of an increase in distance, intensity or duration of an activity. The addition of speed workout , plyometrics etc are high risk behaviour for development of plantar fasciitis. b. equipment - thin soled, loose,lacking arch support or the inability to absorb shock cannot protect feet. RISK FACTOR

13. INTRINSIC FACTOR a) Functional risk tightness in the hamstring,gastrocnemius,soleus,and the achilles tendon are consider risk factor b) Structural risk pes planus(low arch) – cause increase strain at the origin of P.F pes cavus ( high arch) - cause excessive strain on heel Leg length discrepency high BMI c) Degenerative risk ageing and heel pad atrophy Conti…..

14. Age- common in between 40-60yrs of age Sex- women>men Certain type of exercise- activities that place a lot of stress on heel and tissue such as long distance running,ballet dancing and aerobic Occupation Conti….

15. Clinical feature

16. X RAY FINDING help to rule out the other associated condition that can cause heal pain like heel spur ULTRASOUND ultrasound sometime done to measure the plantar fascial thickness. A thickness more than 0.4cm is indicative of plantar fasciitis . diagnosis

17. MRI- fascia rupture Cont …..

18. Lumbar spine disorder Pain radiating down of the leg heel and abnormal reflex Neuropathies Foot pain and night pain Common in diabetic patient . Tarsel tunnel syndrome Numbness at the bottom of the foot Burning pain and paresthesia on the sole of foot. Retrocalcaneal bursitis Pain in retrocalcaneal area. Fat pad atrophy Pain in the area of atrophic heel pain. Differential diagnosis

19. Fat pad atrophy https://images.app.goo.gl/EqBVHfum7zRmfXgk9 https://images.app.goo.gl/3NtsuREAZH6dEPo96

20. History Where is the pain – in my heel Can you point out- commonly at the area of plantar fascia though can be in the medial arch of heel Nature of pain- like walking on a glass needle or knives .I feel like I have a rock in my shoes 24-hrs pattern- worst first thing in the morning when getting out of bed(first step pain) worse after the period of non weight bearing Aggrevating factors- prolong period of standing PHYSICAL EXAMINATION Driving Stair climbing

21. What to do for a living – occupation which involves a lot of standing such as hairdresser or factory workers Activity level- high versus low High BMI High activity level which load foot such as running Recent changes in activity- zero to hero, sudden increase load. Pain assessment onset Aggrevating factor/relieving factor Severity of pain[VAS scale] Type of pain Conti...

22. Weight- obesity Posture gait Footwear – thin soled shoes etc. Foot type- pes planus ,pes cavus PALPATION Discovering the point of maximum tenderness ACHILLES TENDON EVALUATION-shortened A.T is reported in 80percent of cases of plantar fasciitis Observe

23. Windlass test Heel squeze test .- Tenderness or discomfort when the doctor presses down on the middle of your heel indicates potential plantar fasciitis. More intense pain indicates a possible Special test

24. Non weight bearing condition Pt. position- sitting or supine. While stabilizing ankle, passively ext. the proximal phalanx of the hallux at the MTP joint. ( +) test - pain provocation at origin of the plantar fascia OR near the MTP head. test ( wINDLASS test)

25. Pt. position- standing while standing ankle with affected foot on stool and toes over its edge, passively extension the proximal phalanx of the hallux at the MTP joint . ( +) test - pain provocation at the origin of the plantar fascia OR near the MTP head Weight bearing

26. Hot spot test - sit on a chair Bend your knees and bring your affected foot up to rest on the opposite knee. using the thumb down throughout the heel area of the foot.if you experience significant amount of pain or hot spot .it indicates plantar fasciitis. first step test - it is an observation of the first step you take upon rising in the morning when you first get out of the bed and take a step .if you experience a significant amount of pain near the heel of your foot Home assessement [cawleypt.net]

27. Plantar fasciitis is a self-limiting condition that resolve itself with in 6 to 18 months 1.Conservative treatment a. Medication : analgesics or NSAID to decrease pain and inflammation. b. Injection or platelet rich plasma: it is rich in growth factor that help in healing process. c. Corticosteriod injection: in tender area it help to improve pain and inflammation .it is given once or twice in 3 or 6 months treatment

28. Short term goal Long term goal Physiotherapy management To reduce pain To reduce swelling To reduce Tenderness To reduce stress on plantar fascia To maintain associated muscle Property To improve flexibility of calf muscle To maintain balance To improve strength of muscle

29. General measures: to avoid bare foot adequate rest to foot since plantar fasciitis often occur due to overuse. Avoid exercise physical activites to reduce stress on fascia. Ice massage: to reduce pain and inflammation. Ice cube for 5-10 min. Ice bath for 10-15 min. Ice pack for 15-20 min PHYSIOTHERAPY

30. Pain releiving modalities Ultrasound : for 8 min. Laser therapy : low level laser are supposed to stimulate metabolism via the inflammatory pathway. Iontophoresis : by 0.4% of dexamethasone Conti….

31. TENS Pulse rectangular wave via surface electrode on patient skin HIGH TENS frequency: 100 to 150 hz pulse width: 100 to 500 us intensity :12 to 30 mA treatment time: 40 min LOW TENS frequency:1 to 5hz pulse width: 100 to 150 us intensity:>30mA treatment time: 40min Cont….

32. Stretching exercises Calf stretch Toe stretch Towel stretch Tennis ball stretch Frozen can roll STRENGTHENING EXERCISE Towel curl Heel raise Marble pickup Cross your leg over Arch raise Plantar fascia massage Exercise …

33. Cont... Tennis ball stretch Calf stretch Toe stetch

34. Ankle foot plate

35. Cont... Towel curl exercise Pebble pickup Soft tissue manipulation

36. Towel stretch exercise Frozen can roll Arch raise

37. TAPING - used to distrubute force away from stress and irritated fascia .

38. To support arches of the foot. Patient with abnormal biomechanics such as pes planus and pes cavus . Orthotics

39. Provide cuishoining Heel pad Available on amazon https://amzn.in/d/h0P0uqe

40. Design to prevent the shortening of achilles tendon and plantar fascia at night Night splint

41. Journal MFR and stretching exercise Which one is give better results….. https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&q=plantar+fasciitis+physiotherapy+mfr&oq=#d=gs_qabs&t=1713672938510&u=%23p%3DS_6j501z0AUJ Physiotherapy and Occupational Therapy Journal Volume 12 Number 2, April - June 2019 DOI: http://dx.doi.org/10.21088/potj.0974.5777.12219.4

42. Introduction –https://emedicine.medscape.com/article/86143-medication?form=fpf Windlass mechanism- https://youtube.com/shorts/X_DmbR6HF7I?si=-WxF3F-RboBBP0Bx https://www.physio-pedia.com/Plantar_Fasciitis Anatomy – https://www.physio-pedia.com/Plantar_Fasciitis Reference

43. Home assessment special test- https://www.cawleypt.net/2017/02/taking-the-necessary-steps-toward-plantar-fasciitis-relief/ Physical examination https://myheel.trekeducation.org/ Photos – www.google.com Heel squeeze test- https://images.app.goo.gl/2jZtFsZdQePuoM3d8 Journal: https ://scholar.google.com/ scholar?hl = en&as_sdt =0%2C5&q= plantar+fasciitis+physiotherapy+mfr&oq =#d=gs_qabs&t=1713672938510&u=%23p%3DS_6j501z0AUJ Cont …

44. Any two differential diagnosis ? Another name of plantar fasciitis? Clinical features of plantar fasciitis ? Function of plantar fascia? Is it degenerative or inflammatory conditions ? Question